Challenges to nutrition management among patients using antiretroviral therapy in primary health ‘centres’ in Addis Ababa, Ethiopia: A phenomenological study

Helen Ali Ewune; Kassa Daka; Befekadu Bekele; Mengistu Meskele

doi:10.1371/journal.pone.0250919

Peer Review History

Original SubmissionDecember 28, 2019
13 May 2020 Decision Letter - Denise Evans, Editor PONE-D-19-35850 Challenges to nutrition management among patients on antiretroviral therapy in primary health centers’ in Addis Ababa, Ethiopia; A phenomenology study PLOS ONE Dear Ms Ali, 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 paper is interesting and makes a contribution to the field; however, in its current form is not ready for publication. There are a number of grammatical errors, and the manuscript would benefit from being reviewed by a language editor. I would suggest examining published PLOS One papers for the appropriate format and ensuring that your article complies with the author guidelines. For example, the Methods section in the abstract should contain details of the setting and study participants. Lastly, the title should reflect the objective of the study and should include that results are from the patient perspective. We would appreciate receiving your revised manuscript by Jun 27 2020 11:59PM. When you are 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. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols 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). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Denise Evans, PhD Academic Editor PLOS ONE 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 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. Additional Editor Comments (if provided): [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: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 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: No 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: I have uploaded my detailed comments in the form of an attachment. The main revisions include: 1) Proof reading and fixing multiple typos, punctuation problems, and grammatical errors; 2) Elaborate on the what nutritional management mean; 3) Rewrite the introduction; 4)Rephrase the methodology to make it succinct and improve clarity particularly regarding the description of the study area, recruitment of participants and the criteria; and 5) Rewrite the findings in relation to your research question. Reviewer #2: In general, I find that the research aim and the results presented are important to help to improve the current situations related to nutritional interventions among HIV/AIDS patients. However, the paper has the following major gaps that should be critically addressed to be accepted: 1.Intense grammatical and typology errors, almost throughout the document. To mention few; Incomplete sentences: Line #46......in which other themes can be controlled with.....,auther(line #135)....reecordind(line#137). Unclear sentence: The total number of health centers in Addis Ababa is 119 and the average 101 allocation of Health centers in eight health centers per sub-city according to the population 102 coverage...(Line #100-102) 2. The introduction section lacks coherence and didn't clearly define the research problem. It has also grammatical errors. Thus, As the main aim of research is nutrition management in HIV/AIDS patients, better if the introduction begin by defining what nutrition management mean, which I didn't find the correct definition throughout the document. I would like the successive paragraphs to redefine, available evidences towards the challenges of nutrition management and the impact of nutrition non-management in patients. The final paragraph, should clearly indicate why this research is intended and what research gap it fills. 3. The study setting should be Clearly described....use the most recent population estimate (Line #99) 4. Use consistent citation style (Line #103) 5. Who are the research study participants (patients only, or, both patients and health care providers)? (Line # 110-112). It should be consistent and clearly defined 6. Participants inclusion criteria is not very clear. I am really surprised that why the research included only those speaks Amharic? (Line #115) How do you see this from the ethical point of view?. I also find that the exclusion criteria is incomplete. Do you include patients with other severe illnesses? 6. The data collection section should be better focused on and describe the data collection questionnaire, data collectors and the data collection fieldwork appropriately. As to me this section was not adequately described (Line #125). 7. Better if you describe data analysis section about what you did, rather than explaining the different steps of data analysis:-Transcription to original language, -Translation to English, -Forming codes and categories, -Forming themes etc...(Line #152) 8. Scientific rigor and quality assurance should present only what you did. (Line #169) 9. Do you secured oral or written consent? (Line 194) 10. Recommend result section to be presented in the headings below: Participant characteristics * Challenges to nutrition management *Theme 1: Theme 2: Theme 3: Theme 4: Theme 5: Theme 6 In addition, don't interpret findings in the result section and better if the individual responses cited with at least three characteristics: Sex, age, occupation. Interpreted findings: Line # 253-263, 352-356 11. Finally, discussion should be related to the findings presented. ******* 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: Yes: Fisaha Tesfay 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 to be viewed.] 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 us at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-19-35850_reviewer+F.pdf https://doi.org/10.1371/journal.pone.0250919.r001
Revision 1
