Dear Dr Njiro,

Thank you very much for submitting your manuscript "Epidemiology and Treatment Outcomes of Recurrent Tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset" 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.

When you are ready to resubmit, please upload the following:

[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.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[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).

Important additional instructions are given below your reviewer comments.

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,

Victor S. Santos, Ph.D

Academic Editor

PLOS Neglected Tropical Diseases

Mathieu Picardeau

Section 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: The objective was clearly articulated in the hypothesis test, the study was designed well to address the objective and the population was clearly described with the test. The sample size sufficiently ensured the hypothesis and the analysis with good statistical support. the study was concerned with ethically approved

Reviewer #2: The authors set out to conduct a cross-sectional study of the determinants of treatment outcomes in recurrent TB. The hypothesis, results and statistical tests are represented clearly and tested appropriately. They have met the ethical and regulatory requirements.

Reviewer #3: Interesting study with clear and articulate objectives and hypothesis. But the study design is NOT a cross-sectional study but rather a retrospective cohort study with a secondary data analysis. The study population or participants for the study is not clear, is it general TB patients or TB recurrence patients? Looking at the title of the study. This lack of clarity is seen in the analysis outputs.

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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: Yes, the analysis was matched with the plan and the results were presented. Figure, table, and images are clearly stated

Reviewer #2: The analysis presented, matches the intent and the analysis plan laid out by the authors. The results are appropriately written. The authors have tested and presented the results mainly in the form of tables, which is an acceptable way for such data.

Reviewer #3: Wondering the choice of the study participants: The total TB patient in the data set (319,720) or the Patients with TB recurrence (6,310).

I thought the preliminary analysis (sociodemographic) should be focus on TB recurrence data set Not General TB dataset. The total dataset is not relevant, and will not bring out the silent features of the main participants in the study, such as gender difference among the TB recurrence patients etc.

The result looked at the determinants which is part of the epidemiology of TB recurrence, and the distribution such as prevalence

I think N in the title of table 2 is 6,310 instead of N=273,807. Likewise, in Table 4 with N there should be 519 NOT 4,884.

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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: The conclusion is not separately stated in this research. it needs rewriting. The limitation of the analysis was clearly described. The authors described clearly the usefulness of the topic under the study. yes this work addressed the relevance of public health

Reviewer #2: The conclusions are supported by the data presented. However, some of the recommendations presented after the data analysis can be toned down. For example : "We recommend post-treatment follow-up and

prophylaxis with Isoniazid therapy or shorter regimen TB preventive therapy for patients with

recurrent TB, especially those coinfected with HIV." How will this be achieved is beyond the scope of analysis and interpretation. This relies on so many factors and it questions the feasibility and involves socio-poltical structures in place, which is not appropriate for the conducted study, such recommendations should solely be based on results presented.

Reviewer #3: The conclusions are supported by the data with the limitations stated clearly and succinct discussion of public health importance.

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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 is there in this study grammar correction, and the conclusion part total not written they need modification

Reviewer #2: The authors have relied on data presentation with just tables, which is appropriate , I wonder if some other reviwers felt a bit more graphical depiction of some of the key data, would make it more appealing and easy for the readers.

Reviewer #3: Accept with minor revision

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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: This research was important in addressing information regarding awareness of TB in the study area also for globally. in section conclusion may need rewriting the other section is good.

Reviewer #2: The study is well conducted and well written. I have pointed out some areas of improvement but that should not prevent the editors from accepting the study for publication.

Reviewer #3: Interesting, large secondary data which highlight recurrent TB determinants, but would have depicted the sociodemographic features of TB recurrent patients instead of general TB patients in which the data was drawn.

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Reviewer #1: Yes: Chimdesa Adugna

Reviewer #2: Yes: Abhimanyu Abhimanyu

Reviewer #3: No

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

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.

Dear Dr Njiro,

Thank you very much for submitting your manuscript "Epidemiology and Treatment Outcomes of Recurrent Tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset" 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.

Dear authors,

After carefully reviewing the re-submitted manuscript, I would like to request just one tiny modification before considering it acceptable for publication.

As you have designed a study to investigate the prevalence of TB recurrence and associated factors, your study is a "cross-sectional study". As you have designed a study to investigate the prevalence of TB recurrence and associated factors, your study is a "cross-sectional study". Please modify this throughout the text.

Sincerely

Prof. Victor S Santos

Academic Editor

PLoS Neglected Tropical Diseases.

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.

When you are ready to resubmit, please upload the following:

[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.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[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).

Important additional instructions are given below your reviewer comments.

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,

Victor S. Santos, Ph.D

Academic Editor

PLOS Neglected Tropical Diseases

Mathieu Picardeau

Section Editor

PLOS Neglected Tropical Diseases

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

Dear authors,

After carefully reviewing the re-submitted manuscript, I would like to request just one tiny modification before considering it acceptable for publication.

As you have designed a study to investigate the prevalence of TB recurrence and associated factors, your study is a "cross-sectional study". As you have designed a study to investigate the prevalence of TB recurrence and associated factors, your study is a "cross-sectional study". Please modify this throughout the text.

Sincerely

Prof. Victor S Santos

Academic Editor

PLoS Neglected Tropical Diseases.

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

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.

Dear Dr Njiro,

We are pleased to inform you that your manuscript 'Epidemiology and Treatment Outcomes of Recurrent Tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset' 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,

Victor S. Santos, Ph.D

Academic Editor

PLOS Neglected Tropical Diseases

Mathieu Picardeau

Section Editor

PLOS Neglected Tropical Diseases

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