{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:13:25Z","timestamp":1779387205758,"version":"3.53.1"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Benin adopted the World Health Organization\u2019s (WHO) \u201cTest and Treat\u201d recommendation in 2016 and, since 2019, has updated this protocol by including dolutegravir (DTG) as the preferred first-line treatment. Study aimed to assess the prevalence of virological failure (VL\u2009&gt;\u20093log copies\/mL) and review genetic diversity and antiretroviral resistance mutations in patients on antiretroviral treatment for at least 12 months before dolutegravir Era in Benin. Cross-sectional study included patient plasmas from antiretroviral treatment sites nationwide. Viral load was performed in National Reference Laboratory of Health Program Fighting Against AIDS using the Cobas\u00ae 5800 HIV-1 assay. For plasmas those VL above 1000 copies\/mL, nested PCR were done along the entire protease and part of reverse transcriptase. The DNA obtained by the Sanger method was used to determine the subtypes of HIV-1 after editing with DNASTAR SeqMan Pro\u2122 and alignment with ClustalW2 version 2.1. Phylogenetic trees were constructed by the Neighbor-Joining method and recombinants were investigated by bootscanning with Seaview software version 2.1. DNA was subjected to the Stanford University Antiretroviral Resistance Mutation Interpretation Algorithm (\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/hivdb.stanford.edu\/\" xlink:type=\"simple\">https:\/\/hivdb.stanford.edu\/<\/jats:ext-link>\n                    ) to identify the positions of drug-associated resistance mutations. (178\/253; 70.35%) of the samples were correctly amplified and sequenced. CRF02_AG (n\u2009=\u2009104) was the predominant strain observed followed by CRF06_cpx (n\u2009=\u200921), G (n\u2009=\u20095), CRF43_02G (n\u2009=\u20092), CRF37_cpx (n\u2009=\u20092), A1 (n\u2009=\u20091) and unique recombinant forms (URFs) (n\u2009=\u200934) among the 169 samples sequenced on entire protease combined with part of the reverse transcriptase. (164\/178; 92.1%), (141\/178; 79.2%), (160\/178; 89.9%) and (7\/169; 4.1%) patients carried at least one drug resistance associated to NRTIs, NNRTIs and PIs respectively. M184I\/V, TAMSI: (M41L, L210W, T215Y) and TAMSII: (D67N, K70R, K219Q\/E, T215I\/V) represented (71.3%), (21.9%), (35.4%) respectively. K103N\/S was the most preponderant mutations encountered with a proportion of 64.6% followed by V179E (21.3%), P225H (20.2%), V108I (19.1%), Y181C (16.3%), A98G (15.2%), V106I\/M\/A (10.1%). I84V (1.8%) mutation was the major associated PIs encountered followed by L90M, V82A, M46I each encountered twice (1.2%) and I47A, V32I, I54V, G48A, each encountered once (0.6%). Study shows a high genetic diversity with the presence of new strains and underlines the need to regularly review data on genetic diversity and resistance among patients receiving antiretroviral therapy in the country.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0348800","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:34:57Z","timestamp":1779384897000},"page":"e0348800","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV-1 genetic diversity and reverse transcriptase resistance mutations in Benin before dolutegravir era, West Africa"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3594-2105","authenticated-orcid":true,"given":"Edmond","family":"Tchiakpe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9 Kpemahouton","family":"Keke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6002-0941","authenticated-orcid":true,"given":"Patricia","family":"Recordon-Pinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-6245","authenticated-orcid":true,"given":"Abou Abdallah Malick","family":"Diouara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Line","family":"Andreola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moussa","family":"Bachabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldric","family":"Afangnihoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Gbaguidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Osawe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almoustapha","family":"Issiaka Maiga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halimatou","family":"Diop-Ndiaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coumba","family":"Tour\u00e9-Kane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akadiri","family":"Yessoufou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"issue":"11","key":"pone.0348800.