18 Aug 2020 Author Response Responses to Reviewers and Editors We thank the editors and the reviewers. We have included our line by line response under each questions and marked the response blue colored. PONE-D-19-35850 Challenges to nutrition management among patients on antiretroviral therapy in primary health centers’ in Addis Ababa, Ethiopia; A phenomenology study PLOS ONE 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 We thank the editors and Reviewers for these important queries. We have corrected the file naming in which we followed style template. 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. We thank the reviewers. We have included study's minimal data set as the underlying data used 3. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. 1. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. This research was done on sensitive issues (ART clients) and it is not ethically permitted for us to deposit the data to the public. However, the transcripts we used and analyzed during the current study are in the main manuscript and all other necessary data sets are available from the corresponding authors on reasonable request. 2. We will update your Data Availability statement to reflect the information you provide in your cover letter. 3. Additional Editor Comments (if provided): [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: Yes Reviewer #2: Partly ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ________________________________________ 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: No 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: I have uploaded my detailed comments in the form of an attachment. The main revisions include: 1) Proof reading and fixing multiple typos, punctuation problems, and grammatical errors; The language has been edited by good language speaker and attached its evidence in track change copy. 2) Elaborate on the what nutritional management mean; We have added it in the operational definition 3) Rewrite the introduction; We have made corrections to make the introduction coherent 4) Rephrase the methodology to make it succinct and improve clarity particularly regarding the description of the study area, recruitment of participants and the criteria; and We have made corrections depending on your attached comments 5) Rewrite the findings in relation to your research question. We have taken out some interpretations according to the comment given Reviewer #2: In general, I find that the research aim and the results presented are important to help to improve the current situations related to nutritional interventions among HIV/AIDS patients. However, the paper has the following major gaps that should be critically addressed to be accepted: 1.Intense grammatical and typology errors, almost throughout the document. To mention few; *Incomplete sentences: Line #46......in which other themes can be controlled with.....,auther(line #135)....reecordind(line#137). Unclear sentence: The total number of health centers in Addis Ababa is 119 and the average 101 allocation of Health centers in eight health centers per sub-city according to the population 102 coverage...(Line #100-102) Thank you so much, We have made correction according to your comments 2. The introduction section lacks coherence and didn't clearly define the research problem. It has also grammatical errors. Thus, As the main aim of research is nutrition management in HIV/AIDS patients, better if the introduction begin by defining what nutrition management mean, which I didn't find the correct definition throughout the document. I would like the successive paragraphs to redefine, available evidences towards the challenges of nutrition management and the impact of nutrition non-management in patients. The final paragraph, should clearly indicate why this research is intended and what research gap it fills. We have added corrections, thanks 3. The study setting should be Clearly described....use the most recent population estimate (Line #99) We have corrected it using recent reference, thanks 4. Use consistent citation style (Line #103) We have cited a reference, thanks 5. Who are the research study participants (patients only, or, both patients and health care providers)? (Line # 110-112). It should be consistent and clearly defined Thank you, we have edited all your comments 6. Participants inclusion criteria is not very clear. I am really surprised that why the research included only those speaks Amharic? (Line #115) How do you see this from the ethical point of view?. I also find that the exclusion criteria is incomplete. Do you include patients with other severe illnesses? We thank you. We have corrected the exclusion and inclusion criteria as per the comment given. We have included all language speakers however the current study participants were Amaharic speakers 6. The data collection section should be better focused on and describe the data collection questionnaire, data collectors and the data collection fieldwork appropriately. As to me this section was not adequately described (Line #125). We have rephrased and rewrite steps in data collection 7. Better if you describe data analysis section about what you did, rather than explaining the different steps of data analysis:-Transcription to original language, -Translation to English, -Forming codes and categories, -Forming themes etc...(Line #152) Thank you, We made corrections depending on the comments given 8. Scientific rigor and quality assurance should present only what you did. (Line #169) We made corrections on the scientific rigor and quality assurance section 9. Do you secured oral or written consent? (Line 194) Thank you, We have secured oral and written consent 10. Recommend result section to be presented in the headings below: Participant characteristics Challenges to nutrition management Theme 1: Theme 2: Theme 3: Theme 4: Theme 5: *Theme 6 In addition, don't interpret findings in the result section and better if the individual responses cited with at least three characteristics: Sex, age, occupation. Interpreted findings: Line # 253-263, 352-356 We have corrected based on the comment given, thank you 11. Finally, discussion should be related to the findings presented. We have corrected unrelated explanations with the finding ________________________________________ 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: Yes: Fisaha Tesfay 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 to be viewed.] 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 us at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Response to Editors_7_25_2020.docx* https://doi.org/10.1371/journal.pone.0250919.r002
