Understanding the nature of substance use in Zimbabwe: State of the art and ways forward: A scoping review protocol

Blessing N. Marandure; Samson Mhizha; Amanda Wilson; Clement Nhunzvi

doi:10.1371/journal.pone.0272240

Peer Review History

Original SubmissionJuly 15, 2022
31 Jan 2023 Decision Letter - Herb Covington, Editor PONE-D-22-19525Understanding the nature of substance use in Zimbabwe: State of the art and ways forward: A scoping review protocolPLOS ONE Dear Dr. Marandure, 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. I encourage you to carefully consider each of the Reviewer's comments noted below. Importantly, be sure to edit the paper so that the grammar is clear, concise, and correct. Please include a numbered response to each of the Reviewer's comments in your revised manuscript. Please submit your revised manuscript by Mar 09 2023 11:59PM. 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Kind regards, Herb Covington Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes ******** 2. 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Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 ****** 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: No ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Multiple grammatical errors. INTRO: There are statements that are made with no reference. There are connections between various concepts that are made, with no justification. Here are some examples. No reference in line 53/54. Line 54 "This is concerning..." What is concerning? The increase in subs use in Africa vs projected highest increases in Southern Africa vs East and West Africa distributing subs?. Line 56-58: After mentioning the rise of subs use in Africa/Southern Africa, the author fails to show reasons for this rise in subs use to now lead to "become imperative on African states... to develop..." The author also fails to make a case why they refer to the rise in substance use as a crisis. Line 59:no ref.; also unclear how the link is made between addressing substance use disorders and achieving equitable access to mental health services. Lines 72-74: no ref. Lines 89-90: No ref. Line 94: "the situation is further..." Author needs to clarify what situation they are referring to. Lines: 94-99: The author fails to show the link between paucity of substance use treatment facilities in Zimbabwe and "brain drain". Is there evidence that the paucity of substance use treatment facilities is new? And possibly linked to an increasing brain drain? It is possible that Zimbabwe's paucity of subs use treatment facilities is historical, due to under-funding/other factors and predates brain drain. Line 103: "In response to these challenges..." Again, the authors need to be clear to the reader what challenges they are referring to. Is it challenges of increasing subs use, brain drain, paucity of subs treatment facilities or emergence of drug trafficking in the country? Which of these challenges is the drug master plan a response to? METHOD: There seems to be reference to some things done in the past vs those that will still be done. Please check the tense. Line 122: Is Scoping Review suggested or "will be used"? I suggest that the author considers rephrasing this. Line 206: "specific substance use focus". What does that mean? will the author exclude documents that focus on primary healthcare (PHC) systems and include substance use interventions as part of PHC? ****** 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: Dr Tando A.S. Melapi. Department of Psychiatry; University of the Witwatersrand ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0272240.r001
Revision 1
1 Feb 2023 Author Response We thank both the editor and the reviewer for taking the time to review our manuscript. We are pleased to be offered the opportunity to further clarify and refine our manuscript. However, we also note with concern the reviewer's response to the following question:- 5. Is the manuscript presented in an intelligible fashion and written in standard English? Whilst there were minor clarity issues identified in places, we do not feel this warrants the judgement that the manuscript is not written in an intelligible fashion and in standard English. We have highlighted the changes within the manuscript, and have provided a point by point response to the reviewer’s comments as follows:- Reviewer #1: Multiple grammatical errors. INTRO: There are statements that are made with no reference. There are connections between various concepts that are made, with no justification. Here are some examples. Response: We thank the reviewer for these observations. We have clarified and revised the identified issues as noted below. Reviewer #1: No reference in line 53/54. Line 54 "This is concerning..." What is concerning? The increase in subs use in Africa vs projected highest increases in Southern Africa vs East and West Africa distributing subs?. Response: We have now clarified the sentence’s intended meaning (line 55-56). The concern was that of the key drug distribution regions being in Africa. We believe this is a concern due to the link between distribution sites and increases in local availability of drugs identified in the latter part of the introduction. Reviewer #1: Line 56-58: After mentioning the rise of subs use in Africa/Southern Africa, the author fails to show reasons for this rise in subs use to now lead to "become imperative on African states... to develop..." The author also fails to make a case why they refer to the rise in substance use as a crisis. Response: The reasons for the projected rise in substance use have now been identified (lines 58-60). We also agree with the reviewer in regards to the terminology of ‘crisis’. Therefore, we have revised our assertions to be more tentative here and identified an impending rise in substance use disorders instead (line 62-63). Reviewer #1: Line 59:no ref.; also unclear how the link is made between addressing substance use disorders and achieving equitable access to mental health services. Response: The statement represents the authors assertions made in relation to the call made by UNODC in the latest world drug report (referenced in lines 60-62). We have added the UNODC reference to reflect this (line 64). This call by UNODC was made after the launch of the WHO Special Initiative for Mental Health (lines 65-67). Hence, we assert that the call ‘comes on the back of the global focus on mental health and the desire to achieve equitable access to services (lines 64-66). We have added the WHO reference to line 66 for clarity. The WHO Special Initiative seeks to address the treatment gap for mental, neurological and substance use disorders concurrently, and globally (and because access to these services is not equitable at present). Therefore, our assertions here are not identifying the addressing of substance use disorders in isolation as a solution to equitable access to care. However, considering the marginalisation of substance users in access to care more generally, it is not implausible that addressing SUDs would improve equity of access. We have not sought to expand on this as this is beyond the scope of the present paper. Reviewer #1 Lines 72-74: no ref. Response: The reference has now been added (now line 80). Reviewer #1 Lines 89-90: No ref. Response: A reference is not required here as this represents our assertions. We have revised this to identify the statement more explicitly as the authors’ assertion (now line 99). Due to the paucity of literature, there is no primary evidence directly linking the socio-economic situation in Zimbabwe specifically to increases in substance use. What we have done instead is drawn on indirect evidence to support our assertion. Specifically, we go on to provide evidence of endemic poverty in the country (line 94) and evidence identifying poverty as a risk factor for substance use (line 96-98). Based on the identified link between poverty and substance use, it is reasonable to assert a link between the country’s socio-economic challenges and substance use. Reviewer #1 Line 94: "the situation is further..." Author needs to clarify what situation they are referring to. Response: We agree, with the reviewer’s noted lack of clarity here. We have revised the statement accordingly (line 113). Reviewer #1 Lines: 94-99: The author fails to show the link between paucity of substance use treatment facilities in Zimbabwe and "brain drain". Is there evidence that the paucity of substance use treatment facilities is new? And possibly linked to an increasing brain drain? It is possible that Zimbabwe's paucity of subs use treatment facilities is historical, due to under-funding/other factors and predates brain drain. Response: We have identified both underfunding and the brain drain as reasons for paucity of services (lines 115-117). This is evidenced clearly in the situational analysis of the country’s healthcare system conducted as part of the WHO special initiative. Trying to unpick which came first (under-funding or brain drain) is a ‘chicken and the egg problem’ and is beyond the scope of the paper. This information is there for context of what the current challenges are:- in this case limited specialist service provision. Though we also agree that there is value in future studies to conduct in depth analysis of the reasons for the paucity of specialist services as part of efforts to remedy this. Reviewer #1 Line 103: "In response to these challenges..." Again, the authors need to be clear to the reader what challenges they are referring to. Is it challenges of increasing subs use, brain drain, paucity of subs treatment facilities or emergence of drug trafficking in the country? Which of these challenges is the drug master plan a response to? Response: We agree with the lack of clarity here and have identified both the increase in substance use and lack of service provision as the issues to be addressed (line 122-123). Reviewer #1 METHOD: There seems to be reference to some things done in the past vs those that will still be done. Please check the tense. Response: Due to the nature of a study protocol, some of the actions are future actions (i.e. the steps that will be taken to conduct the scoping review e.g line 127), whilst others are past actions (i.e. steps already taken in devising the protocol- e.g. line 129-130). Hence it is not possible for the tenses to be consistent in the method. We have reviewed the method and all tenses align with either past or present actions as they should. We have also written the protocol following the guidance from other published protocols. Reviewer #1 Line 122: Is Scoping Review suggested or "will be used"? I suggest that the author considers rephrasing this. Response: Thank you, we agree this was phased awkwardly. We have now amended for clarity (now line 146). Reviewer #1 Line 206: "specific substance use focus". What does that mean? will the author exclude documents that focus on primary healthcare (PHC) systems and include substance use interventions as part of PHC? Response: All policy and strategic documents that focus on substance use in any capacity (e.g. prevention, intervention etc) will be included in the review. This will go beyond health care systems and include wider drug policy. We have amended for clarity, but also left it broad enough to capture our intended aim (line 232). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0272240.r002
23 Feb 2023 Decision Letter - Herb Covington, Editor Understanding the nature of substance use in Zimbabwe: State of the art and ways forward: A scoping review protocol PONE-D-22-19525R1 Dear Dr. Marandure, 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. I look forward to seeing your Review, on this important topic, when you have completed it. 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Herb Covington Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0272240.r003
Formally Accepted
27 Feb 2023 Acceptance Letter - Herb Covington, Editor PONE-D-22-19525R1 Understanding the nature of substance use in Zimbabwe: State of the art and ways forward: A scoping review protocol Dear Dr. Marandure: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Herb Covington Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0272240.r004

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