PONE-D-22-14713Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020PLOS ONE

Dear Dr. Bejiga,

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 3 experts in the field. They identified many important problems in your submission and provided helpful comments. Please review these comments and provide point-by-point responses.==============================

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Academic Editor

PLOS ONE

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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

Reviewer #3: Yes

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

Reviewer #1: No

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: No

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: The title of the "Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020" topic is interesting.

The sample size is big enough to provide reliable results.

However, authors must clarify the highlighted comments in the attached document.

The literature review is poor in the introduction section.

There is inconsistency in the method section.

The information of Ethiopia background should be summarized and focus on settings where the study have been conducted.

How towns and cities were selected?

There are no FSW in rural settings?

It is not national representative study because some areas were excluded

- Authors should specify the name of tests used in the study.

- Test algorithm

- Sample storage and transportation.

- Clinical management once the test is positive

- Syphilis and HIV results are not part of the study.

In the abstract section authors mentioned that <=0.05 p-value was considered. 0.2 p-value is too high, it can be considered in some few key variables

Median=25 and IQR=8?

Check please

1. Consistency in data analysis:

- Age group categories with p-values <0.05 not appearing in multivariable model. The same for number of sexual partners

2. Multivariable model without bivariate model. What happened? Age of first sex

3. Age at first sex selling not completed

The discussion section is not structured.

The author is reporting the results

The reader will be bored with this so long and light discussion

Reviewer #2: The manuscript by Bedassa et al. is well written and provides important information on the prevalence of HBV and HCV infection in Ethiopian FSWs. Although the main objective of the study was HBV and HCV, the authors provide important information about the prevalence of HIV and syphilis in this population. In my opinion, the manuscript should be published after minor modifications.

1. Authors need to add study exclusion criteria. Only the inclusion criteria were placed.

2. Which kit manufacturers are used?

3. It would be interesting to include the index of FSWs who did not accept to participate in the study.

4. An important detail is the higher prevalence of HBV and anti-HCV in FSWs who reported using codons in their sexual intercourse. What could justify this finding?

5. The prevalence of HBV and anti-HCV in the study was much lower than that observed in the general population of Ethiopia. The authors suggest that this can be influenced by different methodologies. Wouldn't it be interesting to carry out an enzyme immunoassay to confirm the results (if there were financial resources for this)? Could they have too many false negatives? This is a very interesting result of the study. Another important point would be to verify the vaccination coverage for hepatitis B in this population.

Reviewer #3: The authors did a great job giving relevance to aspects of the epidemiology of infectious agents in vulnerable populations and a very rich statistical analysis with a huge sample.

Nonetheless, some excerpts can be improved to provide a better reading and understanding of the article.

1. The authors should clarify the following sections to avoid confusion - lines 254 trhough 259 - the excerpt should focus on co-infection with HIV-positive cases despite HIV-negative cases.

2. Tables 1 to 4 should include a column to add the 95% CI

3. Table 1 presents duplicate entries

4. There are some misspelled words - line 65 "HVC"; line 115-116 duplicated "in 2016"; line 122 - "crass"; line 184 "a liquated"; line 239 "chat"; line 354 "STS".

5. In the results section, under the topic Factors associated with hepatitis B and C, please provide a clearer explanation of what the COR parameter is about. Is it the same AOR presented in the data analysis topic and was it just typed wrong? if so, change the acronym COR to AOR whenever it's mistaken, if not, provide an adequate explanation of how this statistical result was obtained and its purpose.

6. At the beginning of the discussion section, lines 355 and 356, it would be better to present the reference right after the mention of the previous study cited in this paragraph.

7. Review the score on line 321, there should be a point after endemicity.

8. The authors should revise the language to improve readability in lines 340 to 344 to make it more understandable. Do the same for the lines 357 and 358; 371 to 374; 385 to 389; 395 to 397,on line 436 where it starts with ... , a group.

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Reviewer #1: Yes: Mutagoma Mwumvaneza

Reviewer #2: Yes: Luiz Fernando Almeida Machado

Reviewer #3: Yes: Rogério Valois Laurentino

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Attachments

Attachment

Submitted filename: PLOS_ONE-D-22-14713_reviewer (reviewed).pdf

PONE-D-22-14713R1Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020.PLOS ONE

Dear Dr. Bejiga,

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 revised manuscript was reviewed by 2 experts in the field. Both identified some remaining problems in the manuscript which require your careful attention. Please consider the attached comments and provide point-by-point responses.

==============================

Please submit your revised manuscript by Dec 15 2022 11:59PM. 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Yury E Khudyakov, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #2: (No Response)

Reviewer #3: (No Response)

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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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: 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 #2: 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 #2: 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 #2: I would like to thank you for the opportunity to review the manuscript by Bedassa et al. and congratulate the authors for the information regarding the epidemiology of HBV and HCV in Ethiopian FSWs. The manuscript is well written but, in my opinion, needs some adjustments to be published.

Here are my observations:

- Line 66: put HIV in full before the acronym

- In the introduction put the prevalence of HCV in FSWs in Ethiopia

- Line 295: state that 184 were infected with HBV or had HCV Ab, because from the way it is written, you can understand that it was HBV-HCV co-infection.

- My main suggestion for authors to add the prevalence of HBV and HCV Ab in each city (could be in a table) to demonstrate the location(s) of highest prevalence, which could help in decision making regarding the fight against infection by the health authorities.

Reviewer #3: There are several typing corrections that should be looked at more carefully considering maintaining a standard in writing the article, this attention must be given to the spacing of the text for the references that are in parentheses, for example, all citations should follow the same pattern presented in line 63, being clearer and more specific, several times the space was not given in typing between the text and parenthesis of the reference, this needs to be corrected in lines 65, 70, 72, 74, 88, 89, 90, 93, 95, 98, 103, 105, 222, 339, 341, 342, 343, 344, 346, 382, 385, 387, 394, 399, 402, 413. In all these lines, the typing should be like this: are endemic in developing countries (1) [note the space before the quote] instead of like this: .. ..mostly from hepatitis-related cirrhosis and liver cancer(2) [without the space before the citation].

In line 103, a space must be inserted after the period in the excerpt: ...(12).FSW have been identified as a population group with the highest risk for STI...

In lines 106/107 it should be written: to determine instead of to determined in the excerpt: there is no national data among FSW to determined HBV and HCV prevalence and driving factors

In line 114 the word "in" after the period must be capitalized in the passage: ... 120 million and had low per capita income (22). in 2016, when the...

In line 188 it should be written "aliquoted" instead of "a liquidated" in the passage: the plasma was separated and a liquidated in two...

In line 192, a space must be inserted before the abbreviation EPHI in the passage: teams from Ethiopian Public Health institute(EPHI).

In table 1, the font used in the 95% confidence interval column is clearly one size larger than the rest of the table, standardizing for the same font and font size

In line 363 the dot must be after the second parenthesis in the passage: countries.(18, 36-41)

In line 373 it should be "scarce" instead of "scare"

In line 388 it should be "might be related to" instead of "might related to"

In line 400 it should be "through" instead of "though"

Line 401 should not have the dot in the section: ...injection equipment (56).or rather commonly...

In line 443 it should be: "These factors need to be taken" instead of "These need factors to be taken into"

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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 #2: No

Reviewer #3: Yes: Rogério Valois Laurentino

**********

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Prevalence and factors associated with hepatitis B and C virus infections among female Sex workers in Ethiopia: Results of the national biobehavioral Survey, 2020.

PONE-D-22-14713R2

Dear Dr. Bejiga,

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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