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-074464","article-title":"Prevalence and determinants of high-risk human papilloma virus among men who have sex with men in Benin: a cross-sectional study embedded in a demonstration project on pre-exposure prophylaxis against HIV","volume":"13","author":"S Diabat\u00e9","year":"2023","journal-title":"BMJ Open"},{"key":"pone.0348800.ref002","volume-title":"Enqu\u00eate de surveillance de deuxi\u00e8me g\u00e9n\u00e9ration (ESDG) du VIH et des IST aupr\u00e8s des hommes ayant des rapports sexuels avec les hommes (HSH) au B\u00e9nin","author":"Plan International B\u00e9nin","year":"2017"},{"key":"pone.0348800.ref003","volume-title":"Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring","author":"WHO","year":"2021"},{"issue":"1","key":"pone.0348800.ref004","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12981-024-00625-4","article-title":"Determinants of virologic failure among adult HIV patients on first line antiretroviral treatment in Oromia, Central Ethiopia: 2022 a case-control study","volume":"21","author":"WG Ayana","year":"2024","journal-title":"AIDS Res Ther"},{"key":"pone.0348800.ref005","author":"ONUSIDA","year":"2025"},{"key":"pone.0348800.ref006","volume-title":"Estimation des ressources et d\u00e9penses relatives au sida (REDES) au B\u00e9nin en 2022","author":"CNLS-TP","year":"2023"},{"issue":"1","key":"pone.0348800.ref007","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/s13104-020-05151-w","article-title":"Moderate rate of transmitted resistance mutations to antiretrovirals and genetic diversity in newly HIV-1 patients diagnosed in Benin","volume":"13","author":"E Tchiakpe","year":"2020","journal-title":"BMC Res Notes"},{"key":"pone.0348800.ref008","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jgar.2025.11.011","article-title":"Prevalence of pretreatment HIV-1 resistance to integrase strand transfer inhibitors in newly diagnosed and antiretroviral therapy-naive adults in Benin, West Africa","volume":"46","author":"E Tchiakpe","year":"2026","journal-title":"J Glob Antimicrob Resist"},{"key":"pone.0348800.ref009","doi-asserted-by":"crossref","DOI":"10.1177\/11786337211014503","article-title":"High HIV-1 Virological Failure and Drug Resistance among Adult Patients Receiving First-Line ART for At least 12\u2009Months at a Decentralized Urban HIV Clinic Setting in Senegal before the Test-and-Treat","volume":"14","author":"A Ekollo Mbange","year":"2021","journal-title":"Infect Dis (Auckl)"},{"key":"pone.0348800.ref010","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jclinepi.2022.02.005","article-title":"Acquired HIV drug resistance mutations on first-line antiretroviral therapy in Southern Africa: Systematic review and Bayesian evidence synthesis","volume":"148","author":"A Hauser","year":"2022","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"pone.0348800.ref011","article-title":"Development of HIV Drug-Resistance Mutations and Antiretroviral Efficacy Among Vietnamese Patients After Failure of 5-Year First-Line Therapy","volume":"39","author":"TM Hung","year":"2025","journal-title":"J Clin Lab Anal"},{"key":"pone.0348800.ref012","author":"WHO","year":"2023"},{"key":"pone.0348800.ref013","author":"Qiagen"},{"key":"pone.0348800.ref014","first-page":"114","article-title":"Antiretroviral drug resistance in HIV-1 infected patients receiving antiretroviral treatment in routine clinics in Cotonou, Benin","volume":"3","author":"M Monleau","year":"2011","journal-title":"J AIDS HIV"},{"issue":"1","key":"pone.0348800.ref015","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/s13104-020-05151-w","article-title":"Moderate rate of transmitted resistance mutations to antiretrovirals and genetic diversity in newly HIV-1 patients diagnosed in Benin","volume":"13","author":"E Tchiakpe","year":"2020","journal-title":"BMC Res Notes"},{"issue":"1","key":"pone.0348800.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0317882","article-title":"HIV-1 resistance mutations and genetic diversity among children failing antiretroviral treatment in five healthcare facilities in Benin, West Africa","volume":"20","author":"EH Dagba Gbessin","year":"2025","journal-title":"PLoS One"},{"issue":"1","key":"pone.0348800.ref017","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1186\/s13104-018-3804-9","article-title":"Surveillance of transmitted HIV-1 antiretroviral drug resistance in the context of decentralized HIV care in Senegal and the Ebola outbreak in Guinea","volume":"11","author":"AE Mbange","year":"2018","journal-title":"BMC Res Notes"},{"issue":"5","key":"pone.0348800.ref018","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.arcped.2019.06.002","article-title":"Second-line antiretroviral therapy failure and characterization of HIV-1 drug resistance patterns in children in Mali","volume":"26","author":"M Sylla","year":"2019","journal-title":"Arch Pediatr"},{"issue":"1","key":"pone.0348800.ref019","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3390\/v15010128","article-title":"Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage","volume":"15","author":"A Appah","year":"2022","journal-title":"Viruses"},{"key":"pone.0348800.ref020","doi-asserted-by":"crossref","first-page":"3468","DOI":"10.1038\/s41598-020-59944-x","article-title":"Characterisation of HIV-1 Molecular Epidemiology in Nigeria: Origin, Diversity, Demography and Geographic Spread","volume":"10","author":"J Nazziwa","year":"2020","journal-title":"Sci Rep"},{"issue":"11","key":"pone.0348800.ref021","doi-asserted-by":"crossref","first-page":"100912","DOI":"10.1016\/S2666-5247(24)00151-4","article-title":"Global and regional genetic diversity of HIV-1 in 2010-21: systematic review and analysis of prevalence","volume":"5","author":"M Nair","year":"2024","journal-title":"Lancet