Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology

Dennis Aizobu; Yusuf H. Wada; Jennifer Anyanti; Godpower Omoregie; Boluwatife Adesina; Serah Malaba; Morghan Kabeer; Samuel Oyegunle; Akudo Ikpeazu; Omokhudu Idogho

doi:10.1371/journal.pone.0285003

Peer Review History

Original SubmissionAugust 25, 2022
3 Nov 2022 Decision Letter - Jamie Males, Editor PONE-D-22-23769Enablers and Barriers to Effective HIV Self-testing in the Private Sector among Sexually active youths in Nigeria: A Qualitative Study using Journey Map methodologyPLOS ONE Dear Dr. Hassan Wada, 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 respond carefully to all of the points the reviewers have raised when preparing your revision. Please submit your revised manuscript by Dec 17 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. 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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 2. Thank you for stating the following in the Acknowledgments Section of your manuscript: “This study was possible by the generous support of Children’s Investment Fund Foundation (CIFF) - Global Fund partnership through the Population Services International (PSI). The contents herein are the sole responsibility of the authors and do not necessarily reflect the views of SFH, PSI or CIFF. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We appreciate all members of the SFH SHIPS team, NACA, and ANAYD for their support during the data collection. We are most grateful to all the participants who took part in the study.” We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This study was possible by the generous support of Children’s Investment Fund Foundation (CIFF) - Global Fund partnership through the Population Services International (PSI). The contents herein are the sole responsibility of the authors and do not necessarily reflect the views of SFH, PSI or CIFF. 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The following resources for replacing copyrighted map figures may be helpful: USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/ The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/ Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/ Landsat: http://landsat.visibleearth.nasa.gov/ USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/# Natural Earth (public domain): http://www.naturalearthdata.com/ [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: 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: No Reviewer #2: Yes ****** 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: No ****** 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: “Enablers and Barriers to Effective HIV Self-testing in the Private Sector among Sexually active youths in Nigeria: A Qualitative Study using Journey Map methodology” presents qualitative data from in-depth interviews and focus group discussions with 80 participants involved in market research in Lagos, Anambra, and Kano states from January 2021 to October 2021. Although this is an important area of investigation, the current writing is weak and has numerous grammatical errors, making portions of the manuscript difficult to comprehend. I strongly recommend utilizing the services of a copyeditor to enhance clarity. Some of my questions, concerns, and suggestions are as follows: 1. Abstract – The opening sentences in the objectives and methods are very similar. Please revise the objectives to specify that the purpose of this qualitative study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. 2. Introduction – It would be helpful to clarify the meaning of “effective self-testing in the private sector” in the introduction. Does this refer to the distribution of HIV self-testing kits by manufacturers or pharmacies? Would the kits be available for free, or would they have to be purchased? Is this already being done in any states in Nigeria? What types of HIV self-tests are commercially available – oral fluid or finger-stick blood or both? 3. Methods – How were participants recruited? What were the inclusion and exclusion criteria? 4. Methods – Please provide a brief description (2-3 sentences) of the journey map methodology along with appropriate citations for the benefit of readers unfamiliar with this approach. 5. Results – It would be helpful to include a table summarizing the demographic characteristics of the 80 participants. Figure 1 does include their geographic distribution, but no figures have been presented. For example, how many men and women were in the sample? What was the age range? How many lived in urban and peri-urban areas? 6 Discussion – Is there a reason why the results might not be subject to social desirability bias? Reviewer #2: The authors should streamline their manuscript to focus on Enablers and Barriers to effective HIV self-testing in Private sector. Currently the manuscript is disorganized with irrelevant information,which doesn't address the enablers/barriers to effective HIVST. Also the authors should explicitly describe how was the Journey Map method operationalized in this study so a reader can follow. The author should also highlight what was the role of the private sector in this study. Did the author want to describe the role private health delivery systems? The author should use scientific writing, currently the manuscript is full of irrelevant words which doesn't add any value to the paper. The authors should check for grammar and spellings before their next submission. ****** 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: No ******** [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.0285003.r001
