Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men–is it time to re-evaluate STI-screening as a control strategy?

Ulrich Marcus; Massimo Mirandola; Susanne B. Schink; Lorenzo Gios; Axel J. Schmidt

doi:10.1371/journal.pone.0248582

Peer Review History

Original SubmissionNovember 11, 2020
23 Dec 2020 Decision Letter - Ethan Morgan, Editor PONE-D-20-35441 Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men – Is it time to re-evaluate STI-screening as a control strategy? PLOS ONE Dear Dr. Marcus, 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. Apologies that I was unable to secure a second reviewer in a timely fashion. However, from my own reading of the manuscript I agree with the comments made by the single reviewer. Please consider each carefully and incorporate as appropriate. Please submit your revised manuscript by Feb 06 2021 11:59PM. 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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. You indicated have not indicated whether ethical approval was obtained or waived for the EMIS-2010 survey. We understand that the framework for ethical oversight requirements for studies of this type may differ depending on the setting and we would appreciate some further clarification regarding your research. Could you please provide further details on whether approval or a waiver was granted for the EMIS-2010 survey data collection. Please include this information in the manuscript and submission form under "Ethics Statement". 3.We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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 ****** 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 ****** 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: This is an interesting manuscript and I enjoyed reading the results. There are some minor comments regarding introduction and methods and some major concerns regarding the discussion. Overall, I believe that the authors are able and capable of addressing these concerns. Introduction The introduction is very short but describes the current body of evidence well and is highly relevant for most questions tackled in the manuscript at hand. However, at times, this part of the manuscript appears disjointed with a lack of transition between individual paragraphs – especially the ‘observations’ at the end of the introduction are at a little surprising as they appear to be results with some of these not being addressed sufficiently in the introduction itself (e.g., the discussion on condomless sex is very limited in the discussion). Further to this point, it would be helpful to provide more detail here given the sample includes a large number of countries with potentially different epidemiological profiles regarding the use of condoms. Methods The methods of the survey itself are well-explained and the reference to elsewhere is appropriate. The summary provides sufficient information for readers to understand the methodology of the survey itself. I agree with the grouping of variables authors have undertaken for primary outcomes. I recommend to reword the ‘Secondary outcomes’ section; this is currently cumbersome to read. I am confused by the usage of the term ‘policy’ as the manuscript does not analyse testing policies and procedures in different countries but relies on self-reported data. This data may represent local cultures in STI testing and – depending on the analysis and interpretation – also concerning the performance of test, but it unlikely to be able to capture STI testing policies. The ‘hierarchical list of variables’ appears to refer to Hierarchical Segmentation Analysis? If this is the case, please provide further information on the use of this method in context to the data set at hand. NOTE: Some of the figures included were difficult to interpret due to low quality in the file provided by PloSOne. It is unclear if this happened during the submission process or if the quality was limited from the beginning. Results I note that missing responses were discussed in the first paragraph of the results section. Was a missing data analysis conducted to see if there are any differences on main demographic variables between these groups? The result section is clear and presents a thorough (and interesting) analysis. Discussion I agree with the authors that the interpretation of trends and changes is challenging. I was wondering if the inclusion of a case study as part of the results/discussion might be helpful to foster a better understanding of this complexity. E.g., by describing these changes for one country in detail. It might generally be a good idea to provide more in-depth information regarding some of the rather general statements made in the discussion (e.g., ‘STI testing, particularly STI-screening of MSM increased considerable in many countries…”). At this stage large parts of the discussion appear to be an extension of the result section or a further data exploration rather than a critical discussion and contextualisation of the findings. Furthermore, there are concepts briefly mentioned in the discussion that are not contextualised sufficiently and at times with a limited critical perspective (e.g., some of the assumptions associated with risk perception and subsequent behaviour). I again note the usage of the term ‘policy’ in the discussion and question it’s usage. ****** 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 [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. https://doi.org/10.1371/journal.pone.0248582.r001
Revision 1
14 Jan 2021 Author Response Response to the Editors 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 Response: We have re-formatted the manuscript to meet the PLOS ONE style requirements. 2. You have not indicated whether ethical approval was obtained or waived for the EMIS-2010 survey. We understand that the framework for ethical oversight requirements for studies of this type may differ depending on the setting and we would appreciate some further clarification regarding your research. Could you please provide further details on whether approval or a waiver was granted for the EMIS-2010 survey data collection. Please include this information in the manuscript and submission form under "Ethics Statement". Response: We apologise for this oversight. The respective section now reads: Ethics approval was granted by the Research Ethics Committee of the University of Portsmouth for EMIS-2010 (REC application number 08/09:21), and by the Ethics Committee of the London School of Hygiene and Tropical Medicine for EMIS-2017 (reference 14421/RR/8805). 3.We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. Response: As indicated in the submission form, The EMIS-2017 dataset used for this analysis has been obtained from the London School of Hygiene and Tropical Medicine under a data transfer agreement that prohibits to sharing the dataset publicly. Although we cannot make study data publicly accessible at the time of publication, all authors commit to make the data underlying the findings of the study available in compliance with the PLOS Data Availability Policy. Data requests should be addressed to the London School of Hygiene and Tropical Medicine Research Operations Office Data Management Lead: alex.hollander@lshtm.ac.uk, the first author (MarcusU@rki.de), and the Principal Investigator of EMIS-2017 (Peter.Weatherburn@lshtm.ac.uk). Individuals requesting data should present their research objective(s) and enclose a list of requested variables. To protect the confidentiality of participants, data sharing is contingent upon appropriate data handling and good scientific practice by the person requesting the data and should furthermore be in accordance with all applicable local requirements. The London School of Hygiene and Tropical Medicine administrative offices