PONE-D-19-32362

A case-control investigation of HIV outbreak in the northern district of Unnao, India unearths an underlying spread of HCV

PLOS ONE

Dear Dr. Panda,

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Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

I agree with the two reviewers that the paper has interest and presents on an important topic. However, in its present form it does't meet criteria for publishing. Re-organization and focus will significantly improve the manuscript. In addition to editorial (grammar) review, this paper could be shortened by 20% by focusing on the main findings.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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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

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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: No

Reviewer #2: Yes

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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: Thank you for asking me to review this article under consideration. 1. The article has many typographical errors and the authors should employ the use of GRAMMARLY, (it is a free tool) to help in edits throughout the document. 2. The methodology needs to be re-written. Study area. Study design, Study population. Sample size determination. Sampling technique. Dependent and independent variables. eligibility criteria. Data collection tool and procedure; was this interviewer assisted or administered? remember to include who took the blood samples and how? Where was the tool adapted from? was it validated? any pretests? Data analysis: SPSS? Descriptive statistics computed? Ethical considerations: ethics committee and how consent was obtained from participants, how research assistants were trained on e.g confidentiality. Keeping respondents identities anonymous?

Reporting them under these sub sections, helps for clarity. many of these sub themes were either totally absent or mixed up together.

3. Discussion. Why is the first line mentioning secondary data analysis? Please clarify. The second paragraph that mentions bias should be moved to the last paragraph and how these were addressed should be included.

4. There was no conclusion or recommendation. Please kindly include this

5. An algorithm for how this cases and controls were selected should be done.

6. This artcle from pubmed can be a great guide in re-organizing the article.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049326/

Determinants of Anemia among HIV-Positive Children on Highly Active Antiretroviral Therapy Attending Hospitals of North Wollo Zone, Amhara Region, Ethiopia, 2019: A Case-Control Study

7. The conclusion and recommendations should please be in response to the objectives of the paper, and the results respectively.

Thank you for the opportunity

Reviewer #2: This is an interesting study on a major public health issue observed in several Asian countries where the use of unsterilized injection equipment for medical use and outbreaks of HCV or HIV are common. However, there are several issues in the current manuscripts:

1. The population is not adequately described ,especially for an international reader. A small table including the total population of Uttar Pradesh, Unnao district, Bangarmau block and Premganj township-villages of Karimuddinpur and Chakmeerapur should be included.

2. The history of blood transfusion and invasive surgical procedures is not included in the tables.

3. The statistics in the multivariate analysis are not adequate. I recommend to present models including "Received intramuscular injection in last five years" or "Received intravenous fluid for treatment in last five years" in addition to the current model including "Syringe & needle used during intramuscular injection in last five years". The last model may be problematic since the potencial for recall bias is high.

4. In figure 3 the legend does not describe the meaning of different colours.

5. I recommend modification of the title to emphasise the main findings of the study e.g. unsterilized injection equipment for medical use is a cause of the HIV outbreak and extremely high prevalence of HCV.

6. The authors should discuss the generalisability of the HCV findings for Unnao district and Uttar Pradesh. Their discussion is very confusing in this very important issue.

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Reviewer #1: No

Reviewer #2: Yes: Angelos Hatzakis MD PHD

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Unsterile injection equipment associated with HIV outbreak and an extremely high prevalence of HCV - a case-control investigation from Unnao, India

PONE-D-19-32362R1

Dear Dr. Panda,

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.

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Kind regards,

Kimberly Page, PhD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. 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: (No Response)

Reviewer #2: Yes

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

Reviewer #1: (No Response)

Reviewer #2: Yes

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4. 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 Response)

Reviewer #2: Yes

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5. 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: (No Response)

Reviewer #2: Yes

**********

6. 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: (No Response)

Reviewer #2: (No Response)

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7. 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: Yes: Angelos Hatzakis