PONE-D-20-07483

Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

PLOS ONE

Dear Dr. Plymoth,

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Jianhong Zhou

Associate Editor

PLOS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

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: I read with interest this manuscript.

I think that is well wrote and with a good idea research from an important setting (Ethiopia)

Only some suggestions:

1. Introduction: line 44 is the definition of social determinants of health (cite Marmot et al on this issue)

join line 55-56; delete line 71-72

2. Methods: write the time of the study.

3. Results:well wrote. Delete line189

4. Discussion: well wrote. Compare with other study of low setting (ec cite Prevalence and Predictors of Malaria in Human Immunodeficiency Virus Infected Patients in Beira, Mozambique. Int J Environ Res Public Health. 2018;15(9):2032. Published 2018 Sep 17 and The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique. Int J Environ Res Public Health. 2018;15(7):1350. Published 2018 Jun 27. doi:10.3390/ijerph15071350) who underline how women and child are the most vulenrable group and the comorbidity and co-infection with Malaria can be devasting in people with HIV.

Furhermore, as for HIV also TB responde to social determinats of health. (doi:10.1016/j.tube.2017.01.002 and doi:10.1186/s13104-018-3209-9)

5. Conclusion: improve with a advocy that only pharmacological approuch is not sufficient to control burden of HIV

6. Table and statistical analysis are very well done. Congratulations

Reviewer #2: Introduction

Since such factors might be associated

66 with risk of HIV transmission, we also investigated whether lack of virological

67 suppression during ART is associated with high-risk sexual behaviour.

Reviewer comments

Yes, socioeconomic factors might be associated with HIV transmission, but I don’t see why you use that fact to support your secondary aim, you cannot use that fact to motivate your reason for investigating the association between virological suppression during ART and high-risk behaviour (you may look for a reference that supports this association), rather simply state that: A secondary aim of our study was to investigate the association between virological suppression and high-risk sexual behaviour.

For this purpose,

68 we performed a case-control study of ART recipients at Ethiopian public health

69 facilities, comparing persons with VL>1000 copies/ml to those with virological

70 suppression.

Reviewer comments

To me, that statement makes it as if you are conducting a solely comparative study, it completely drifts away from your title and the introduction. Nowhere in the introduction do you talk about virologically suppressed Vs non-suppressed. Besides the fact that you are focusing attention on the association between lack of virological suppression and socioeconomic condition, the comparative factor strengthens your study even further. If you are comparing, this aspect of your study must “come out” in the study title, introduction and the aims. WHY ARE YOU COMPARING THE VIROLOGICALLY SUPPRESSED VS. NON SUPPRESSED? To have a referral point? Then say so. WOULD YOU HAVE FOUND DIFFERENT RESULTS IF YOU HAD NOT COMPARED, i.e., if you had only sought for associations between socioeconomic conditions and those with VL>1000 copies/ml?

Alternatively, your sentence could read: In order to understand the socioeconomic conditions impacting on virological suppression, we performed a case-control study of ART recipients at Ethiopian public health facilities, comparing persons with VL>1000 copies/ml to those with virological suppression.

Methods, results and ethical considerations

Reviewer comments

Comprehensive and well-articulated.

Discussion

Reviewer comments

The discussion is adequate. However, you fail to compare your findings with other studies that have also ‘compared’ virologically suppressed vs. non-suppressed.

General comments

All in all, this is a good study, and I praise you for the good work.

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Reviewer #1: Yes: Francesco Di Gennaro

Reviewer #2: Yes: Smart Z Mabweazara

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PONE-D-20-07483R1

Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

PLOS ONE

Dear Dr. Plymoth,

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.

Please submit your revised manuscript by Jan 02 2021 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,

Kennedy Otwombe

Academic Editor

PLOS ONE

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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 #3: 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: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: I Don't Know

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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: Yes

Reviewer #3: Yes

**********

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: Yes

Reviewer #3: 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: Authors improve their manuscript that now can be publish

I appreciate the research question and also the setting of study

Reviewer #3: Pages 15-18 mentions several significant p-values, yet no mention applying Holm-Sidak. Exactly how were these multiple p-values addressed to minimize Type 1 error?

Table 4 p value are those post-Holm Sidak? Better to see the original p-values apply the Holm-Sidak, then show the outcome.

Other tables show the p-values as well, we they not included in the Holm-Sidak correction?

The Holm-Sidak application confuses. Please clarify…

There are still problems with the abbreviations, where a number of them were given at first mention without presenting the meaning.

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Reviewer #1: No

Reviewer #3: No

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Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

PONE-D-20-07483R2

Dear Dr. Plymoth,

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.

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Academic Editor

PLOS ONE

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