PONE-D-22-12468Adherence to the HIV early infant diagnosis testing protocol among HIV exposed infants in a hard-to-reach fishing community in UgandaPLOS ONE

Dear Dr. Ssekamatte,

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The reviewers have raised a number of major concerns, specifically that the language used may not be fully appropriate for a study including minors. Could you please carefully revise the manuscript to address all comments raised?

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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: Yes

Reviewer #2: 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

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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

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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: Title: Adherence to the HIV early infant diagnosis testing protocol among HIV exposed infants in a hard-to-reach fishing community in Uganda

Overview and general comments: A well written and important article describing adherence HIV testing protocols for early infant diagnosis in high burden fishing communities in Uganda. Authors used a cross sectional study design and secondary data to determine factors associated with non-adherence to EID testing protocols. In general, the paper is well written with some areas for clarification. The language used throughout the paper seems to assume as if children were adult participants. The word adherence to EID seems inappropriate.

Specific comments: Below are a few specific comments.

Abstract: Very well written but includes a couple of sentences that should be edited for clarity.

Line 44. None of the HIV-exposed infants had “done” all the EID tests... Should be rewritten to read as “None of the HIV-exposed infants had “received” all the EID tests…

Line 51. None of the HIV-exposed infants “adhered” to all the EID tests of HIV testing protocol. Should be rewritten to read…None of the HIV-exposed infants “received” all the EID tests of HIV testing protocol.

Live 51-53. The sentence “Adherence to the 1st DNA PCR was positively associated with being a single mother and exclusive breast” should be rewritten to read as “Receiving the 1st DNA PCR was positively associated with being an infant born to a single mother and exclusively breast fed”

Introduction: Well written and gives the context under which the study was conducted. Author should consider moving part of the last paragraph to the methods section.

Methods: Describes the setting clearly but apart from fishing, no other risk or contextual factors such as sex work, transactional work, challenges accessing health care including the limited number of facilities and expense of travelling to them. Lack of electricity. Describing these will help readers understand the results.

Sample size. Not sure of the formular is needed. The word “deviate” should be written as “deviation”.

The word adherence in methods should probably be changed especially as the paper describes infants.

Data management: under data management, some items are described as very generically. Categorical and continuous variables could be named.

Results: The data is clearly presented and linked. First title “Flow chart for mother-infant file…” is incomplete and probably not required.

Some of the description of results should be framed correctly since the study subjects were infants. For example, the line that reads, “Overall, none of the study participants had done all the recommended tests within the recommended time frame”. Could be written as none of the infants had received all recommended tests

Tables are very clear but are incompletely labeled. Each table should be labeled in such a way that it can be understood, should include the study area e.g. Buvuma and time period e.g. YYYY-YYYY

For example, table 5 is not well described. “ Table 5: Distribution of adherence to EID of HIV testing protocol at scheduled time points. Authors should rename all tables for clarity.

The subtitle after table 5, has grammatical errors and should be rewritten.

Discussion:

The last sentence of the first paragraph is not easy to understand.

Conclusion: well written.

Reviewer #2: The manuscript is written well, the methodology is clear, and the analysis was made properly and support the manuscript conclusion.

I would suggest few comments:

In section materials and methods: Providing a map illustrating the localities of the study would be more informative

In results: Numbers under subtitle "Average time taken to undergo EID tests and turnaround time" should be followed by weeks

In conclusions: Replace " marital status" by " non married females"

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Reviewer #1: No

Reviewer #2: Yes: Mohammed A. AboElkhair

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Attachments

Attachment

Submitted filename: Reviewer comments_Bateganya.docx

Attachment

Submitted filename: PONE-D-22-12468.pdf

Early infant diagnosis testing for HIV in a hard-to-reach fishing community in Uganda

PONE-D-22-12468R1

Dear Tonny Ssekamatte,

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,

Hamufare Dumisani Dumisani Mugauri, Ph.D. Public Health

Academic Editor

PLOS ONE

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 #2: 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 #2: Yes

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

Reviewer #1: Yes

Reviewer #2: (No Response)

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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 #2: Yes

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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 #2: 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: An excellent manuscript of great importance. The revised manuscript reads very well. All previous comments have been satisfactorily addressed

Reviewer #2: (No Response)

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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: Yes: Moses Bateganya

Reviewer #2: No

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