Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil

Marly Marques da Cruz; Vanda Lúcia Cota; Nena Lentini; Trista Bingham; Gregory Parent; Solange Kanso; Liza Regina Bueno Rosso; Bernardo Almeida; Raquel Maria Cardoso Torres; Cristiane Yumi Nakamura; Ana Carolina Faria e Silva Santelli

doi:10.1371/journal.pone.0249877

Peer Review History

Original SubmissionMay 14, 2020
6 Jan 2021 Decision Letter - Natasha McDonald, Editor PONE-D-20-13677 Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil PLOS ONE Dear Dr. Cota, 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. The reviewers felt that a number of issues should be resolved before the manuscript can be further considered for publication. In particular, several concerns arose about the presentation of the methodology, the discussion and the reporting methods/criteria that should be used in the study. The reviewers' comments can be viewed in full below. Please submit your revised manuscript by Feb 19 2021 11:59PM. 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PLOS defines a competing interest as anything that interferes with, or could reasonably be perceived as interfering with, the full and objective presentation, peer review, editorial decision-making, or publication of research or non-research articles submitted to one of the journals. Competing interests can be financial or non-financial, professional, or personal. Competing interests can arise in relationship to an organization or another person. Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests [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 Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 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: Yes 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: No ****** 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 a useful study looking at various HIV testing/screening methods in Brazil. However, additional clarification around each strategy and the methodology would help the reader more accurately assess the effectiveness of each. The economic evaluation could be enhanced. Introduction Paragraph starting with line 101: The incidence rates cited are now 6 years old. How have trends changed more recently with the introduction of PrEP? Methods The methods would be more clear if the three comparisons were stated straight away. It is not clear what is being compared. From table 1, it appears that the MTU is being compared with fixed services at the COA and NGO. However, the text then introduces self-testing. How does the self-testing fit? Is it a separated comparison group or is it a function of one or all of the aforementioned groups? Other relevant information that needs to be more clear: did all strategies occur at the same time, or were they simultaneous? Did all allow all ages? Did all recruit MSM equally, or did particular strategies target a more general LGBT audience? Cost study-did the cost study cover different dates/time period than the testing data? If not, please clarify (the dates appear to overlap in table 4, but this is not mentioned in the methods). If so, I suggest revising to have costs and test dates align. Results Self-testing Was there an attempt to record the results from these test? Discussion The discussion about cost seems to be missing text? Line 425 introduces this topic by saying that self-testing is ranked second. There is no other discussion of costs. This should be added. Also, the conclusion that self-testing is effective is not supported by the data in this analysis since we don’t know how many people actually used the tests that were delivered. Reviewer #2: The paper must be substantially improved in order to be published. Please see specific the comments in the attach file. The paper must follow some EQUATOR guidelines; in my opinion the CHEERS is the most adequate. ****** 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.] 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. Attachments Attachment Submitted filename: REVIEW_PLOSdec2020.docx https://doi.org/10.1371/journal.pone.0249877.r001
Revision 1
19 Feb 2021 Author Response Reviewer #1: This is a useful study looking at various HIV testing/screening methods in Brazil. However, additional clarification around each strategy and the methodology would help the reader more accurately assess the effectiveness of each. The economic evaluation could be enhanced. Introduction Paragraph starting with line 101: The incidence rates cited are now 6 years old. How have trends changed more recently with the introduction of PrEP? Response: the reference has been updated. Methods The methods would be more clear if the three comparisons were stated straight away. It is not clear what is being compared. From table 1, it appears that the MTU is being compared with fixed services at the COA and NGO. However, the text then introduces self-testing. How does the self-testing fit? Is it a separated comparison group or is it a function of one or all of the aforementioned groups? Response: this section was re-written. The self -testing strategy is not being compared with the other three strategies (COA, NGO and MTU). Other relevant information that