PONE-D-19-32104

Factors associated with HIV testing among young females; further analysis of the 2016 Ethiopian Demographic and Health Survey.

PLOS ONE

Dear Mr Bekele,

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Kwasi Torpey, MD PhD MPH

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

The authors should review the references and ensure it is consistent with the journal requirements

1. Typo in Reference 7, 10 Correct spelling of "Organazation"

2. Ref 8,9,11,14 - Please change from CAPS

3. Ref 16 - Not consistent with referencing guidelines. Has initial then surname. Please correct

4. Ref 17,18,19, 20 is non compliant with referencing guidelines. Please correct

5. Ref 39: Who is the author?

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors need to address the comments raised in the summary of the review and in the manuscript as per attachments before the manuscript being considered for publication

Section Comment, question, suggestion.

Abstract 1. Well summarised abstract.

2. Lacked quantifications of the problem, how low is low HIV testing in Ethiopia?

3. Regarding the knowledge gap:

o What are the advantages of us having this information? Who will benefit from the study being conducted and how?

o Limited information does not warrant a study to be conducted. The missing information has to be useful in some way to the study stakeholders.

4. Would be better to mention the age range. Who is considered to be a young woman for this study? 15-19 years? Or 15-24?

5. The conclusion summarized the results without any further recommendations.

o Recommendations are needed to show the implication of the study findings either to policy and/or to practice.

Introduction

Background 1. Throughout the entire background, entire paragraphs had only one citation on the last sentence. Please revisit citations.

2. It is still unclear who is a “young woman”. It is informative for the reader to have an age range earlier on in the paper.

3. For the paragraph concerning previously identified significant predictors;

o It would be more informative to mention the exact levels/categories which were found to be significant predictors e.g. Rural/urban? Which category was significant?

o It would also be informative to mention whether they are predictors of higher/lower odds of HIV testing.

4. And thereafter identifying the factors, how would the results be used? After these bottle-necks have been identified.

Methodology 1. Why only include women who were sexually active in the past 12 months into the study? Please provide an elaboration.

o The risk of HIV does not change regardless of the time since last sexual intercourse.

o Wouldn’t a more appropriate exclusion criteria be women who NEVER had sexual intercourse?

2. For the outcome definition;

o Why the focus on those who tested in past 12 months?

o Why not use if she EVER tested for HIV?

o Why are those who tested before 12 months considered as if they have never tested and coded as 0?

3. How was HIV knowledge measured?

4. Did you consider using alternatives to logistic regression if you identified the outcome of interest to be common? >10% prevalent.

5. “Bivariate regression analysis was done to examine associations between contraceptive use and the selected predictor variables”;

o Does this study measure contraceptive use OR HIV testing?

6. “In addition, correlation among predictor variables was assed using variance inflation factor before recruiting variables to the final mode.”

o What do you mean? Is it correlation or collinearity?

Results 1. For every table caption, please include N=???

2. For every variable in the tables with category “other”, please provide an explanation on who/what “other” means.

3. Did you consider life time sexual partners? Or those in the past 12 months? Please make clear.

4. What is chat? Concerning the variable “chewed chat”

5. The percentages presented in Table 3 are column percentages,

o Which means the interpretations should be “among those tested for HIV, 26.22% were aged 15-19”.

o Please revise the interpretation provided above.

Discussion Please apply these for the entire discussion section;

1. For each finding, it would be more informative to report numbers/findings that these previous studies reported. It would be informative to mention them in brief so the reader may compare.

2. What is the implication of each study finding? Are you recommending for the Ethiopian government to adopt a similar strategy to increase HIV testing as Uganda?

3. Discussing only similarities/differences of study findings is not enough. You need to go a step further and show the implications of this study findings to either policy or to practice.

Strengths and limitations 1. This section is missing from the paper

Conclusion + Recommendations 1. The conclusion provided a summary of the main results of the paper.

2. Please provide recommendations basing on the results of this study. How can these findings be applied to benefit the stakeholders of the study? The women, policy makers, government officials?

Reviewer #2: Manuscript Number: PONE-D-19-32104

Full Title: Factors associated with HIV testing among young females; further analysis of the 2016

Ethiopian Demographic and Health Survey.

