PONE-D-20-02975

Implementing active surveillance for TB – The views of managers in a resource limited setting, South Africa.

PLOS ONE

Dear Dr Ajudua,

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.

We would appreciate receiving your revised manuscript by Jun 19 2020 11:59PM. 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,

Petros Isaakidis

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include additional information regarding the interview guide used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a guide as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

[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

**********

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

Reviewer #1: Yes

Reviewer #2: N/A

**********

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

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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: Overall this is a well written and interesting qualitative study which aimed to assess manager’s views on the implementation of active surveillance for TB. This is addressing a gap in the literature as there have not been many studies to date which have investigated this. Additionally, the results can potentially drive changes in clinical practice and ensure that resources are streamlined in order to ensure effective service delivery.

General Comments:

Kindly avoid the use of stigmatizing language i.e. defaulter, suspected TB case.

Throughout, ensure that you double check your grammar. There are multiple instance of incorrect grammar.

Introduction:

In the introduction section you should mention that TB is THE LEADING cause of mortality in South Africa

This section, while very interesting is quite long. I recommend that you try to make this more concise. As noted below, some of the information provided in the introduction describing the programme might be better suited in the methods section.

Methods:

In the section on the setting you might want to consider providing some information on the burden of TB and the coinciding HIV prevalence. Additionally, if you have any information on the average income/housing situation there this might help to better contextualize the context.

In the section on the data collection, you might want to specify what language the interviews were done in and if they required any translation. Additionally, it might be useful to provide some information on the questions asked. You could consider including the questionnaire in an annex. Overall, without being able to review the semi-structured questionnaire it is hard to understand the questions asked and what further areas were investigated. I think that sharing this would help future research carry out similar investigations or make the needed adaptations to them.

Lines 152-160 could be included under a subheading titled programme description. Then I think some of the details regarding the programme provided in the introduction section could be moved here.

Discussion:

I recommend that you include the summary of the key findings in the results section rather than the discussion section. Maybe you could do that in the beginning of the results section and then unpack each point further in the subsections as you have already done. This could for example be placed after line 203.

In the discussion check your sentence on lines 451-52; it does not make sense.

On line 463 is there a more recent document you can reference.

Paragraphs on 433-441 and 469-482 both talk about security risks and challenges as a result. You might want to consider combining these paragraphs to avoid redundancy.

On lines 492-499 it seems as though you are discussing some of your imitations. However, I recommend that you specifically stipulate that the study is subject to limitations which include XXXXXXX. You have included all the relevant information here, I just think that it needs to be slightly reframed.

Reviewer #2: The qualitative study entitled “Implementing active surveillance for TB – The views of managers in a resource limited setting, South Africa” addresses the critical question of what frontline TB program managers see to be key challenges and solutions in implementing active surveillance for TB. The study interviewed 10 of 12 Eastern Cape provincial TB managers. The authors conclude that a multi-faceted facility and community-based approach would be most effective for active case finding.

This paper addresses an important question that informs TB policy and the research design and qualitative methods are appropriate for the research question. However, I recommend that the presentation of the interview data be more structured and streamlined to increase the contribution of the paper to our understanding of TB program design.

The paper claims to present “innovative” ideas for improving active surveillance, however it’s not clear that the qualitative interviews provide a lot of new information on these topics that hasn’t already been covered in the literature. The introduction should perform a more thorough literature review to identify gaps in our understanding of how to design active surveillance for TB.

Table 1 clearly summarizes the results in an accessible way. I suggest using a framework like this for the rest of the paper. In its current form, the results and discussion sections meander a little through the responses to questions rather than concisely laying out the main themes from the interviews and illustrative quotes to accompany them.

Did the interviews ask about prioritization of the different innovative ideas? The solutions are presented as a long list, which makes it hard for resource-limited programs to identify the highest-impact components to implement. Is there a way to infer some sort of prioritization from the frequency or intensity of themes raised by interviewees?

The conclusion that “this study suggests a multi-faceted facility and community-based approach would be most effective for active case finding” is quite general, especially considering it’s based on direct interviews with TB program managers. I suggest combing through the results in this paper to identify a more significant contribution to our knowledge that this study brings to light.

Both the introduction and the discussion section are quite long. I’d suggest streamlining them to convey the main points more efficiently which will increase readership of the article.

The quotes included in the article do not add an awful lot of color or information to the paper. I’d suggest including a table with several shorter quotes on each topic that focus on key phrases related to the study themes. Perhaps the discussion could weave more detail around the quotes to make it clear what each quote brings to light.

**********

6. 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

[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.]

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. Registration is free. 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. Please note that Supporting Information files do not need this step.

PONE-D-20-02975R1

Implementing active surveillance for TB – The views of managers in a resource limited setting, South Africa.

PLOS ONE

Dear Dr. Ajudua,

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.

While I see that the authors have adequately responded to most of the reviewers' comments and suggestions and have satisfactorily revised their manuscript, I particularly noticed that they have not addressed the issue of stigmatizing language and terms, such a defaulters. I also recommend that authors use the COREQ checklist, or other relevant checklists listed by the Equator Network, such as the SRQR, to ensure complete reporting.

Please submit your revised manuscript by Sep 18 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Petros Isaakidis

Academic Editor

PLOS ONE

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

[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.]

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. Registration is free. 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Implementing active surveillance for TB – The views of managers in a resource limited setting, South Africa.

PONE-D-20-02975R2

Dear Dr. Ajudua,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Petros Isaakidis

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: