A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai

Karikalan Nagarajan; Malaisamy Muniyandi; Senthil Sellappan; Srimathi Karunanidhi; Keerthana Senthilkumar; Bharathidasan Palani; Lavanya Jeyabal; Rajendran Krishnan

doi:10.1371/journal.pone.0280812

Peer Review History

Original SubmissionMay 25, 2022
4 Oct 2022 Decision Letter - Jayanta Kumar Bora, Editor PONE-D-22-14977A study on tuberculosis disease disclosure patterns and its associated factors and outcomes: A prospective observational study in Chennai, south IndiaPLOS ONE Dear Dr. Malaisamy Muniyandi, 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. Please submit your revised manuscript by 4th November 2022. 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. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 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: No ****** 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: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 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: Journal Name: PLOS Manuscript ID: PONE-D-22-14977 Manuscript Title: “A study on tuberculosis disease disclosure patterns and its associated factors and outcomes: A prospective observational study in Chennai, south India" Reviewer Comments: The authors have investigated tuberculosis disease disclosure patterns and its associated factors. Reviewer has found many some problems. Detailed evaluation is given below: Abstract: Authors should reduce abstract. Background: Please state the research questions/hypothesis of the study. Methodology: 1. Did authors measure internal consistency of their questionnaire, if yes how? 2. In Statistical analysis, authors should only describe statistical methods, i.e mention statistical techniques/models, and describe why they use in their study. Please remove outcome and independent variables from the subtitle and make a subtitle, Variable where authors describe about outcome and independent variables separately. Authors used univariate and multivariate (multiple) logistic regression model, in multiple logistic regression model consider more than one independent variable, great chance to get multicollinearity problems among selected independent variables, please describe who authors check the multicollinearity problems, and how they overcome the problem if available. 3. Please describe separately inclusion/exclusion criteria, sampling, data collection procedure etc. Reviewer #2: This is an interesting paper based on primary data. The paper is well written . However it need improvement in following 1. In introduction the social stigma attached to TB in India may be discussed. Second, how the disclosure adversely/ positively affect patients treatment and health may be discussed. 2.From title Outcome may be dropped 3.Tables: All tables should have uniformly 2 decimals. 4. Table 3 No. should be replaced with N. Do not show number or % for N<30. there are many cases with N less than 10. Must be replaced with __ mentioning in footnote number not shown due to small number Put N as last row (all cases) % in parentthesese should be shown without barcket It basically shown the percentage of XX by characteristics 5. Keep all column from Odd ratio onwards. Drop the columns except variable 6. A recent paper is missed in literaure review Pathak, D., Vasishtha, G., & Mohanty, S. K. (2021). Association of multidimensional poverty and tuberculosis in India. BMC Public Health, 21(1), 1-12. Reviewer #3: This paper provides very interesting research work addressing the prospective observational evidence of the TB diseases patterns in Chennai. 1. The introduction section requires substantial improvement. It looks too short and not enough existing studies included. I would suggest adding more literatures and add a conceptual framework. 2. Can you remove the word South India from the title (if possible).? 3. In Table 1, the total frequency has not been included? Can you revise table 1? 4. In Table 2, the total frequency has also not been included? Can you revise table 2? 5. The age-group needs to be reclassified, for example- 0-4 years, 5-14 years, 15-29 years, 30-44 years, 45-59 years, and 60+ years. 6. In Table 5, the adjusted odds ratio for occupation is missing? why? also why the reference category is not arranged properly? 7. The Table 6 is not clear. 8. The title of the Figure 1 is unclear. 9. In Table 4, you have use * sign. But the meaning of * sign is missing in the footnotes. 10. In the result section of the multivariate analysis, the interpretation needs substantial improvement. For-example. include the values of odds ratio with their p value or std.error or confidence interval. 11. What is the strength and drawback of this study? 12.Author should make the integers into one or two decimal places. 13. Any additional policy recommendation? 14. Write the data availability section separately in brief. For example... whether it is publicly available or not. if not then explain why? ******** 6. 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: Yes: Sanjay K Mohanty Reviewer #3: Yes: Saddaf Naaz Akhtar ******** [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. Attachments Attachment Submitted filename: REPORT.docx https://doi.org/10.1371/journal.pone.0280812.r001
Revision 1
7 Nov 2022 Author Response S No Reviewer’s Comments Authors responses Page No in Manuscript Reviewer 1 1 Authors should reduce abstract. As suggested we have edited and reduced abstract to nearly 300 words. Page -2 2 Please state the research questions/hypothesis of the study. As suggested we have added research question under the method section of the revised manuscript. Page 5 3 Did authors measure internal consistency of their questionnaire, if yes how? We have used a test -retest method and certain other checks to ensure the internal consistency of the tool which we have used. We have explained this in the method section and have added a published reference which we have made already. Page 8 4 In Statistical analysis, authors should only describe statistical methods, i.e mention statistical techniques/models, and describe why they use in their study. Please remove outcome and independent variables from the subtitle and make a subtitle, Variable where authors describe about outcome and independent variables separately. As suggested by reviewer we have revised and separated the statistical methods and outcome/ independent variables under different subtitles. Page 8 5 Authors used univariate and multivariate (multiple) logistic regression model, in multiple logistic regression model consider more than one independent variable, great chance to get multicollinearity problems among selected independent variables, please describe who authors check the multicollinearity problems, and how they overcome the problem if available. We thank the reviewer for raising this important point. For multiple regressions we calculated variance inflation factor VIA ins STATA and found that all variables had less than 4 and the mean VIA was only 1.63 indicating that that collinearity was not affecting our analysis. We have included this detail in the revised manuscript I results section. Page 8,12 6 Please describe separately inclusion/exclusion criteria, sampling, data collection procedure etc. As suggested have given separate sub titles and details of inclusion/exclusion criteria, sampling, data collection procedure, analysis, and outcome/ independent variables in the revised manuscript. Page 5 Reviewer 2 Comments 1 This is an interesting paper based on primary data. The paper is well written . However it need improvement in following We thank the reviewer for positively acknowledging the importance of our study. We have made the necessary changes as suggested 2 In introduction the social stigma attached to TB in India may be discussed. Second, how the disclosure adversely/ positively affect patients treatment and health may be discussed. As suggested by the reviewers we have outlined the relationship between disclosure, stigma, poor mental status etc with references in the revised papers. We have added the available literature on positive outcomes of TB disclosure from a setting similar to India. We have also provided a detailed discussion of how disclosures and positive outcomes are important Page 3,4 3 .From title Outcome may be dropped We have modified the title as suggested by the reviewer Page 1 4 .Tables: All tables should have uniformly 2 decimals. As suggested we have given 2 decimals uniformly in all tables. Page 22-27 5 Table 3 No. should be replaced with N. Do not show number or % for N<30. there are many cases with N less than 10. Must be replaced with __ mentioning in footnote number not shown due to small number Put N as last row (all cases) % in parentheses should be shown without bracket It basically shown the percentage of XX by characteristics As suggested we have replaced the lower numbers . however we have kept it at a level less than <10. This was to highlight incremental changes in disclosures made at different timepoints which are important We have removed the parenthesis for % in all tables and have made N %as the last row in table header Page 24 6 Keep all column from Odd ratio onwards. Drop the columns except variable We have dropped the columns before Odds ratio as suggested. Page 22-27 7 A recent paper is missed in literaure review Pathak, D., Vasishtha, G., & Mohanty, S. K. (2021). Association of multidimensional poverty and tuberculosis in India. BMC Public Health, 21(1), 1-12. As suggested we have added this recent and important literature in the revised manuscript Page 15 Reviewer 3 Comments 1 This paper provides very interesting research work addressing the prospective observational evidence of the TB diseases patterns in Chennai. We thank the reviewer for positively acknowledging the importance of our study. 2 The introduction section requires substantial improvement. It looks too short and not enough existing studies included. I would suggest adding more literatures and add a conceptual framework. As suggested by the reviewers we have improved our introduction section and have added the literature. We have outlined the relationship between disclosure, stigma, poor mental status etc with references in the revised papers. Page 3-4 3 Can you remove the word South India from the title (if possible).? We have modified the title as suggested by the reviewer Page 1 4 In Table 1, the total frequency has not been included? Can you revise table 1? We have added the total frequency in Table 1 as suggested Page 22 5 In Table 2, the total frequency has also not been included? Can you revise table 2? We have added the total frequency in Table 2 as suggested Page 23 6 The age-group needs to be reclassified, for example- 0-4 years, 5-14 years, 15-29 years, 30-44 years, 45-59 years, and 60+ years. We would like to clarify that the present study included only adult TB patients and their contacts. As such our age categorisation were made from 18 years and above. Our categorisation thus does not have 0-4, 5-14 and 15 plus years. Our categorisation was made based on the prior assumption of TB burden among different age brackets based on TB program data in the study settings. 