PONE-D-22-13140Qualitative hepatitis C virus RNA assay identifies active infection with sufficient viral load for treatment among Phetchabun residents in ThailandPLOS ONE

Dear Dr. Poovorawan,

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.

Your manuscript was reviewed by one expert in the field. Unfortunately, other potential reviewers could not accept the invitation. The reviewer identified essential problems which require your attention. I would like to add that your work is important and may benefit from a more extensive discussion of cost-effectiveness of your strategy. Also, it would be of interest to readers to know your opinion on how the suggested testing strategy is applicable to low prevalence populations. Please consider discussing briefly whether separation of local anti-HCV and central HCV RNA testing may result in losses to care in low and high prevalence settings? It seems that your strategy of using qualitative HCV RNA assays may reduce such losses among high prevalence populations.  Will it work in general population with low level of HCV infections?

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Comments to the Author

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Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: Thank you for asking me to review this study that confirms that almost three-quarters of patients testing RDT positive for hep C in a province in Thailand are viraemic. The study supports the use of a qualitative test and confirms the vast majority,~98% have HCV VLs >5000IU/ml. I have just a few comments/questions of clarity:

1. Could the authors explain the basis of Thai Government policy to only offer treatment to patients with HCV VLs >5000IU/ml?

2. Why did the authors consider using a qualitative test? Was this to confirm its predictive value? Is there a cost saving on the qualitative test? The qualitative test helps in confirming that most had VLs >5000IU/ml - there is no clarity on why the qualitative test was performed?

3. Were any patients identified in the study linked to care? If not, will this still occur?

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Reviewer #1: No

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Qualitative hepatitis C virus RNA assay identifies active infection with sufficient viral load for treatment among Phetchabun residents in Thailand

PONE-D-22-13140R1

Dear Dr. Poovorawan,

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,

Yury E Khudyakov, PhD

Academic Editor

PLOS ONE

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