Microbe"},{"key":"pone.0348800.ref022","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/1742-4690-4-67","article-title":"Identifying HIV-1 dual infections","volume":"4","author":"AC van der Kuyl","year":"2007","journal-title":"Retrovirology"},{"key":"pone.0348800.ref023","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.virol.2019.06.009","article-title":"Reduced frequency of HIV superinfection in a high-risk cohort in Zambia","volume":"535","author":"E Woodson","year":"2019","journal-title":"Virology"},{"key":"pone.0348800.ref024","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3390\/pathogens13050349","article-title":"Co-infections and superinfections between HIV-1 and other human viruses at the cellular level","volume":"13","author":"C Acchioni","year":"2024","journal-title":"Pathogens"},{"issue":"1","key":"pone.0348800.ref025","doi-asserted-by":"crossref","first-page":"9964","DOI":"10.1038\/s41598-025-94290-w","article-title":"Unraveling HIV-1 transmission patterns through molecular surveillance in a hotspot in Yunnan Province, China","volume":"15","author":"H Yang","year":"2025","journal-title":"Sci Rep"},{"issue":"4","key":"pone.0348800.ref026","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/COH.0000000000000287","article-title":"Persistent HIV-1 replication during antiretroviral therapy","volume":"11","author":"J Martinez-Picado","year":"2016","journal-title":"Curr Opin HIV AIDS"},{"issue":"7","key":"pone.0348800.ref027","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1086\/507526","article-title":"Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression","volume":"43","author":"DR Bangsberg","year":"2006","journal-title":"Clin Infect Dis"},{"key":"pone.0348800.ref028","first-page":"95","article-title":"Prevalence and determinants of adherence to antiretroviral treatment among HIV patients on first-line regimen: a cross-sectional study in Dakar, Senegal","volume":"33","author":"MAS Mbengue","year":"2019","journal-title":"Pan Afr Med J"},{"key":"pone.0348800.ref029","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/hiv.12716","article-title":"Two-drug vs. three-drug combinations for HIV-1: Do we have enough data to make the switch?","author":"S Moreno","year":"2019","journal-title":"HIV Med"},{"key":"pone.0348800.ref030","year":"2022"},{"issue":"5","key":"pone.0348800.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(23)00051-6","article-title":"Long-acting antiretrovirals and HIV treatment adherence","volume":"10","author":"JB Nachega","year":"2023","journal-title":"Lancet HIV"},{"key":"pone.0348800.ref032","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12981-015-0082-7","article-title":"Virological outcome among HIV-1 infected patients on first-line antiretroviral treatment in semi-rural HIV clinics in Togo","volume":"12","author":"AA Konou","year":"2015","journal-title":"AIDS Res Ther"},{"issue":"2","key":"pone.0348800.ref033","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4314\/ahs.v23i2.12","article-title":"Biological parameters determining the effectiveness of monitoring of HIV \/ AIDS infected patients in Morocco","volume":"23","author":"M Echchakery","year":"2023","journal-title":"Afr Health Sci"},{"issue":"7","key":"pone.0348800.ref034","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1111\/tmi.12717","article-title":"Drug resistance mutations after the first 12 months on antiretroviral therapy and determinants of virological failure in Rwanda","volume":"21","author":"J d\u2019Amour Ndahimana","year":"2016","journal-title":"Trop Med Int Health"},{"issue":"2","key":"pone.0348800.ref035","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1093\/jac\/dkab406","article-title":"Prevalence and patterns of HIV drug resistance in patients with suspected virological failure in North-Western Tanzania","volume":"77","author":"S Henerico","year":"2022","journal-title":"J Antimicrob Chemother"},{"issue":"10","key":"pone.0348800.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276730","article-title":"Rate of virological failure and HIV-1 drug resistance among HIV-infected adolescents in routine follow-up on health facilities in Cameroon","volume":"17","author":"CI Penda","year":"2022","journal-title":"PLoS One"},{"issue":"10","key":"pone.0348800.ref037","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1093\/jac\/dkz266","article-title":"Long-term virological outcomes, failure and acquired resistance in a large cohort of Ugandan children","volume":"74","author":"MHW Huibers","year":"2019","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"pone.0348800.ref038","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-058347","article-title":"HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa: a cross-sectional survey","volume":"12","author":"NK Ngandu","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0348800.ref039","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s12977-014-0079-7","article-title":"HIV-1 Gag C-terminal amino acid substitutions emerging under selective pressure of protease inhibitors in patient populations infected with different HIV-1 subtypes","volume":"11","author":"G