Revision 1
16 Jan 2023 Author Response Society for Family Health, No. 8 Port Harcourt Crescent Abuja, Nigeria November 15th 2022 The Editor-in-Chief, Editorial Office PLOS ONE Dear Editor-in-Chief, We thank the academic editor and the reviewers for the comments to improve on our manuscript [PONE-D-22-23769]. Please see below our itemized point-by-point responses has been highlighted. Moreover, in the revised manuscript, all changes have been tracked to indicate the revised sections. We would be happy to clarify any aspect of our responses if needed. Best Regards, Yusuf H. Wada Corresponding Author hwada@sfhnigeria.org Academic Editor 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 We thank the academic editor for this comment, we have updated the manuscript with the PLOS ONE’s style requirement as advised. 2. Thank you for stating the following in the Acknowledgments Section of your manuscript: “This study was possible by the generous support of Children’s Investment Fund Foundation (CIFF) - Global Fund partnership through the Population Services International (PSI). The contents herein are the sole responsibility of the authors and do not necessarily reflect the views of SFH, PSI or CIFF. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We appreciate all members of the SFH SHIPS team, NACA, and ANAYD for their support during the data collection. We are most grateful to all the participants who took part in the study.” We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This study was possible by the generous support of Children’s Investment Fund Foundation (CIFF) - Global Fund partnership through the Population Services International (PSI). The contents herein are the sole responsibility of the authors and do not necessarily reflect the views of SFH, PSI or CIFF. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. “ Please include your amended statements within your cover letter; we will change the online submission form on your behalf We thank the academic editor for this. This have been addressed. 3. Thank you for stating the following in your Competing Interests section: “None” Please complete your Competing Interests on the online submission form to state any Competing Interests. If you have no competing interests, please state "The authors have declared that no competing interests exist.", as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now This information should be included in your cover letter; we will change the online submission form on your behalf. We thank the academic editor for this. This have been addressed. 4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. We thank the academic editor for this. 5. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure. We thank the academic editor for this. We have changed in figure to a new one as reflected in the fig 1 uploaded. 6. We note that Figure 1 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright. We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: a. You may seek permission from the original copyright holder of Figure(s) [#] to publish the content specifically under the CC BY 4.0 license. We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text: “I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.” Please upload the completed Content Permission Form or other proof of granted permissions as an "Other" file with your submission. In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].” b. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. The following resources for replacing copyrighted map figures may be helpful: USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/ The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/ Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/ Landsat: http://landsat.visibleearth.nasa.gov/ USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/# Natural Earth (public domain): http://www.naturalearthdata.com/ [Note: HTML markup is below. Please do not edit.] We thank the academic editor for this. We have provided a replacement map as directed. 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: Partly 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: 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: No Reviewer #2: Yes 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: No 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: “Enablers and Barriers to Effective HIV Self-testing in the Private Sector among Sexually active youths in Nigeria: A Qualitative Study using Journey Map methodology” presents qualitative data from in-depth interviews and focus group discussions with 80 participants involved in market research in Lagos, Anambra, and Kano states from January 2021 to October 2021. Although this is an important area of investigation, the current writing is weak and has numerous grammatical errors, making portions of the manuscript difficult to comprehend. I strongly recommend utilizing the services of a copyeditor to enhance clarity. Some of my questions, concerns, and suggestions are as follows: We thank the reviewer 1 for this comment. The manuscript has been edited by a copyeditor to enhance clarity as advised. 1. Abstract – The opening sentences in the objectives and methods are very similar. Please revise the objectives to specify that the purpose of this qualitative study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. We thank the reviewer 1 for this comment, the objectives of the study have been rephrased as advised. 