Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge

Ibrahim Jahun; Ishaq Said; Ibrahim El-Imam; Akipu Ehoche; Ibrahim Dalhatu; Aminu Yakubu; Stacie Greby; Megan Bronson; Kristin Brown; Moyosola Bamidele; Andrew T. Boyd; Pamela Bachanas; Emilio Dirlikov; Chinedu Agbakwuru; Andrew Abutu; Michelle Williams-Sherlock; Denis Onotu; Solomon Odafe; Daniel B. Williams; Orji Bassey; Obinna Ogbanufe; Chibuzor Onyenuobi; Ayo Adeola; Chidozie Meribe; Timothy Efuntoye; Omodele J. Fagbamigbe; Ayodele Fagbemi; Uzoma Ene; Tingir Nguhemen; Ifunanya Mgbakor; Matthias Alagi; Olugbenga Asaolu; Ademola Oladipo; Joy Amafah; Charles Nzelu; Patrick Dakum; Charles Mensah; Ahmad Aliyu; Prosper Okonkwo; Bolanle Oyeledun; John Oko; Akudo Ikpeazu; Aliyu Gambo; Manhattan Charurat; Tedd Ellerbrock; Sani Aliyu; Mahesh Swaminathan

doi:10.1371/journal.pone.0257476

Peer Review History

Original SubmissionMay 11, 2021
6 Aug 2021 Decision Letter - Kwasi Torpey, Editor PONE-D-21-15583 Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge. PLOS ONE Dear Dr. Ibrahim Jahun, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 15th September 2021. 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. 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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. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. Thank you for stating the following in the Acknowledgments Section of your manuscript: “This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of CDC Cooperative Agreement No. CDC-RFAGH17-1753.“ We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of CDC Cooperative Agreement No. CDC-RFAGH00-2018-01 and No. CDC-RFAGH17-1753. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. We note that you have referenced : Dirlikov E, Jahun I, Odafe S. F, et al. (2021). Rapid Scale-up of an Antiretroviral Therapy Program Before and During the COVID-19 Pandemic — Nine States, Nigeria, March 31, 2019–September 30, 2020 (MMWR – unpublished) and Jahun I, Dirlikov E, Odafe S. F et al. (2021). Ensuring Efficient Targeted Community Testing Services in Low HIV Prevalence Settings in Nigeria, October 2019–March 2020: Acceleration to HIV Epidemic Control (unpublished paper). which has currently not yet been accepted for publication. Please remove this from your References and amend this to state in the body of your manuscript: (ie “Bewick et al. [Unpublished]”) as detailed online in our guide for authors http://journals.plos.org/plosone/s/submission-guidelines#loc-reference-style. Please review your reference list to ensure that it is complete and correct. 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The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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: 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: 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 article is an important contribution to improving the continuum of care from HIV testing to treatment. This article reports on two programs and sources of data: NIIS and Surge ART, and their respective efforts to increase community-based HIV testing, linkage to care, and ART initiation. General comments: 1) the article provided a lot of information to digest for readers unfamiliar to these programs, and the article can benefit from some structuring to introduce and link these programs; 2) the article can be written more concisely and with some copy/editing. Where possible, reduce on the use of acronyms as it makes it very difficult to read. Detailed comments: - Line 52: Correct years (2024) - Line 78-79: Articulate how documentation and monitoring factors affected LTC exactly - Line 106: Clarify difference between linkage coordinator and the counsellor-interviewer? And what is the role of the FRFP if the CBO is doing this? - Line 271: Noted change from passive to active LTC - in NIIS you gave people a choice, in Surge ART you weren't require to give people a choice because it was not a study setting? - Line 271: How did mobile community testing and linkage team's role complement CBO's efforts? Tease out more specifically? (If you were to do this in another setting, would you still have CBO? Did these 2 groups play unique roles?) - CTI strategy - starter pack ART is for how long? How is client linked to his/her static clinic? Or do you notice attrition? - Can you discuss the policy environment that allows for CTI? Anything unique about composition of mobile team/ CBOs that allows for roll out of CTI? Thank you. Reviewer #2: 1. The background information as shown in the abstract (Lines 29-33) suggest that the focus of the work is on ART Surge. However, the paper seems more focused on NAIS and not ART Surge. In addition, the authors are using the results of the 2018 NAIS and a basis to provide an overview of the NAIIS LTC strategy and describe the impact in both the NAIIS (2018) and the Surge. I think the background need some finetuning to give some clarity. 2. In addition to the 3-month Retention rate, it would have been good if the authors could also determine 6-month Retention rate for the cohorts that are eligible (those that initiated treatment/ART from Oct-19 to Jan-20) this will help determine if the PLHIV are being retained in care for a longer time. 3. The reason stated in lines 252-254: “On the other hand, the lower linkage rates seen among those who did not know their status may have been either because they were known HIV-positive participants on ART but refused to disclose their HIV-positive status during the survey, asymptomatic, or not ready to accept their HIV-positive status” seems to be inconsistent with the statement in lines 55-58 to the effect that the presence of ARVs in blood of all identified PLHIV during NAIIS was undertaken). If NAIS checked for the presence of ARV in the blood of all identified PLHIV, then it will be possible to identify those who were already positive and refused to disclose their HIV-positive status during the survey through the unique ID. 4. Typographical errors Line 52 (2024-2019) should be corrected Reference in line 241 (154) should be corrected. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