Review Comments

The manuscript presents the very interesting and useful study that is very crucial to inform the improvement in HIV counselling and testing in Ethiopia and other sub-Saharan countries. The authors presented straight forward findings that are easy to follow. However, authors need to revise the manuscript per the below recommendations. The writing style, mainly on structuring the paragraphs, gramma and typos may need to be given more attention in the whole manuscript.

Abstract.

1. Well structured,

2. Few grammatical errors exist and one statements (e.g ….. those who ever had alcohol (AOR 1.46; 95% (CI; 1.09, 1.98)) and young women who visited health facility (AOR 1.78; (95% CI; 1.36, 2.32)) higher odds of being tested for HIV.) has a word missing

Background

3. Paragraph 3, last statement needs further elaboration to put context. It is unclear as to which population is represented by the 30 % of people living with HIV.

4. Citations need to be specific to the statements rather than lumping all the references to the last statement of the paragraph.

5. The last paragraph of introduction indicates that there are few studies, on factors associated with HIV testing among young women in Ethiopia. Unless the gap is identified in those studies, the current study is unjustifiable. The authors may need to present what those studies found and their gaps to justify why the current study is needed.

6. The authors may need to revise the whole introduction section and correct the grammatical, spelling, and space errors.

Methods and Materials

7. Statistical analysis needs to be described clearer. The authors indicate that “Bivariate regression analysis was done to examine associations between contraceptive use and the selected predictor variables. Contraceptive use was not listed as an outcome variable in the above section. Authors may need to check if this is correct.

8. The procedure for weighting the data to account for non-response and disproportionate sampling need to be transparently described.

Results

9. The results are well written; however, the authors may consider making the results more concise. It is possible to fuse tables 1 and 3; and 2 and 3 by considering that the numbers in table 3 are subsets of Tables 1 and 2.

10. The authors may also need to indicate which variables were adjusted in the multivariate model, what criteria were used for selecting such variables for adjusting and/or justification.

11. The data for crude odds ratio for rural residency in table 4 is missing

12. The authors may also want to reformat the Table 4 so that numbers separated by comma are spaced.

Discussion

13. The discussion has interpreted and compared the findings with the previous studies. However, the authors may need to restructure the discussion a bit, so they begin the section by summarizing what they found and later discussing the results.

14. Discussion of the methodological strengths and weaknesses/limitations of their study is missing

15. Although they found the factors associated with HIV testing among sexually active young women in Ethiopia, their discussion needs to translate and discuss the findings by relating to the real issues among young women in Ethiopia.

16. To improve the success of the HIV counselling and testing program, the authors need to indicate the implications for practice and further research.

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Reviewer #1: Yes: Michael Johnson Mahande

Reviewer #2: Yes: MASIKA, Golden Mwakibo

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Attachments

Attachment

Submitted filename: Summary for reviewers comments.docx

Attachment

Submitted filename: Mahande_PONE-D-19-32104_MASHA_edit.docx

PONE-D-19-32104R1

Factors associated with HIV testing among young females; further analysis of the 2016 Ethiopian Demographic and Health Survey.

PLOS ONE

Dear Mr Yibeltal Bekele,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript has several language errors which need attention.

We would appreciate receiving your revised manuscript by 30th January 2020. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable 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. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Kwasi Torpey, MD PhD MPH

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The manuscript requires significant copyediting before acceptance. The language in its current form is not acceptable. I strongly suggest a fluent native speaker copyedits the document. There are several language errors through the whole document too numerous to recount. I am highlighting a few

Title page: Correspondent should read corresponding

Abstract Line 5. low HIV testing and counseling service use better written low utilization of HIV testing and counseling service

Introduction: Line 1 5,000 people were infected should be 5,000 people are infected

Line 3 disproportionally should be disproportionately

Intro 2nd para Line 1 and 2 "early life of transmitted from mother to child …… needs to rephrase. There are many more in the narrative

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

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Factors associated with HIV testing among young females; further analysis of the 2016 Ethiopian demographic and health survey data

PONE-D-19-32104R2

Dear Mr Yibeltal Bekele,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Kwasi Torpey, MD PhD MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: