PONE-D-22-00269Policy and programmatic directions for the Lesotho tuberculosis programme: findings of the national tuberculosis prevalence survey, 2019PLOS ONE

Dear Dr. KAK,

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The manuscript entitled “Policy and programmatic directions for the Lesotho tuberculosis programme: findings of the national tuberculosis prevalence survey, 2019” is an interesting study. The TB prevalence survey is important to inform estimates of TB disease burden in the 30 high TB burden countries, of which Lesotho is part. The survey was accomplished in 2019 and the data were available, according to the Global Tuberculosis Report 2021. Accompanying the report, this scientific manuscript will help global readers to learn and understand the methods used for the survey, and to obtain a clear picture of TB burden in Lesotho, like Vietnam’s publication (2020) : https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232142 .

However, after looking through the manuscript, there are many issues that authors need to address before it ready for a publication. In this stage, the manuscript is not ready for publication.

1. The introduction needs to clarify the importance of the study. Readers with adequate tuberculosis background may understand what TB prevalence survey is. But it is also important to provide sufficient information why TB prevalence survey is required in Lesotho, what is the link with the TB estimation numbers, and what is the use of the data.

2. The tables and figures used templates provided by the WHO. However, authors did not check them before submission, and now they are very confusing to be read and reviewed. It is better to first check all text, figures, and tables are formatted following the guidelines. Also please check that Table 2 and 3 are duplicated with different formats.

3. Authors need to be careful to use terms ‘prevalence’, ‘prevalence per 100 000’, and ‘prevalence rate’. They will be very different in interpretation between each other. Please check again throughout the manuscript.

4. In Discussion, it will be better to highlight that the findings from this TB prevalence survey refine the previous prevalence estimation published in the WHO Report. Also, better to discuss how it could be replicated, and should be implemented in regular period (how if ‘yes’, and why if ‘not’). Are the resources available for repeated prevalence, and if not, how to deal with it?

5. The discussion lacks references. There are many prevalence surveys published, mostly in PloS, but not cited in this paper, for example:

a. Zambia: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146392

b. Vietnam: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232142

c. Kenya: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209098

d. Bangladesh: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044980

6. References should conform with journal guidance. Please see the author guidance. There is no time pressure for refining all formatting before submission, and it will also help reviewers to provide the best comments for improvement.

7. This paper still needs English proof-editing before further submission.

Reviewer #2: Congratulations for this manuscript that reports the results of the first ever national tuberculosis (TB) prevalence survey in Lesotho. You have followed the international guidance to carry out the survey, revealed a very high estimated prevalence and found out about community health seeking behavior. The manuscript is well and clearly written and its flow is good. There a few typos that you will, no doubt, fix in due course (please check separator commas in line 270, Figure 2 and Table 3, consider writing MTB in full in Tables 2 and 3.

A couple of other points for your consideration:

MAJOR:

* You touch on HIV related issues on lines 83-84, 286 and 335 but you do not explain anywhere how Lesotho is performing on 90:90:90/95:95:95. This information is essential in view of your finding of 2,5 fold prevalence of TB among PLHIV compared with HIV-uninfected participants. Is the 'problem' the proportion of PLHIV who know their status? There must be an error when you mention of a high proportion of people 15-49 years knowing their status - 23% is low. What is the reported level of viral suppression among PLHIV In HIV care/ART? Are there issues of poor retention? In line 337, you state that the TB-HIV burden remains high - is this in line with other countries in southern Africa, the world's HIV epicenter? What does literature tell us? What is your hypothesis regarding this high burden?

* line 207: 62 participants reported both a current and past episode of TB? How does this compare with findings reported by other prevalence surveys? Is it high (in keeping with TB-HIV burden) or low? You may wish to discuss this point further.

MINOR:

* line 194: word 'than' missing?

* Conclusion: could you make 1-2 specific recommendations directed to the NTP (and general health services) about quality of health and particularly TB case finding and holding services? How can Lesotho narrow the case finding gap? What are your recommendations to policy makers?

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Reviewer #1: No

Reviewer #2: No

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PONE-D-22-00269R1Policy and programmatic directions for the Lesotho tuberculosis programme: findings of the national tuberculosis prevalence survey, 2019PLOS ONE

Dear Dr. KAK,

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.

Thank you for addressing the reviewers' comments, which you have done well. A minor point still to be improved is use of the word "cases" e.g. in table legends where this should be consistently replaced by "participants with TB" or words to that effect, wherever possible.

Please submit your revised manuscript by Jul 25 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,

Kevin Schwartzman

Academic Editor

PLOS ONE

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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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Policy and programmatic directions for the Lesotho tuberculosis programme: findings of the national tuberculosis prevalence survey, 2019

PONE-D-22-00269R2

Dear Dr. KAK,

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,

Kevin Schwartzman

Academic Editor

PLOS ONE

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