29 Aug 2021 Author Response Response to Academic Editor’s comments/queries: Query 1: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: Thank you for your observations. The authors have downloaded PLOS ONE style template and format and ensured that the revised paper is well aligned with the requirements. Query 2: We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Response: Thank you for your observations and apologies for the mismatch which was due to typographic error. This is now corrected, and the correct grant information is: “This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention (CDC) under the terms of CDC Cooperative Agreement No. CDC-RFAGH00-2018-01 and No. CDC-RFAGH17-1753” Query 3: Thank you for stating the following in the Acknowledgments Section of your manuscript: “This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention (CDC) under the terms of CDC Cooperative Agreement No. CDC-RFAGH17-1753. “ We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention (CDC) under the terms of CDC Cooperative Agreement No. CDC-RFAGH00-2018-01 and No. CDC-RFAGH17-1753. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.” Response: Thank you for your observations. • Funding information is removed from the manuscript. • The correct funding statement should be: “This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention (CDC) under the terms of CDC Cooperative Agreement No. CDC-RFAGH00-2018-01 and No. CDC-RFAGH17-1753. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.” Query 4: We note that you have referenced: Dirlikov E, Jahun I, Odafe S. F, et al. (2021). Rapid Scale-up of an Antiretroviral Therapy Program Before and During the COVID-19 Pandemic — Nine States, Nigeria, March 31, 2019–September 30, 2020 (MMWR – unpublished) and Jahun I, Dirlikov E, Odafe S. F et al. (2021). Ensuring Efficient Targeted Community Testing Services in Low HIV Prevalence Settings in Nigeria, October 2019–March 2020: Acceleration to HIV Epidemic Control (unpublished paper), which has currently not yet been accepted for publication. Please remove this from your References and amend this to state in the body of your manuscript: (ie “Bewick et al. [Unpublished]”) as detailed online in our guide for authors. Response: Thank you for the guidance. Kindly note: • Dirlikov E, Jahun I, Odafe S. F, et al. (2021). Rapid Scale-up of an Antiretroviral Therapy Program Before and During the COVID-19 Pandemic — Nine States, Nigeria, March 31, 2019–September 30, 2020 is now published and reference is updated accordingly. https://www.cdc.gov/mmwr/volumes/70/wr/mm7012a3.htm • Jahun I, Dirlikov E, Odafe S. F et al. (2021). Ensuring Efficient Targeted Community Testing Services in Low HIV Prevalence Settings in Nigeria, October 2019–March 2020: Acceleration to HIV Epidemic Control. This paper is also now published and reference is updated accordingly. https://www.dovepress.com/articles.php?article_id=68206. Response to Reviewer 1 comments/queries: General comments: 1. the article provided a lot of information to digest for readers unfamiliar to these programs, and the article can benefit from some structuring to introduce and link these programs. Response: Thank you for your observations and recommendations. The article is edited and restricted and the two programs are now well integrated. The flow has now improved substantially. 2. the article can be written more concisely and with some copy/editing. Where possible, reduce on the use of acronyms as it makes it very difficult to read. Response: Thank you for your observations and recommendations. The authors have reworked the article in response to your recommendations. Detailed comments: • Line 52: Correct years (2024) Response: Thank you for the observation. years corrected (2004 – 2019), see line 57. • Line 78-79: Articulate how documentation and monitoring factors affected LTC exactly Response: Thank you for the observation. Here is the updated versions: “Documentation and monitoring challenges include use of paper-based records with potential for include compromised confidentiality, transcription errors, and duplication of records resulting in inability to determine if PLHIV have successfully linked or linkage success and to track patients in real-time.”. See line 84 – 87 • Line 106: Clarify difference between linkage coordinator and the counsellor-interviewer? And what is the role of the FRFP if the CBO is doing this? Response: Thank you for the comment. Kindly see edits from line 104 – 108. “In each state, a survey Linkage Coordinator (LC) was assigned to lead and coordinate linkage to care (LTC) activities using a directory of HIV care and treatment facilities. The LC liaised with the CBOs and the person designated as the referral focal staff in each facility to ensure they performed their assigned responsibilities in compliance with NAIIS LTC standard operating procedure. The LC managed all LTC processes using an LC dashboard in real-time. The facility referral focal person managed and completed referral at facility level by enrolling client, guiding client through facility flow for adherence counselling, treatment initiation and other related services. The facility