PONE-D-22-07174Knowledge, attitudes and practices of community treatment supporters administering multidrug-resistant tuberculosis injections: a cross-sectional study in rural EswatiniPLOS ONE

Dear Dr. Peresu,

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Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Please address issues raised by reviewer 2 in the manuscript

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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: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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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: This is a very interesting and relevant study. The findings and recommendations on appropriate task-shifting of basic health services to lay community members, in resource-limited settings will be helpful for further research.

Author should complete the omission in the sentence, "Instead of making trips to the . . .., MDR-TB patients receive their daily injections and DOT from CTSs in their (the patients’) homes."

Reviewer #2: The authors’ address a topical subject of relevance to the target audience of PLOS ONE using quantitative methods to assess the knowledge, attitudes and practices of community treatment supporters administering multidrug-resistant tuberculosis injections in rural Eswatini. This should be encouraged. The authors should make minor revisions based on the following issues raised below:

1. Abstract

In the methodology section, authors did not include the number patient homes where observations were conducted on the CTSs actual practice.

Action: Authors to include the number of CTSs that were sampled for observation in the methodology section of the abstract.

2. Introduction

This paper is a deep dive into practical aspects of MDR-TB management and goes to length to describe the KAP of the CTSs on administering MDR-TB injections. The field of DR-TB management is a rapidly changing field as treatment regimen and recommendations are changed as new evidence is available. There is no description by the authors of the treatment regimen including type of injectable that was used in the country by the CTSs. This is critical information to help readers underground the program context/background better.

Action: Authors to include description of MDR-TB drug regimen in use at the time of the study as part of the background.

3. Methods:

a) In the sampling sub-section of the methodology, the authors describe how the 20 CTSs were selected through a proportionate random sampling from the 3 main facilities after a stratified sampling. The distribution of the 82 purposively selected CTSs among the 3 facilities which form the sampling frame for the stratified sampling is unclear.

Action: Clearly describe the distribution of the 82 purposively selected CTSs among the 3 main facilities. This will clarify the size of the sampling frame

b) In the Instrument development and measures sub-section, paragraph 2 (line 12) the authors describe Table 4 as having 12 questions assessing CTSs’ self-reported practices for MDR-TB. A review of table 4 shows responses to 11 questions rather than 12.

Action: Authors to review table 4 and update accordingly.

Thank you

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Reviewer Recommendation and Comments for Manuscript Number PONE-D-22-07174.docx

Knowledge, attitudes and practices of community treatment supporters administering multidrug-resistant tuberculosis injections: a cross-sectional study in rural Eswatini

PONE-D-22-07174R1

Dear Dr. Peresu,

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,

Bassey E. Ebenso, Ph.D., M.P.H., M.D.,

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The revisions made to your manuscript (Revision Number 1) have sufficiently addressed comments raised by two independent reviewers

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 #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: 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 #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

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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: We thank the author(s) for submitting the corrections and making necessary revisions. The corrections and 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: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Reviewers comments PONE-D-22-07174_Updated.docx