Li","year":"2014","journal-title":"Retrovirology"},{"issue":"2","key":"pone.0348800.ref040","doi-asserted-by":"crossref","DOI":"10.1093\/ve\/vex019","article-title":"Adaptive HIV-1 evolutionary trajectories are constrained by protein stability","volume":"3","author":"AS Olabode","year":"2017","journal-title":"Virus Evol"},{"issue":"2","key":"pone.0348800.ref041","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2174\/187152611795589663","article-title":"HIV treatment adherence, drug resistance, virologic failure: evolving concepts","volume":"11","author":"JB Nachega","year":"2011","journal-title":"Infect Disord Drug Targets"},{"issue":"2","key":"pone.0348800.ref042","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1128\/JCM.02452-12","article-title":"HIV-1 genetic diversity and drug resistance among Senegalese patients in the public health system","volume":"51","author":"M Thiam","year":"2013","journal-title":"J Clin Microbiol"},{"issue":"4","key":"pone.0348800.ref043","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1139\/gen-2020-0112","article-title":"Determination of reverse transcriptase inhibitor resistance mutations in HIV-1 infected children in C\u00f4te d\u2019Ivoire","volume":"64","author":"M Camara-Cisse","year":"2021","journal-title":"Genome"},{"issue":"1","key":"pone.0348800.ref044","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/jac\/dkp412","article-title":"Level of viral load and antiretroviral resistance after 6 months of non-nucleoside reverse transcriptase inhibitor first-line treatment in HIV-1-infected children in Mali","volume":"65","author":"D Germanaud","year":"2010","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"pone.0348800.ref045","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1093\/infdis\/jiab413","article-title":"Kinetics of Archived M184V Mutation in Treatment-Experienced Virally Suppressed HIV-Infected Patients","volume":"225","author":"R Palich","year":"2022","journal-title":"J Infect Dis"},{"issue":"10","key":"pone.0348800.ref046","doi-asserted-by":"crossref","first-page":"2986","DOI":"10.1093\/jac\/dkaa287","article-title":"Impact of archived M184V\/I mutation on the effectiveness of switch to co-formulated elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide among virally suppressed people living with HIV","volume":"75","author":"G-J Chen","year":"2020","journal-title":"J Antimicrob Chemother"},{"issue":"8","key":"pone.0348800.ref047","doi-asserted-by":"crossref","first-page":"647","DOI":"10.2174\/157016212803901356","article-title":"Resistance-associated mutations after initial antiretroviral treatment failure in a large cohort of patients infected with HIV-1 subtype CRF01_AE","volume":"10","author":"J Praparattanapan","year":"2012","journal-title":"Curr HIV Res"},{"issue":"1","key":"pone.0348800.ref048","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s40249-017-0377-0","article-title":"Sensitive detection of HIV-1 resistance to Zidovudine and impact on treatment outcomes in low- to middle-income countries","volume":"6","author":"RM Gibson","year":"2017","journal-title":"Infect Dis Poverty"},{"issue":"3","key":"pone.0348800.ref049","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1177\/095632020401500302","article-title":"Clinical utility of current NNRTIs and perspectives of new agents in this class under development","volume":"15","author":"Z Zhang","year":"2004","journal-title":"Antivir Chem Chemother"},{"issue":"1","key":"pone.0348800.ref050","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/infdis\/jiae131","article-title":"Impact of Low-Frequency Human Immunodeficiency Virus Type 1 Drug Resistance Mutations on Antiretroviral Therapy Outcomes","volume":"230","author":"RM Burdorf","year":"2024","journal-title":"J Infect Dis"},{"issue":"1","key":"pone.0348800.ref051","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1128\/AAC.48.1.172-175.2004","article-title":"Evolution of human immunodeficiency virus type 1 (HIV-1) resistance mutations in nonnucleoside reverse transcriptase inhibitors (NNRTIs) in HIV-1-infected patients switched to antiretroviral therapy without NNRTIs","volume":"48","author":"V Joly","year":"2004","journal-title":"Antimicrob Agents Chemother"},{"issue":"5","key":"pone.0348800.ref052","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1086\/511433","article-title":"Persistence of K103N-containing HIV-1 variants after single-dose nevirapine for prevention of HIV-1 mother-to-child transmission","volume":"195","author":"TS Flys","year":"2007","journal-title":"J Infect Dis"},{"issue":"1","key":"pone.0348800.ref053","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1186\/s12879-024-09156-9","article-title":"HIV protease resistance mutations in patients receiving second-line antiretroviral therapy in Libreville, Gabon","volume":"24","author":"GF Nzengui-Nzengui","year":"2024","journal-title":"BMC Infect Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348800","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:35:04Z","timestamp":1779384904000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348800"}},"subtitle":[],"editor":[{"given":"Anne","family":"Kapaata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0348800","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}