7 In Table 5, the adjusted odds ratio for occupation is missing? why? also why the reference category is not arranged properly? Variables which were statistically insignificant IN univariate analysis was not included in multivariate regression. We have added a footnotes to clarify this. Also we have edited the tables and made clearer the reference category and rest. Page 26 8 The Table 6 is not clear. We have edited the Table 6 title, headers and given footnotes to make it clearer. Page 27 9 The title of the Figure 1 is unclear. We have edited the title of figure to make it clearer. Page 28 10 In Table 4, you have use * sign. But the meaning of * sign is missing in the footnotes. We have added the meaning of * sign in the revised manuscript. Page 25 11 In the result section of the multivariate analysis, the interpretation needs substantial improvement. For-example. include the values of odds ratio with their p value or std.error or confidence interval. As suggested we have added the values of odds ratio, p value and confidence interval and added explanations in the results part. Page 11 12 What is the strength and drawback of this study? We have added strengths and drawbacks of this study in the discussion part as suggested by the reviewer Page 16,17 13 Author should make the integers into one or two decimal places. As suggested we have standardised the decimals to two integers Page 22-27 14 Any additional policy recommendation? We have added policy recommendations in the discussion part as suggested by the reviewer Page 16 15 Write the data availability section separately in brief. For example... whether it is publicly available or not. if not then explain why? We have added the data availability section as suggested by the reviewer Page 18 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0280812.r002
15 Dec 2022 Decision Letter - Jayanta Kumar Bora, Editor PONE-D-22-14977R1A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in ChennaiPLOS ONE Dear Dr. Malaisamy Muniyandi, 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. Please submit your revised manuscript by Jan 29 2023 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, Jayanta Kumar Bora, 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. [Note: HTML markup is below. Please do not edit.] 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 #3: All comments have been addressed ******** 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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 #1: 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 #1: 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 #1: Authors have addressed all comments. However, I have three comments/suggestions; Methodology 1. Please move “Research question” from Methodology to Background (Please follow the paper, https://reader.elsevier.com/reader/sd/pii/S2666915321000962?token=84C91341547EA36C337EA4417603D907AE4D4853F0B66663B86A1BDC476A79390C4E01EA421AF721AE46FF91A511EF8D&originRegion=eu-west-1&originCreation=20221208125421) 2. In “Exclusion Criteria” Please complete the sentence “Drug resistant TB patients, TB patients with HIV and other life-threatening comorbidity” 3. Please provide the mathematical formula that was used for calculating sample size. Reviewer #3: I am thankful to the authors for revising and updating the manuscript with my comments. I don't have additional comments. ****** 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 #3: Yes: Saddaf Naaz Akhtar ******** [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.0280812.r003
Revision 2
5 Jan 2023 Author Response Reviewer 1 1. Authors have addressed all comments. However, I have three comments/suggestions; We thank the reviewer for acknowledging the revision. 2. Please move “Research question” from Methodology to Background As suggested we have added research question under the background section of the revised manuscript as a separate para 3. In “Exclusion Criteria” Please complete the sentence “Drug resistant TB patients, TB patients with HIV and other life-threatening comorbidity” We have reworded this sentence 4. Please provide the mathematical formula that was used for calculating sample size As suggested we have provided the formula used for sample size in the revised version Reviewer 3 Comments 1. I am thankful to the authors for revising and updating the manuscript with my comments. I don't have additional comments. We thank the reviewer for acknowledging the revision https://doi.org/10.1371/journal.pone.0280812.r004
10 Jan 2023 Decision Letter - Jayanta Kumar Bora, Editor A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai PONE-D-22-14977R2 Dear Dr. Malaisamy Muniyandi, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication subject to address the minor comments raised by one reviewer. Once it is done then it will be formally accepted for publication and should 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. 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, Jayanta Kumar Bora,PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0280812.r005
Formally Accepted
17 Jan 2023 Acceptance Letter - Jayanta Kumar Bora, Editor PONE-D-22-14977R2 A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai Dear Dr. Muniyandi: 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. Jayanta Kumar Bora Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0280812.r006

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