9 Dec 2020 Decision Letter - Denise Evans, Editor PONE-D-19-35850R1 Challenges to nutrition management among patients on antiretroviral therapy in primary health centers’ in Addis Ababa, Ethiopia; A phenomenology study PLOS ONE Dear Dr. Ali, 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 have your paper thoroughly checked for grammar, spelling, and typographical errors. Failure to do so will result in further delays in processing your manuscript. ============================== Please submit your revised manuscript by Jan 23 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, Denise Evans, PhD Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] 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 #2: All comments have been addressed Reviewer #3: (No Response) ******** 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 #2: (No Response) Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: (No Response) Reviewer #3: N/A ****** 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 #2: (No Response) 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 #2: (No Response) Reviewer #3: No ****** 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 #2: (No Response) Reviewer #3: 1.There is a need to be clear, correct and unambiguous (in the English used) and the manuscript presented here does not provide a concise research problem. 2. An overview of the semi-structured interview guide and a detailed selection criteria for the sample informed by literature and then snowballing in order to trace additional participants would have been useful in the methods section. A composite summary of themes could have been a useful addition in the results section. ****** 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 #2: Yes: Dawit Wolde Daka Reviewer #3: Yes:** Nozipho O. Musakwa [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.0250919.r003
Revision 2
20 Jan 2021 Author Response Manuscript title: Challenges to nutrition management among patients using antiretroviral therapy in primary health ‘centres’ in Addis Ababa, Ethiopia: A phenomenological study ID: PONE-D-19-35850R1 Date: 18 January 2021 Q. Language edition requested by the editor We thank the editor for this vital query. The language of our manuscript is now edited by a native English language speaker, professor Roger Watson, who is helping researchers in the author aid service platform. He has now extensively revised the English twice, and we have corrected it. The modified files (edited twice) are indicated in the manuscript with track changes 1 and 2. Attachments Attachment Submitted filename: Response for editor and reviewers.docx https://doi.org/10.1371/journal.pone.0250919.r004
3 Mar 2021 Decision Letter - Denise Evans, Editor PONE-D-19-35850R2 Challenges to nutrition management among patients on antiretroviral therapy in primary health centers’ in Addis Ababa, Ethiopia; A phenomenology study PLOS ONE Dear Dr. Ali, 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 consider the Reviewers advice to check the manuscript for language and grammatical errors to improve the quality of your manuscript. Please submit your revised manuscript by Apr 17 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, Denise Evans, PhD 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.] 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 #3: 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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: 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 #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 #3: No ****** 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 #3: The English needs to be tightened up more to ensure that it is clear, correct and unambiguous. Overall an important study to find out from patients what stops them from adhering to treatment from a nutritional point of view ****** 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 #3: Yes:** Nozipho O. Musakwa [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.0250919.r005
Revision 3
23 Mar 2021 Author Response Thank you very much! It was very helpful. It was a great opportunity. I would like to thank the editors and reviewers for their fruitful support. Attachments Attachment Submitted filename: Response for editors_ 15 March 2021.docx https://doi.org/10.1371/journal.pone.0250919.r006
19 Apr 2021 Decision Letter - Denise Evans, Editor Challenges to nutrition management among patients using antiretroviral therapy in primary health ‘centres’ in Addis Ababa, Ethiopia: A phenomenological study PONE-D-19-35850R3 Dear Dr. Ali, 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, Denise Evans, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0250919.r007
Formally Accepted
2 Jun 2021 Acceptance Letter - Denise Evans, Editor PONE-D-19-35850R3 Challenges to nutrition management among patients using antiretroviral therapy in primary health ‘centres’ in Addis Ababa, Ethiopia: A phenomenological study Dear Dr. Ali Ewune: 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 Dr. Denise Evans Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0250919.r008

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