referral focal person also ensured all LTC and treatment initiation processes are well documented in real-time”. See line 138 – 148 • Line 271: Noted change from passive to active LTC - in NIIS you gave people a choice, in Surge ART you weren't require to give people a choice because it was not a study setting? Response: Thank you for your question. Kindly see edits from line 224 – 227. “In the Surge, participants were not offered the option of passive referral because the Surge was not a study – it was an intervention aimed at fast tracking Nigeria’s progress towards achieving the 1st 90 and lessons from the NAIIS LTC had shown ALTC to be superior to PLTC”. • Line 271: How did mobile community testing and linkage team's role complement CBO's efforts? Tease out more specifically? (If you were to do this in another setting, would you still have CBO? Did these 2 groups play unique roles?) Response: Thanks for your question. Kindly see edits in line 172. Please see line 350 – 352. “This was because unlike NAIIS, which is limited to selected enumeration areas, the Surge covers larger geographical locations, which available CBOs were not able cover alone” • CTI strategy - starter pack ART is for how long? How is client linked to his/her static clinic? Or do you notice attrition? • Can you discuss the policy environment that allows for CTI? Anything unique about composition of mobile team/ CBOs that allows for roll out of CTI? Response (for both CTI strategy and CTI policy): Thank you for your questions. Kindly see edits from line 231 -237. “CTI involved the provision of 3-month ARV starter pack (first ART dispense) right in the community to newly identified PLHIV who presented with no symptoms and reported being stable, in line with the National Task Shifting and Task Sharing Policy. Upon utilization of the starter pack, the client has the option of getting refill in the community or to visit the facility of his/her choice from the directory of treatment facilities if there is a medical concern. The CBOs and the mobile community teams were responsible for their assigned clients throughout the continuum of care, including ensuring the clients were retained.” Response to Reviewer 2 comments/queries: • The background information as shown in the abstract (Lines 29-33) suggest that the focus of the work is on ART Surge. However, the paper seems more focused on NAIS and not ART Surge. In addition, the authors are using the results of the 2018 NAIS and a basis to provide an overview of the NAIIS LTC strategy and describe the impact in both the NAIIS (2018) and the Surge. I think the background need some finetuning to give some clarity. Response: Thank you for the very important feedback. This is well noted and addressed in the abstract and the background is substantially edited to address your observations. • In addition to the 3-month Retention rate, it would have been good if the authors could also determine 6-month Retention rate for the cohorts that are eligible (those that initiated treatment/ART from Oct-19 to Jan-20) this will help determine if the PLHIV are being retained in care for a longer time. Response: Thank you for your recommendation. This aspect is being addressed in another paper which investigated retention in Surge. The paper has been approved by CDC science office and is submitted to a journal. The paper will refence this paper once accepted. • The reason stated in lines 252-254: “On the other hand, the lower linkage rates seen among those who did not know their status may have been either because they were known HIV-positive participants on ART but refused to disclose their HIV-positive status during the survey, asymptomatic, or not ready to accept their HIV-positive status” seems to be inconsistent with the statement in lines 55-58 to the effect that the presence of ARVs in blood of all identified PLHIV during NAIIS was undertaken). If NAIS checked for the presence of ARV in the blood of all identified PLHIV, then it will be possible to identify those who were already positive and refused to disclose their HIV-positive status during the survey through the unique ID. Response: Thank you for your comments. Yes, NAIIS checked for blood ARVs but unfortunately the results of the blood ARVs were received after the survey (about 6 months later). On the other hand, LTC and treatment initiation were done in the field almost in real-time during the survey, hence we relied on self-reported ARV use. Nevertheless, there is another paper which provided answer to your question and the paper is submitted to PLOS ONE and is undergoing review. The paper provided in-depth review of implication of self-reported HIV status and ARV use. • Typographical errors - Line 52 (2024-2019) should be corrected. Thank you for your observation. This has been corrected to (2004 – 2019) - Reference in line 241 (154) should be corrected. Thank you for your observation. This has been corrected in line 307 (now 12 and not 154) - Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0257476.r002
2 Sep 2021 Decision Letter - Kwasi Torpey, Editor Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge. PONE-D-21-15583R1 Dear Dr. Jahun, 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, Professor Kwasi Torpey, MD PhD MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0257476.r003
Formally Accepted
8 Sep 2021 Acceptance Letter - Kwasi Torpey, Editor PONE-D-21-15583R1 Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge. Dear Dr. Jahun: 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 Kwasi Torpey Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0257476.r004

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