PONE-D-21-02247

Mother-to-child transmission of HIV infection and its associated factors on the rural coast of southern Mozambique

PLOS ONE

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PLOS ONE

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Additional Editor Comments:

dear authors follow reviewers 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: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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: Yes

Reviewer #2: Yes

Reviewer #3: 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: Yes

Reviewer #2: Yes

Reviewer #3: 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: I read with great interest the paper. I find it well wrote and with good idea research.

In fact Mozambique has high burden of HIV and burden control is very topic in this country

Only some suggestions

1. Introduction: Add data on global burden of HIV and newly diagnosis wordwide and in low setting. Child with HIV are "child at risl" to poor health adn social outcome (see and cite The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique. Int J Environ Res Public Health. 2018 Jun 27;15(7):1350. doi: 10.3390/ijerph15071350). Furthermore, mozabique has also a catastrofic events as Ciclone Idai and Eloise. I think that this is crucial to mantein HIV services expecailly for mother and child during this frequent natural disaster (see and cite HIV continuity of care after Cyclone Idai in Mozambique. Lancet HIV. 2020 Mar;7(3):e159-e160.)

2. Method: are clear

3. ethics Committee: it is ok

3. Result: appear correct statistical analisys

4. Discussion: discuss better two action to improve the services : 1. Improve capacity building (see and cite Capacity assessment for provision of quality sexual reproductive health and HIV-integrated services in Karamoja, Uganda) crucial in Africa and the role of task shiting to improve the service may play a role in the improvement of the global effectiveness of care for HIV infected children if integrated into a wider range of public health measures. (cite Pathways of care for HIV infected children in Beira, Mozambique: pre-post intervention study to assess impact of task shifting. BMC Public Health. 2018 Jun 7;18(1):703. )

5. Conclusion: are coherent with the paper.

Reviewer #2: The title should be as follows: vertical transmission of HIV in the district of Belene, Province of Gaza-Mozambique.

Because the mother's transmission for children can be done using the same sharp objects that is common to the rural population and without education.

it is not clear how the sample was obtained.

I think the 90 sample is not representative for all of Mozambique.

Reviewer #3: Manuscript Number: PONE-D-21-02247

Title: Mother-to-child transmission of HIV infection and its associated factors on the rural

coast of southern Mozambique.

Reviewer’s comments:

Congratulations to the authors for the study. This manuscript reports an interesting analysis with the great impact to the public health, conducted in the rural coast of southern Mozambique, an area with a high prevalence of HIV infection.

My minor comments/suggestions are listed below to improve the manuscript:

1. Abstract

Methods Section:

The study methodology described in the summary does not allow readers to understand how the study was conducted, you just say the type of study it is. Please, the authors should briefly describe how the study was carried out, for example: Who are "the Cases", how were they enrolled, what age were they. Also who were controls and how the contorols were also enrolled to the study, there was some matching between case and controls? Each enrolled “Case” how many “Controls” were considered.

2. The main body of manuscript

a) Results Section:

• The description of the results appears to be confusing. It is not clear how many women were recruited for study. It is understood that the study included 90 pregnant women, 30 women who transmitted HIV infection to their children and 60 women who did not transmitted HIV. Is that what you mean here? Please this is strongly recommended to rewrite the results section to make it clearer. It could be better if the author presents the percentage of women who transmitted HIV to their children and the percentage of women who did not transmitted HIV.

• The authors say that in the adjusted analysis for maternal age and gestational age at the first ante natal consultation shown to be as risk factors of transmission but do not say what was the gestational age of the first antenatal consultation that was associated with HIV transmission from the mother to the child. This is important to guide the staff who dealing with this issue to take into account when they are giving lectures to prevent mother-to-child transmission of HIV infection as you present regarding to the pregnant woman's viral load. It is very clear that viral load of 1000 copies or more is a risk factor for transmission. Authors should present to readers what was the gestational age at the first antenatal consultation that was associated with HIV transmission from mother to child.

• In evaluating factors related to the transmission of HIV from mother to child in the Table 1, it would be good to calculate the Odds ratio of each variable analyzed to see the trends of the associations.

• In the table 2 Please calculate the P-value

b) Discussion section

The discussion seems weak. In this section you have to bring what your results and the results found by other scientists and do not refer readers to the bibliographic references. For example, in the first paragraph of your discussion you say that the factors for mother-to-child transmission of HIV are described in a fair job in Rwanda, but what does the publication of Rwanda's work say? Please rewrite and discussion.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Sozinho Acacio

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Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province - Mozambique

PONE-D-21-02247R1

Dear Dr. Isabelle,

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,

Claudia Marotta

Academic Editor

PLOS ONE

Additional Editor Comments:

dear authors 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 #3: 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 #3: Yes

**********

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

Reviewer #1: Yes

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 #1: Yes

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 #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors wrote an important paper from interesting setting. Research from low setting are precious and key to global health action

Reviewer #3: Congratulations to the authors for the study. This manuscript reports an interesting analysis with a major impact on public health, carried out on the rural coast of southern Mozambique, an area with a high prevalence of HIV infection. That is why I think it will be of interest to readers of this journal, especially those who work in areas of high HIV prevalence, a fact that will contribute to reducing the transmission of HIV from mother to child. It as original research and well statiscally conducted.

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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: No

Reviewer #3: No