needs to be more clear: did all strategies occur at the same time, or were they simultaneous? Did all allow all ages? Did all recruit MSM equally, or did particular strategies target a more general LGBT audience? Response: please see time horizon and target population. All strategies targeted the same population equally – MSM, however the e-testing (self-testing) targeted MSM aged 18 and above and the other three strategies, target MSM aged 14 and above. Cost study-did the cost study cover different dates/time period than the testing data? If not, please clarify (the dates appear to overlap in table 4, but this is not mentioned in the methods). If so, I suggest revising to have costs and test dates align. Response: please see time horizon. The cost study collected retrospective from each testing outlet covering a 12-month period (March 2015 to February 2016). Results Self-testing Was there an attempt to record the results from these tests? Response: the results were collected and reported however there is no comparison with the other three strategies Discussion The discussion about cost seems to be missing text? Line 425 introduces this topic by saying that self-testing is ranked second. There is no other discussion of costs. This should be added. Also, the conclusion that self-testing is effective is not supported by the data in this analysis since we don’t know how many people actually used the tests that were delivered. Response: this paragraph has been re-written Reviewer #2: The paper must be substantially improved in order to be published. Please see specific the comments in the attach file. The paper must follow some EQUATOR guidelines; in my opinion the CHEERS is the most adequate. General Observations 1.I had some difficulties in order to understand the main objective of the paper and its specific objectives; in the abstract there are objectives defined but related to the project AHA, not to this paper; then, in the introduction (last paragraph) it is stated another different objective. Also these objectives are not related to the Title. Reading the paper, I get the impression that the main objective of this paper is to compare the cost-effectiveness of several interventions/strategies used in Curitiba to expand access to HIV rapid testing in MSM and to improve the linkage of HIV positive MSM to health services and treatment. If it is the case, then the title should be different, namely it must reflect the type of approach used by the authors (health economic evaluation/ cost/ cost-effectiveness, etc..). Response: revisions made 2. I had some difficulties in finding the most adequate Equator Guideline to review the article; however, I think that it should be the CHEERS Checklist- Items to include when reporting economic evaluations of health interventions. Consequently, the paper must be revised according to this Guideline. Response: revisions made Specific Commentaries Abstract Introduction. The authors must write in a very clear way the aim and the specific objectives of the paper (and not the objectives of the AHA) Methods. Specify the type of study, the participants and statistical tests used to compare participant’s characteristics between groups. Results. They should respond to specific objectives; it is not the case. Response: the abstract was rewritten. Introduction In line 117 it will be interesting to have some figures about the prevalence/ incidence of HIV in Curitiba population if possible by sex and age and compared with the whole country. Response: information added to the manuscript In line 130, aim and specific objectives must be clearly defined (in order to be then compared with the results). If possible, specify the research question. Response: the aims and objectives were rewritten. Methods This section must be reorganized, ideally following the structure bellow: • Target population and subgroups • Setting and location • Study perspective and its relation to the costs being evaluated. • Description of the interventions or strategies being compared and state why they were chosen. • Time horizon • Choice of health outcomes • Measurement of effectiveness • Estimating resources and costs • Statistical Analysis (with the tests used) and why they were chosen Response: This section has been re-written In lines, 138-141, separate the type of study, from the variables. Response: it was re-written In lines 235-241 the description of variables is not a statistical analysis. Response: correction made – description was moved to “Choice of health outcomes” within methods section In line 241 the authors stated they used frequencies and medians; its ok; however, in the results (footnotes in Tables 2 and 3) they refer to statistical tests; these tests must be described in the statistical analysis section. Response: has been rewritten and is in the statistical analysis section within methods section Lines 242-245 are not related to statistical analysis. Response: correction made – description was moved to “Choice of health outcomes” within methods section Results The Results section must follow CHEERS guidelines and must be coherent with the specific objectives. Response: revision was made in both