2. Introduction – It would be helpful to clarify the meaning of “effective self-testing in the private sector” in the introduction. Does this refer to the distribution of HIV self-testing kits by manufacturers or pharmacies? Would the kits be available for free, or would they have to be purchased? Is this already being done in any states in Nigeria? What types of HIV self-tests are commercially available – oral fluid or finger-stick blood or both? We thank reviewer 1 for this comment. Within the context of this manuscript, effective self-testing in the private sector means the effective utilization of HIVST kits and linkage to sexual reproductive health services and to HIV prevention by pharmacies (who are only approved to provide those services), while the distribution of HIV self-testing at the retail level is by the pharmacies. This is in line with the revised National HIV and AIDS strategic framework 2019-2021 as a priority policy and porgarmmatic approach to HIV response in Nigeria (NACA. Revised National HIV and AIDS Strategic Framework 2019-2021. Abuja: Nigeria. National Agency for Control of AIDS; 2019). We also updated the manuscript to reflect the context of effective self-testing in the private sector. The kits would have to be purchased at the pharmacies and currently being sold in different pharmacies in Lagos, FCT, Rivers, Akwa-Ibom, Anambra and other states in Nigeria. Therefore, this pilot study finding is set to to provide evidencebased date and influence government, policy makers, donors and business/investment case to scale up free, incentivized or subsidized HIVST kits and for successful future HIVST campaigns in the private sector. There are many types of HIVST kits commercially available in Nigeria such as OraQuick (oral-fluid based), Mylan (blood-based), Insti (blood-based), DrGregs (blood based) and 3-H viral blood check (blood-based). There have been some discrepancies from regulatory bodies on which is approved or not, reason we didn’t discuss earlier in our introduction. All comment raised by the reviewer have been inputted in the introduction part of the manuscript (line 77-84). 3. Methods – How were participants recruited? What were the inclusion and exclusion criteria? We thank reviewer 1 for this comment. The recruitment of participant was using a clearly spelt-out eligibility criteria (see below) and using a convenience sampling from a list of participants who fulfilled the criteria using a CBOs & CSOs drafted list and were willing to write an informed consent, which was carried out in accordance with ethical guidelines of 1975 declaration of Hesinki Declaration of 1975, revised 2000. Inclusion criteria were being either male or female, aged between 18 and 29, being sexually active, currently a resident of urban or peri urban setting in Nigeria, has ever taken an HIVST and other group who has never taken an HIVST, willing and able to provide verbal oral informed consent, and willing to consent to an audio recorded session. We have updated the participant selection and recruitment part to reflect the comment being raised (line 125-133). 4. Methods – Please provide a brief description (2-3 sentences) of the journey map methodology along with appropriate citations for the benefit of readers unfamiliar with this approach. We thank reviewer 1 for this comment. We have updated the method with a journey map section as recommended. 5. Results – It would be helpful to include a table summarizing the demographic characteristics of the 80 participants. Figure 1 does include their geographic distribution, but no figures have been presented. For example, how many men and women were in the sample? What was the age range? How many lived in urban and peri-urban areas? We thank reviewer 1 for this comment. We have updated the result section with (Table 1) to reflect the gender, age range and geographic distribution. 6 Discussion – Is there a reason why the results might not be subject to social desirability bias? We thank the reviewer for this comment. We have already reported in our limitations that our study might be subject to social desirability bias, but we try as much to reduce it by using indirect questions, self-completion, the use of proxy users (both the users and non-users), and random sampling from list of participants presented. This have also been updated in the manuscript. Reviewer #2: The authors should streamline their manuscript to focus on Enablers and Barriers to effective HIV self-testing in Private sector. Currently the manuscript is disorganized with irrelevant information, which doesn't address the enablers/barriers to effective HIVST. We thank the reviewer 2 for the comment. We have ie Also, the authors should explicitly describe how was the Journey Map method operationalized in this study so a reader can follow. We thank reviewer 2 for this comment. This have been reflected in the methodology section by adding a journey map method, how participants were recruited and the inclusion and exclusion criteria. The author should also highlight what was the role of the private sector in this study. Did the author want to describe the role private health delivery systems? We thank the reviewer 2 for this comment. We have updated the introduction section to reflect the context of private sector in this study. The author should use scientific writing, currently the manuscript is full of irrelevant words which doesn't add any value to the paper. The authors should check for grammar and spellings before their next submission. We thank the reviewer for this comment. We have employed the service of a copy writer and now reflect in the updated manuscript. 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: No Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0285003.r002
