PONE-D-21-05519

Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study

PLOS ONE

Dear Dr. Felipe Lima dos Santos,

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Francesco Di Gennaro

Academic Editor

PLOS ONE

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Additional Editor Comments:

dear authors follow reviewer suggestion to improve your paper

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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: No

Reviewer #2: Yes

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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: The aim of the study was to analyse the discourses of participants who were diagnosed with MDR-TB, the perception of why they acquired this health condition and barriers to seeking care during the Covid-19 pandemic. I tried to see whether the objectives have been met.

Of the four discursive blocks formed, the first; “why did the disease develop? Social and economic factors” is expected to bring out the perceptions of the participants on the causal factors of MDRTB. Though the discursive analysis did bring out the fact that the participants have a low socioeconomic status, the verbatim did not suggest that the participants have perception that their low socioeconomic condition has causal relationship with their disease condition. The discursive analysis did not yield significant additional information than what could have been inferred from the quantitative data on the sociodemographic profile as four among the seven are unemployed.

The second discursive block “barriers to seeking care and difficulties assessing health services” has met the objective.

The third discursive block “a blessing in disguise: side effects of multi drug resistant tuberculosis treatment” has many weaknesses. The adjective used by the authors (“high” doses) indicates that the authors are biased about the side effect since the clinical dosage is according to the body weight to minimize adverse effects. I do not comprehend why adverse reaction is to be highlighted as a blessing in disguise.

The fourth discursive block “tuberculosis and Covid-19 – a necessary discourse” has a contextual relevance that has highlighted the barrier to seeking care. It highlights the impact of low preparedness of system on disease programs. More in depth analysis of this discursive block might have added more relevance to the study rather than the contribution to the currently available knowledge base by the three other blocks.

Reviewer #2: Thank you for the opportunity to read this interesting paper.

I find it well wrote on important research question.

Below my suggestions

1. Introduction:Update data on Tb burden from TB Report 2020. Line 100-107: add the role of social determinants of health in TB MDR onset and on therapy failure (see and cite Social determinants of therapy failure and multi drug resistance among people with tuberculosis: A review. Tuberculosis (Edinb). and Predictors of therapy failure in newly diagnosed pulmonary tuberculosis cases in Beira, Mozambique. BMC Res Notes. 2018 Feb 5;11(1):99.)

2.Methods and Results: are clear

3. Discussion: add the role of covid pandemic and disruption of Tb services resulting in TB diagnosis delay and worste clinical presentation and outcome

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Reviewer #1: No

Reviewer #2: No

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Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study

PONE-D-21-05519R1

Dear Dr. Felipe,

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,

Francesco Di Gennaro

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

congratulations

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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

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: Yes

Reviewer #2: Yes

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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: Thanks for revising the manuscript considering the suggestions. I do not have additional comments on the revision.

Reviewer #2: authors improved their paper that now can be accept. The research question is important and also the setting of study is relevant. congratulations

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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: Yes: Shibu Balakrishnan

Reviewer #2: No