Dear Dr DEMBELE,

Thank you very much for submitting your manuscript "Implementation of mass drug administration for neglected tropical diseases in Guinea during the COVID-19 pandemic" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. The reviewers appreciated the attention to an important topic. Based on the reviews, we are likely to accept this manuscript for publication, providing that you modify the manuscript according to the review recommendations.

Please prepare and submit your revised manuscript within 30 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email.

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[1] A letter containing a detailed list of your responses to all review comments, and a description of the changes you have made in the manuscript.

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[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

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Thank you again for your submission to our journal. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Matthew C Freeman, MPH, Ph.D.

Associate Editor

PLOS Neglected Tropical Diseases

Christine Petersen

Deputy Editor

PLOS Neglected Tropical Diseases

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Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: - Are the objectives of the study clearly articulated with a clear testable hypothesis stated? yes but no hypothesis du to study design(report)

-Is the study design appropriate to address the stated objectives? Yes

-Is the population clearly described and appropriate for the hypothesis being tested? Yes only population is clearly described

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested? The sample signe like too small to be representative.

-Were correct statistical analysis used to support conclusions? yes

-Are there concerns about ethical or regulatory requirements being met? yes

Reviewer #2: Yes indeed the methods are well explained.

The authors need to better explain the following in the section of risk assessment “drug distribution platforms”

Please the following need more precision “travelers from Conakry avoid crowded vehicles.”

Please the following is a repetition and not well written “The MDA and prevention and protection against COVID-19 messages were disseminated by local media before and during the campaign.

Please rewrite the following part in social mobilization section “Some routine activities, such as the national campaign launch ceremony were cancelled to prevent the gathering of crowds.”

“Central level program staff and supervisors were tested for COVID-19 before leaving Conakry and only staff with negative results travelled to the districts and conducted the supervision. All supervisors observed COVID-19 mitigation measures during supervision visits, including wearing face masks, social distancing of two meters, and using hand sanitizer.” As a limit the authors did not indicated whether those negative while in the field respected confinement period before working because the newly infected will not be positive directly

I will suggest to the authors to add study population section and sample size for more clarification

Reviewer #3: The objectives should be clearly articulated, preferably by stating the general objective and 2-3 specific objectives. These should be closely aligned to Similarly clear study questions. The discussion should then be restructured to speak to the objectives.

Reviewer #4: Minor revisions

- In the 1st sentence of the Methods section, the word “in” seems to be a typo, please double check it

- The break times are the riskiest periods during the training sessions, was there specific directions for these periods? If yes, please specify them

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: -Does the analysis presented match the analysis plan? Yes

-Are the results clearly and completely presented? Yes but should be more clear to compare MDA coverage with the results of previous MDA to measure the impact of COVID-19.

-Are the figures (Tables, Images) of sufficient quality for clarity? Yes bu need to be review with comment above

Reviewer #2: Yes the results are well presented

“Thus, the results presented here relate to adherence to the contingency plan for the implementation of MDA in the context of the COVID-19 epidemic (barrier and preventive measures against COVID-19) in 14 HDs.” Read this part carefully something is missing”

Tables and figures are good

Reviewer #3: No revision required

Reviewer #4: Minor revisions

- In table 1, please explain the coverage > 100% or discuss them in the appropriate section

- Please check this sentence of the last paragraph of the Results section « Adherence to the mitigation measures for districts reporting COVID-19 cases was similar compared to districts where no case of COVID-19 was confirmed (Table 2). »

- The last sentence of the Results sections contains a word that need to be checked and replaced; the same sentence seems to consider a p value =0.05 as statistically significant. A p value should be <0.05 to be considered statistically significant.

- Some of the small numbers in the last table seems to require a Fisher Exact test instead of an uncorrected Chi square test (i.e. Household participants reluctant to participate in MDA line), Please double check

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: -Are the conclusions supported by the data presented? Yes

-Are the limitations of analysis clearly described? Yes

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study? Yes but not sufficient

-Is public health relevance addressed? The study focuses on the proportions of actors who apply the barrier measures. It doesn't give much scientific interest. It would have been good to push the study by measuring the impact of the campaign on the occurrence of new cases of COVID-19 and especially if actors have developed signs after this campaign.

Reviewer #2: “The results demonstrate that implementation of MDA in the context of COVID-19 is programmatically challenging, but that with appropriate planning, resources, and training, risk mitigation measures can be rapidly applied.” I will suggest to remove “that”

Reviewer #3: No revision required

Reviewer #4: (No Response)

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: Minor Revision

Reviewer #2: (No Response)

Reviewer #3: No revision required

Reviewer #4: Minor modifications

Abstract:

- A definition of the world CDDs team and Households would be helpful in understanding these concepts.