sections in order to adjust coherency with the objectives. We did not follow Cheers guidelines as this paper is not an economic evaluation, even though there is cost analysis included in it. Table 2 in footnote 6 it is stated that: Statistical tests were performed for the difference of proportions (z test and Fisher's test) in pairs for the strategies - COA and NGO; COA and MTU; NGOs and MTU - only for COA and NGO, the result was not significant. The sentence: the result was not significant is not adequate; what result? What is being compared? What is the significant level? Tests must be described in Methods section; and in the results we have to understand which result was not significantly different from another one. Because we are comparing groups. More rigour is needed. Response: the footnote was rewritten and the tests performed were described in the statistical analysis section within methods Table 3. Footnote. Same observation. Response: the footnote was rewritten and the tests performed were described in the statistical analysis section within methods Table 4. The title is related to COST-EFFECTIVENESS. It is the first time we are faced with this expression that has a very powerful meaning in economic evaluations of health interventions The authors must explain in the Methods section what type of cost-effectiveness approach they are using and why? Response: this section has been re-written with appropriated wording Figures 2 and 3 are not very clear from the graphical point of view. I think that tables with figures are more frequently used in this context. Response: the figures were transformed into tables Attachments Attachment Submitted filename: rebuttal_letter.docx https://doi.org/10.1371/journal.pone.0249877.r002
18 Mar 2021 Decision Letter - Maria do Rosário Oliveira Martins, Editor PONE-D-20-13677R1 Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil PLOS ONE Dear Dr. Cota After careful consideration, we feel that major revisions suggested by the reviewers have been addressed. However, there are still minor changes that need to be considered before publication. Methods Section, Statistical Analysis The first paragraph must be corrected as suggested below: "In the analyzes, absolute frequencies, ......, as well as unilateral statistical tests for the difference in proportions - z test and/or Fisher test, depending on the number of expected observations per cell." In the third paragraph don’t include table numbers (Table 3) because these tables are in the results. Results section Footnotes in Table 3 need to be revised. Footnote 5- According to test, the proportion of the NGO (68.2%) is not significantly greater than that of the MTU (67.5%). Footnote 6- According to the test, the proportion of the COA (69.8%) is not significantly lower than that of the NGO (80.0%). In table 3 replace average age by median age to be consistent with the sentence in the paragraph below the table. We look forward to receiving your revised manuscript. Kind regards, Maria do Rosário Oliveira Martins, Ph.D Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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. https://doi.org/10.1371/journal.pone.0249877.r003
Revision 2
23 Mar 2021 Author Response Methods Section, Statistical Analysis: The first paragraph must be corrected as suggested below: "In the analyzes, absolute frequencies, ......, as well as unilateral statistical tests for the difference in proportions - z test and/or Fisher test, depending on the number of expected observations per cell." Response: Changes made. In the third paragraph don’t include table numbers (Table 3) because these tables are in the results. Response: Changes made. Results section: Footnotes in Table 3 need to be revised. Footnote 5- According to test, the proportion of the NGO (68.2%) is not significantly greater than that of the MTU (67.5%). Footnote 6- According to the test, the proportion of the COA (69.8%) is not significantly lower than that of the NGO (80.0%). Response: You mentioned table 3, but the notes refer to table 2. Changes made on table 2. In table 3 replace average age by median age to be consistent with the sentence in the paragraph below the table. Response: Changes made. Attachments Attachment Submitted filename: rebuttal_letter.docx https://doi.org/10.1371/journal.pone.0249877.r004
29 Mar 2021 Decision Letter - Maria do Rosário Oliveira Martins, Editor Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil PONE-D-20-13677R2 Dear Dr. Vanda Cota, 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, Maria do Rosário Oliveira Martins, Ph.D Guest Editor PLOS ONE Additional Editor Comments (optional): The authors made all suggested changes. The paper can be accepted. Reviewers' comments: https://doi.org/10.1371/journal.pone.0249877.r005
Formally Accepted
26 Apr 2021 Acceptance Letter - Maria do Rosário Oliveira Martins, Editor PONE-D-20-13677R2 Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil Dear Dr. Cota: 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 Maria do Rosário Oliveira Martins Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0249877.r006

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