are located at Keppel Street, London WC1E 7HT, United Kingdom. Response to the Reviewer Reviewer #1: This is an interesting manuscript and I enjoyed reading the results. There are some minor comments regarding introduction and methods and some major concerns regarding the discussion. Overall, I believe that the authors are able and capable of addressing these concerns. Response: We thank the reviewer for their positive evaluation and comments. Introduction The introduction is very short but describes the current body of evidence well and is highly relevant for most questions tackled in the manuscript at hand. However, at times, this part of the manuscript appears disjointed with a lack of transition between individual paragraphs – especially the ‘observations’ at the end of the introduction are at a little surprising as they appear to be results with some of these not being addressed sufficiently in the introduction itself (e.g., the discussion on condomless sex is very limited in the discussion). Further to this point, it would be helpful to provide more detail here given the sample includes a large number of countries with potentially different epidemiological profiles regarding the use of condoms. Response: As suggested, we addressed the issues in the Introduction and re-phrased the last paragraph. Methods The methods of the survey itself are well-explained and the reference to elsewhere is appropriate. The summary provides sufficient information for readers to understand the methodology of the survey itself. I agree with the grouping of variables authors have undertaken for primary outcomes. I recommend to reword the ‘Secondary outcomes’ section; this is currently cumbersome to read. Response: We have reworded the ‘Secondary outcomes’ section to improve the flow of the argument. I am confused by the usage of the term ‘policy’ as the manuscript does not analyze testing policies and procedures in different countries but relies on self-reported data. This data may represent local cultures in STI testing and – depending on the analysis and interpretation – also concerning the performance of test, but it unlikely to be able to capture STI testing policies. Response: We thank the reviewer for this comment. We have now introduced a careful distinction between the terms ‘policy’ and ‘practices’. The ‘hierarchical list of variables’ appears to refer to Hierarchical Segmentation Analysis? If this is the case, please provide further information on the use of this method in context to the data set at hand. Response: The use of the term ‘hierarchical’ may be misleading in this context and we deleted it. The list of variables was chosen on theoretical assumptions, and we arranged them in the regression analysis in the following order: 1) Time (survey wave); 2) Survey artefacts (language, discrepant data); 3) Sample composition/demographics (age, settlement size, HIV diagnosis); 4) Testing behavior (screening recency used as surrogate for screening frequency); 5) Sexual behavior (partner number, type of partner, anal intercourse with the last non-steady partner, and condom use with the last non-steady partner); 6) country-level intervention practices (proportion of respondents screened). No Hierarchical Segmentation Analysis was used. NOTE: Some of the figures included were difficult to interpret due to low quality in the file provided by PloSOne. It is unclear if this happened during the submission process or if the quality was limited from the beginning. Response: We used the tools provided by PLOS ONE to create the figures, and the uploaded figures were of high quality. We do not know what happens during the submission process and would appreciate input from the editors or technical team to make sure that the quality of the figures is maintained. Results I note that missing responses were discussed in the first paragraph of the results section. Was a missing data analysis conducted to see if there are any differences on main demographic variables between these groups? Response: We have added a short description of a missing data analysis in the limitations section. In summary, respondents with missing responses on screening are likely to have a lower probability for having received an STI diagnosis than respondents who answered these questions. The result section is clear and presents a thorough (and interesting) analysis. Discussion I agree with the authors that the interpretation of trends and changes is challenging. I was wondering if the inclusion of a case study as part of the results/discussion might be helpful to foster a better understanding of this complexity. E.g., by describing these changes for one country in detail. It might generally be a good idea to provide more in-depth information regarding some of the rather general statements made in the discussion (e.g., ‘STI testing, particularly STI-screening of MSM increased considerable in many countries…”). At this stage large parts of the discussion appear to be an extension of the result section or a further data exploration rather than a critical discussion and contextualisation of the findings. Furthermore, there are concepts briefly mentioned in the discussion that are not contextualised sufficiently and at times with a limited critical perspective (e.g., some of the assumptions associated with risk perception and subsequent behaviour). I again note the usage of the term ‘policy’ in the discussion and question its usage. Response: As mentioned above we have replaced the term ‘policy’ by ‘practices’ where appropriate. We have prepared a case study, describing in detail the changes between the two survey waves for a single country. This case study would add a minimum of 500 words to the manuscript. We are not convinced that including a case study in the manuscript would be useful. Various factors changed in numerous countries to different extents. Details about changes between the two survey waves for all countries are contained in the figures and supplementary tables. An appropriate way to deal with this complexity is the use of multivariate multilevel regression analyses, in which we control e.g. for the effects of changes in the sample composition and survey artefacts such as the French translation issue, as we presented. We hope that we can resolve the issue of the quality of the uploaded figures through input from the technical team at PLOS ONE, so that graphics will be of optimal quality/resolution/file size. We have extended contextualization and the discussion of some of the findings where applicable. Thank you. Attachments Attachment Submitted filename: PONE_response-to-reviewer (2).docx https://doi.org/10.1371/journal.pone.0248582.r002
2 Mar 2021 Decision Letter - Zixin Wang, Editor Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men – Is it time to re-evaluate STI-screening as a control strategy? PONE-D-20-35441R1 Dear Dr. Marcus, 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, Zixin Wang, PhD. 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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 ****** 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 ****** 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: The authors have done a good job of revising the manuscript in line with my suggestions. I have no further comments. ****** 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 https://doi.org/10.1371/journal.pone.0248582.r003
Formally Accepted
5 Mar 2021 Acceptance Letter - Zixin Wang, Editor PONE-D-20-35441R1 Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men – is it time to re-evaluate STI-screening as a control strategy? Dear Dr. Marcus: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Zixin Wang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0248582.r004

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