PONE-D-21-27516Implants for HIV prevention in young women: Provider perceptions and lessons learnt from contraceptive implant provisionPLOS ONE

Dear Dr. Humphries,

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Rupa R. Patel, MD

Academic Editor

PLOS ONE

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3. Thank you for stating the following in the Acknowledgments Section of your manuscript: 

"The authorship team would like to thank all the study staff, the CAPRISA Vulindlela Community Research Support Group, the Vulindlela community, Provincial and District Departments of Health, and the healthcare workers willingness to contribute to and participate in the study. We thank the South African Medical Research Council Special initiative grant (00251), South African Department of Science and Innovation-National Research Foundation Centre of Excellence in HIV Prevention for their funding support. We would also like to acknowledge Brett Marshall and Revina Munsamy, two masters fellows who assisted the team with coding the data"

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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: 

"Funding: Funding for the study was provided by South African Medical Research Council Special initiative grant (00251), and partial support from the Department of Science and Innovation-National Research Foundation Centre of Excellence in HIV Prevention"

Please include your amended statements within your cover letter; we will change the online submission form on your behalf

Editor Comments:

This you for this manuscript on a much needed topic to enhance global PrEP rollout.

Please find my comments below:

Overall formatting

-I agree with the comments provided by the reviewers on grammar, capitalization of headings, and consistency regarding the verb tense throughout the manuscript.

Introduction

Methods

-Under procedure: Please clearly state the study inclusion criteria for example, age, place of work, language, able to consent, gender, education level, experience with contraception discussions, experience # of years of work, type of professional, experience with implanting devices, experience with a certain # of contraceptives, etc.

-Under procedure: Please state if participants offered compensation for transportation if they were.

-Under procedure: Please provide more information on translation and back translation; was the guide created in English, translated into isiZulu and then back translated for accuracy?

-Under procedure: Please better describe the recruitment process and if there were study marketing materials used to recruit potential participants.

-Under procedure: Was there purposeful sampling to recruit those with experience with placing contraceptive devices and those who had no experience?

-Was there a survey that was administered, in addition to the qualitative guide, to capture demographics, years of experience, and other information presented in Table 1 and that you gathered but did not present in this paper? If so, please include it in the appendix as well as describe the survey’s domains or info in the text in the methods section.

Results

Table

-Please create a more tradition Table 1 that includes N=18. Please use the headings in a column to the left and write them as rows. Then supply columns for CHW and PHCs and Both CHW/PHCs. You can place the Ns in the heading rows.

-In the table, please include a row for age (range and median or mean) and a row for years of experience in the public health settings (range and median or mean).

Quotes

-For the labels for the quotes, please stay consistent with PHC Nurse or CHW. Nurse is labeled as Nurse.

-Please label all the quotes. The last quote in the long-acting nature section has no participant label.

-If possible, please add more CHW quotes in the long acting section, if applicable.

Supplemental materials

-Please provide the interview guide in English and in isiZulu.

-Please provide the survey administered to capture demographics etc both in English and in isiZulu. This would be different than the qualitative questions.

-Please provide a visual of any frameworks/theories that the qualitative guide and this study was based on, if any.

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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: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: No

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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: No

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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 made minimal revisions related to grammar and format. I recommend special attention to capitalization of the headings and subheadings, use of full name before use of acronyms, and tense (learnt vs. learned, for example). I highlighted in blue an area that I suggest could be more fully examined and discussed. For example the theme termed as social context also points to intimate partner violence (IPV). Beyond social determinant, IPV is related to structural level determinants of health (i.e. policy and laws) that ultimately impact the individual in their utilization of a desired implant method. My other major recommendation is related to the possible limitations of the findings = as the sample may be biased due to their *own* (personal) experiences of implants as a contraceptive method for pregnancy prevention, given that the respondents are all women and may most likely be within their reproductive years or recently past this period in their own lives. Finally, I recommend a statement early on in the manuscript that within the context of this study, the authors/researchers are identifying gender - "women" - defined as cisgender women (i.e. individual assigned female sex at birth that identifies their gender as woman).

Reviewer #2: Thank you for this important study. Your manuscript highlights the importance of including stakeholders and end-user service providers in the design and delivery stages of HIV Prevention technologies, particularly areas with a high HIV burden.

MINOR Recommendations: Please copyedit the manuscript. Particularly cross-check sentence cases, headers, and tables to ensure they are consistent with the required formatting guidelines.

MAJOR Recommendations: More clarity regarding the primary perspective/experience being explored.

The introduction states the importance of exploring both provider and end-user engagement however the study sample does not include end-users.

The manuscript aims to explore the service provider perspectives of delivery of PrEP implants; however, there are findings and exemplar quotations that support the perspectives of health care workers as potential users of PrEP implants for themselves as women.

For example the quotation: "I see a lot of benefits, mainly time-saving, as I don’t need to [come] to the clinic all the

time. It saves both time and money. Also, if I feel pain I would feel it once and the next

time I feel pain will be after three years when the implant is removed unlike feeling pain

every 3 months. (IDI3 – Nurse)"

It seems to reflect the Nurse's perspective of using the PrEP implant as opposed to the Nurse's perspective of providing the care, service, or anticipated attitudes from potential users.

In the conclusion you state, "Our findings highlight that the characteristics of PrEP implants that are perceived to be

beneficial by HCWs may not align with that of potential users."

I am unable to find within the manuscript any interview data/findings from potential users as a comparison to firmly support this statement.

I hope you all find these recommendations helpful. Thank you for your excellent contributions to the field.

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Reviewer #1: Yes: Gabriela Santana Betancourt

Reviewer #2: No

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Attachments

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Submitted filename: PONE-D-21-27516-GSBreview-comments.pdf

Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision

PONE-D-21-27516R1

Dear Dr. Humphries,

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.

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Kind regards,

Rupa R. Patel, MD

Academic Editor

PLOS ONE