Ethical considerations
RECRUITMENT
All stages of this study were conducted in accordance with the principles of the Helsinki Declaration. This study received ethical approval from the University of Illinois at Chicago and the Malawi College of Medicine Research Committee before study recruitment began. After the community meeting introducing the study, those who were interested in participating completed individual signed informed consent. Adults and youth over age 17 consented as adults. Youth ages 13–17 are minors under Malawi law. A waiver was obtained to allow obtaining permission from only one parent or guardian. Because youth were old enough to understand the consent process, each youth and one parent or guardian completed the consent process together. The study was explained to them together and questions from both parent and youth were answered. Then both parent and youth signed the consent form. To minimize any perceived parental coercion, youth assent was reconfirmed verbally prior to the first data collection when the parent was not present.