- At least 2 sentences started with numbers

Background

- Please add a reference at the end of the first paragraph of the Background section

- Please split the last sentence of the 3rd paragraph into two sentences to gain in clarity

Discussion

- At the end of the second paragraph of the Discussion sections, it would be informative to name the key stakeholders evocated.

- Please check the 2nd sentence of the 4th paragraph “Firstly, six out of seven HDs of LF districts which did not achieve the minimum coverage had reported cases of COVID-19. » for clarity

- In the same paragraph and elsewhere in the manuscript, the authors seem to be using interchangeably « households » and « households’ members », please look at that carefully and adapt according to the meaning of the concept in each sentence throughout the manuscript.

References

- Many references used are not eligible for a peer reviewed paper

- References that are not peer reviewed journal articles should have a web link and date of access

- The types of documents eligible for citation as a reference should be check on the Journal’s website

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: The study is interesting but remains in the form of a report. The authors could have extended this study by taking into account the impact of the implementation of barrier measures on the transmission of COVID-19. If they were effective, the results could be used as evidence to be strongly recommended to other countries.

Reviewer #2: Please revise this section size “The participatory approach, led by the NTDP, to develop the contingency plan contributed to wide acceptance of restarting the MDA from all key stakeholders.”

Please read this again not sure if this statement is correct as it is “and it was not possible to calculate STH coverage for SAC only” . my question is why not even if it was integrated normally I will be possible to report

This need also to be taken into account in the mitigation plan like asking and get agreement with communities for the best tie during the day distribute the drugs “During the rainy season, access to the target population and some places are difficult and people are not often in the household during the MDA campaign.”

Reviewer #3: The study is relevant to the current realities of COVID-19 and provides useful insights on how programs can implement interventions to safeguard gains already made, while taking necessary precautions to minimize the risk of getting infected with the disease.

Reviewer #4: This paper describes a real and current issue that threatened interventions targeting NTDs. It provides with an attitude that is well described and could help in the future when similar situation is faced.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Dr. Sultani Hadley Matendechero

Reviewer #4: Yes: Yaya Ibrahim Coulibaly

Figure Files:

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References

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article's retracted status in the References list and also include a citation and full reference for the retraction notice.

Attachments

Attachment

Submitted filename: MDA experience in COVID-19 context Guinea.docx

Attachment

Submitted filename: PNTD-D-21-00572_reviewer.pdf

Dear Dr DEMBELE,

We are pleased to inform you that your manuscript 'Implementation of mass drug administration for neglected tropical diseases in Guinea during the COVID-19 pandemic' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

Should you, your institution's press office or the journal office choose to press release your paper, you will automatically be opted out of early publication. We ask that you notify us now if you or your institution is planning to press release the article. All press must be co-ordinated with PLOS.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Matthew C Freeman, MPH, Ph.D.

Associate Editor

PLOS Neglected Tropical Diseases

Christine Petersen

Deputy Editor

PLOS Neglected Tropical Diseases

***********************************************************

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: Are the objectives of the study clearly articulated with a clear testable hypothesis stated? Yes

-Is the study design appropriate to address the stated objectives? Yes

-Is the population clearly described and appropriate for the hypothesis being tested? Yes

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested? Yes

-Were correct statistical analysis used to support conclusions? Yes

-Are there concerns about ethical or regulatory requirements being met? Yes

Reviewer #2: the authors address all my previous comment and suggestions related to methods

Reviewer #3: The methods are clearly illustrated. Objectives are stated and well articulated.

**********

Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: Does the analysis presented match the analysis plan? Yes

-Are the results clearly and completely presented? Yes

-Are the figures (Tables, Images) of sufficient quality for clarity? Yes

Reviewer #2: the authors address all my previous comment and suggestions related to results

Reviewer #3: The result are well presented and analyses.

**********

Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Are the conclusions supported by the data presented? Yes

-Are the limitations of analysis clearly described? Yes

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study? Yes

-Is public health relevance addressed? Yes

Reviewer #2: my concern about the conclusion part was also addressed

Reviewer #3: The conclusion is well captured and relevance to current circumstances clearly demonstrated.

**********

Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: Accept

Reviewer #2: fine to me

Reviewer #3: (No Response)

**********

Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: NA

Reviewer #2: i think the paper is now well presented and clear and will be helpful for others settings /countries to learn from this paper and prepare their mitigate plan for NTDS activities implementation under COVID 19 and others emergency infectious epidemic or pandemic.

Reviewer #3: All areas of previous concern have been adequately addressed.

**********

PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Dr. Sultani Hadley Matendechero