29 Mar 2023 Decision Letter - Adetayo Olorunlana, Editor PONE-D-22-23769R1Enablers and Barriers to Effective HIV Self-testing in the Private Sector among Sexually active youths in Nigeria: A Qualitative Study using Journey Map methodologyPLOS ONE Dear Dr. Hassan Wada, 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 May 13 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, Adetayo Olorunlana, Ph.D. 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 #2: 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 #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: The authors should streamline their manuscript to focus on Enablers and Barriers to effective HIV self-testing in Private sector. Currently the manuscript is disorganized with irrelevant information,which doesn't address the enablers/barriers to effective HIVST. Also the authors should explicitly describe how was the Journey Map method operationalized in this study so a reader can follow. The author should also highlight what was the role of the private sector in this study. Did the author want to describe the role private health delivery systems? The author should use scientific writing, currently the manuscript is full of irrelevant words which doesn't add any value to the paper. The authors should check for grammar and spellings before their next submission. Reviewer #3: In their present manuscript, the authors have documented factors likely to influence young people's uptake of HIV self-testing in Nigeria through a qualitative approach. The objective is clear and a timely question in the context of HIV prevention in West Africa. The method is appropriate, and the authors have correctly addressed previous reviewer suggestions. Here are a few comments to consider to further strengthen the manuscript: •The authors should ensure that the paper is formatted according to the COREQ checklist. Methods: •Consider moving the “Recruitment and participants selection” section after the “Journey map operation” section. •Line 121: Describe the HIV prevention stage. Refer to the following articles that describes HIV prevention continuum. A. McNairy, Margaret L, and Wafaa M El-Sadr. “A paradigm shift: focus on the HIV prevention continuum.” Clinical infectious diseases: an official publication of the Infectious Diseases Society of America vol. 59 Suppl 1,Suppl 1 (2014): S12-5. doi:10.1093/cid/ciu251. B. Horn, Tim et al. “Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model.” Journal of the International AIDS Society vol. 19,1 21263. 17 Nov. 2016, doi:10.7448/IAS.19.1.21263. •Where was the interview conducted and by whom? •Include more description about the study setting. Anambra, Kano and Lagos states. Perhaps mention that these states were identified as PEPFAR priority states given evidence of high HIV burden and unmet needs for HIV/AIDS treatment services •How was data triangulated? Result •Consider deleting “The journey map is the process with each stage having its own characteristics using the person’s experience to identify problems and suggest an improvement. However, the person perceives this as a real journey that can be used to improve each stage of HIV self-testing.” This has already bee described in the methods section. •Line 213 revise to “While the barriers identified at the attracting stage..” •Line 250, include the dollar equivalence of the naira ****** 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: Chisom Obiezu-umeh ******** [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: PONE-Reviewers comment_BN1.pdf https://doi.org/10.1371/journal.pone.0285003.r003
Revision 2
3 Apr 2023 Author Response Society for Family Health, No. 8 Port Harcourt Crescent Abuja, Nigeria March 30th 2023 The Editor-in-Chief, Editorial Office PLOS ONE Dear Editor-in-Chief, We thank the academic editor and the reviewers for the comments to improve on our manuscript [PONE-D-22-23769]. Please see below our itemized point-by-point responses has been highlighted. Moreover, in the revised manuscript, all changes have been tracked to indicate the revised sections. We would be happy to clarify any aspect of our responses if needed. Best Regards, Yusuf H. Wada Corresponding Author hwada@sfhnigeria.org Reviewer #2: The authors should streamline their manuscript to focus on Enablers and Barriers to effective HIV self-testing in Private sector. Currently the manuscript is disorganized with irrelevant information, which doesn't address the enablers/barriers to effective HIVST. Also, the authors should explicitly describe how was the Journey Map method operationalized in this study so a reader can follow. The author should also highlight what was the role of the private sector in this study. Did the author want to describe the role private health delivery systems? The author should use scientific writing, currently the manuscript is full of irrelevant words which doesn't add any value to the paper. The authors should check for grammar and spellings before their next submission. We thank the reviewer for this comment. We have reviewed how the Journey map was operationalized (line 112-125), describe the role of private sector in the manuscript, reviewed by a native speaker for irrelevant word and updated the format/logical flow using the COREQ checklist which was adopted from Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007. Volume 19, Number 6: pp. 349 – 357 as highlighted by the other reviewer. Reviewer #3: In their present manuscript, the authors have documented factors likely to influence young people's uptake of HIV self-testing in Nigeria through a qualitative approach. The objective is clear and a timely question in the context of HIV prevention in West Africa. The method is appropriate, and the authors have correctly addressed previous reviewer suggestions. Here are a few comments to consider to further strengthen the manuscript: •The authors should ensure that the paper is formatted according to the COREQ checklist. We thank the reviewer for this comment. We have formatted the manuscript according to the COREQ checklist and updated as appropriate. The COREQ Checklist was adopted from Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007. Volume 19, Number 6: pp. 349 – 357. Methods: •Consider moving the “Recruitment and participants selection” section after the “Journey map operation” section. We thank the reviewer for this comment. We have revised as advised with the recruitment and participants selection after the journey map operation section. •Line 121: Describe the HIV prevention stage. Refer to the following articles that describes HIV prevention continuum. A. McNairy, Margaret L, and Wafaa M El-Sadr. “A paradigm shift: focus on the HIV prevention continuum.” Clinical infectious diseases: an official publication of the Infectious Diseases Society of America vol. 59 Suppl 1,Suppl 1 (2014): S12-5. doi:10.1093/cid/ciu251. B. Horn, Tim et al. “Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model.” Journal of the International AIDS Society vol. 19,1 21263. 17 Nov. 2016, doi:10.7448/IAS.19.1.21263. We thank the reviewer for this comment. We have referred to the article and revised as appropriate (see line 126-131 and reference 18-20). •Where was the interview conducted and by whom? We thank the reviewer for this comment. We already have that captured in the manuscript (line 157- 162). We have also included a sentence and updated the manuscript on who conducted the interview and by whom. “The project team from SFH and Busara who were part of the face validity team carried out the qualitative research and collected data in the four dominant language of Nigeria (English, Igbo, Hausa, and Yoruba) using the IDIs and FGDs guides. IDIs were done in English over the phone, while FGDs were conducted in-person for the sexually active youths using the four languages in the three states. We conducted gender-specific FGDs - one FGD was either all men or all women, but we mixed HIVST users and HIVST non-users. During both the IDIs and FGDs, we asked respondents open-ended questions regarding their opinions and perceptions of HIVST, and for IDIs with HIVST users, we asked questions about their past experiences with taking up and using HIVST kits”. •Include more description about the study setting. Anambra, Kano and Lagos states. Perhaps mention that these states were identified as PEPFAR priority states given evidence of high HIV burden and unmet needs for HIV/AIDS treatment services We thank the reviewer for this comment. We have included the brief description of the study setting and identify them as PEPFAR priority states and other supporting information as advised (see line 110-117). •How was data triangulated? We thank the reviewer for this comment. We have included how the data was triangulated in our manuscript as advised (see line 167-170). Result •Consider deleting “The journey map is the process with each stage having its own characteristics using the person’s experience to identify problems and suggest an improvement. However, the person perceives this as a real journey that can be used to improve each stage of HIV self-testing.” This has already been described in the methods section. We thank the reviewer for this comment. This have been revised and deleted this section. •Line 213 revise to “While the barriers identified at the attracting stage.” We thank the reviewer for this comment. We have revised as advised. •Line 250, include the dollar equivalence of the naira We thank the reviewer for this comment. We have included the dollar equivalence of the naira (US$ 0.2-2). Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0285003.r004
13 Apr 2023 Decision Letter - Adetayo Olorunlana, Editor Enablers and Barriers to Effective HIV Self-testing in the Private Sector among Sexually active youths in Nigeria: A Qualitative Study using Journey Map methodology PONE-D-22-23769R2 Dear Dr. Hassan Wada, 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. 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, Adetayo Olorunlana, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0285003.r005
Formally Accepted
17 Apr 2023 Acceptance Letter - Adetayo Olorunlana, Editor PONE-D-22-23769R2 Enablers and Barriers to Effective HIV Self-testing in the Private Sector among Sexually active youths in Nigeria: A Qualitative Study using Journey Map methodology Dear Dr. Hassan Wada: 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 Associate Professor Adetayo Olorunlana Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0285003.r006

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