PONE-D-22-28673“Because of Covid…”: The impacts of Covid-19 on First Nation people accessing the HIV cascade of care in Manitoba, Canada.PLOS ONE

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Academic Editor

PLOS ONE

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Additional Editor Comments:

General comments

1. There are some grammatical and sentence structure errors that needs attention

2. It is not essential to name study team members in the manuscript. Moreover, the named co-principal investigator is not indicated as an author on the manuscript

3. All quotations should be presented in the results section

4. Discussion of the results in relation to previous studies and implications on health systems and policy could enhanced

5. The study limitation could be summarised

Specific comments

1. As a qualitative study the authors stated using questionnaires as the data collection tool in the abstract. This should be corrected appropriately

2. The second paragraph of the introduction on page 5 contains methods and results. This section should focus on the problem and gap(s) in research that this study seeks to fill

3. The “understanding the context” section could be summarised and added to the methods as the study setting

4. The following statement imply an implicit bias in the analysis of the data "The peer research associates brought to the interviews and analysis their knowledge, experience and insights that are unique to people with lived experience”. As part of the research team their knowledge and experience should not influenced the analysis

5. Provide the ethical approval numbers

6. Provide months in which data collection began and ended

7. Information on the type of demographic collected has been repeated on page 11

8. The authors indicated that both inductive and deductive analysis techniques were used in the study. The authors should be clear on how and why both analysis techniques were used.

9. The authors indicated that data on gender and sexual orientation cannot be reported due to the small number and confidential issues. All the reported data has been anonymised so I don’t think there is any risk of breaching confidentiality. Furthermore, differences of opinions on gender and sexual orientation could be essential for designing interventions

10. Some of the quotes can be shortened by focusing on the main information. Also, some quotes could be grouped together under one narrative for better coherence. For instance, the delays in getting appointment is associated with delays in receiving medications. These two points could be merged. Each quotation should also be presented in separate paragraph with more identifiers of the participant such as age and/or sex

11. There is no need to itemize the themes before reporting the detailed results. This leads to avoidable repetitions

12. Consider rephrasing "Disruption to overall well-being....” to "Decline of overall well-being..."

13. On page 16 "... ability to have a private conversation cold compromised communication” should be corrected to “... the inability to…"

14. On page 16, the following sentence does not connect with the previous statements and the subsequent quote does not match the narrative: "However, HCPs in the north had to find work arounds so that they could communicate with their clients. “Facebook was a way that Facebook messenger was another way in which our program was accessing clients” (HCP)." Further clarification is required

15. The sentence "If an individual tried to make an appointment at a northern clinic." On page 19 is seems out place

16. On page 20, in the sentence “The lack of attention on the impacts of Covid-19 on people who were living with HIV left those with lived experience feeling unsupported, further stigmatized and deprioritized” needs to be appropriately phrased. It currently presents people living with HIV and those with lives experience as different groups of people.

17. The sub-themes under theme 3 are very similar particularly themes 3A and 3C. I suggest those two themes be combined

18. The second and third paragraph of the discussion could be merged since they present similar information.

19. On page 26 the authors indicated that “The Covid-19 epidemic began at the time we were planning to start our interviews and thus our planned study process was significantly disrupted.” The authors need to restructure this sentence appropriately since it implies the impact of the Covid-19 epidemic is not the main objective of the study.

20. The second paragraph of the conclusion is redundant. The conclusion should be more directed to the implication of the findings to improving healthcare delivery for marginalised people and PWLE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

**********

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

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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: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript is well written--the introduction section explains the research clearly and in a lucid manner, making it easy to understand. The methods section is well detailed and the results section is elaborate.

Reviewer #2: General comments

1. There are some grammatical and sentence structure errors that needs attention

2. It is not essential to name study team members in the manuscript. Moreover, the named co-principal investigator is not indicated as an author on the manuscript

3. All quotations should be presented in the results section

4. Discussion of the results in relation to previous studies and implications on health systems and policy could enhanced

5. The study limitation could be summarised

Specific comments

1. As a qualitative study the authors stated using questionnaires as the data collection tool in the abstract. This should be corrected appropriately

2. The second paragraph of the introduction on page 5 contains methods and results. This section should focus on the problem and gap(s) in research that this study seeks to fill

3. The “understanding the context” section could be summarised and added to the methods as the study setting

4. The following statement imply an implicit bias in the analysis of the data "The peer research associates brought to the interviews and analysis their knowledge, experience and insights that are unique to people with lived experience”. As part of the research team their knowledge and experience should not influenced the analysis

5. Provide the ethical approval numbers

6. Provide months in which data collection began and ended

7. Information on the type of demographic collected has been repeated on page 11

8. The authors indicated that both inductive and deductive analysis techniques were used in the study. The authors should be clear on how and why both analysis techniques were used.

9. The authors indicated that data on gender and sexual orientation cannot be reported due to the small number and confidential issues. All the reported data has been anonymised so I don’t think there is any risk of breaching confidentiality. Furthermore, differences of opinions on gender and sexual orientation could be essential for designing interventions

10. Some of the quotes can be shortened by focusing on the main information. Also, some quotes could be grouped together under one narrative for better coherence. For instance, the delays in getting appointment is associated with delays in receiving medications. These two points could be merged. Each quotation should also be presented in separate paragraph with more identifiers of the participant such as age and/or sex

11. There is no need to itemize the themes before reporting the detailed results. This leads to avoidable repetitions

12. Consider rephrasing "Disruption to overall well-being....” to "Decline of overall well-being..."

13. On page 16 "... ability to have a private conversation cold compromised communication” should be corrected to “... the inability to…"

14. On page 16, the following sentence does not connect with the previous statements and the subsequent quote does not match the narrative: "However, HCPs in the north had to find work arounds so that they could communicate with their clients. “Facebook was a way that Facebook messenger was another way in which our program was accessing clients” (HCP)." Further clarification is required

15. The sentence "If an individual tried to make an appointment at a northern clinic." On page 19 is seems out place

16. On page 20, in the sentence “The lack of attention on the impacts of Covid-19 on people who were living with HIV left those with lived experience feeling unsupported, further stigmatized and deprioritized” needs to be appropriately phrased. It currently presents people living with HIV and those with lives experience as different groups of people.

17. The sub-themes under theme 3 are very similar particularly themes 3A and 3C. I suggest those two themes be combined

18. The second and third paragraph of the discussion could be merged since they present similar information.

19. On page 26 the authors indicated that “The Covid-19 epidemic began at the time we were planning to start our interviews and thus our planned study process was significantly disrupted.” The authors need to restructure this sentence appropriately since it implies the impact of the Covid-19 epidemic is not the main objective of the study.

20. The second paragraph of the conclusion is redundant. The conclusion should be more directed to the implication of the findings to improving healthcare delivery for marginalised people and PWLE

**********

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Reviewer #1: No

Reviewer #2: No

**********

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“Because of Covid…”: The impacts of Covid-19 on First Nation people accessing the HIV cascade of care in Manitoba, Canada.

PONE-D-22-28673R1

Dear Dr. Larcombe,

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,

Miracle Ayomikun Adesina, BPT

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: