PONE-D-23-05654Population-level prevalence of detectable HIV viremia in people who inject drugs in Ukraine: implications for HIV treatment and case finding interventions.PLOS ONE

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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: I Don't Know

Reviewer #2: Yes

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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: Yes

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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: General

This is a well written paper. It presents on an important issue in achieving the 90-90-90 – viral load suppression. By presenting prevalence of detectable viraemia and its correlates, the information could help drive efforts at achieving the 3rd 95 of the UN strategy among HIV-positive PWIDs in Ukraine.

The comments I provide here are to help the reader of the paper when published to better understand the information provided

Abstract

Line 33/34. In describing the relationship between HIV-negative PWID and HIV-positive PWID, consider using the phrase “compared with” in place of the word “unlike”.

Materials and methods

• General: This section has all the information needed, but the arrangement can be confusing. It appears the methods described here are reported in a previous study by Sazanova et al (2020; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244572#pone-0244572-t002). If this is the case, authors are advised to refer the reader of this manuscript to the paper by Sazanova for details of the methods and endeavor to summarize it here, following the chronology and clarity in the referenced paper.

• However, I provide further specific comments below:

Study setting and design

• The chronological presentation of the paragraphs can be improved for better logical flow.

• The section includes sample size determination and calculation, which is not covered in the sub-heading. Consider a new section on sample size or expand the present sub-heading to include it – e.g “Study setting, design and sample”.

• Lines 71/73 – Part of the sentence here is a repetition of the first sentence in this section. Consider reviewing this sentence to remove redundancy.

• Lines 79/80 – Unless the aim here is to demonstrate the role of incentives in the recruitment, I would suggest that this issue is presented under the “ethical considerations” section.

Data collection

• General – one can deduce that what is presented here is a set of procedures used to collect data for the study. In chronology as presented, this includes blood collection and biomarker testing, and questionnaire-based interview. For better clarity, the authors may wish to consider presenting these separate paragraphs. Issues about how the data from the separate parts of the study was linked and referral services provided for HIV and HCV-positive participants can be discussed subsequently. But it is also important to mention what happened to HIV and HCV-negative participants. A sentence on pre and posttest counselling can be added in chronological flow with referral services to make the appropriate point.

• Line 82/83 – In the light of the general observation above, the authors may wish to revise the opening sentence to be more specific about the data collection algorithm alone. For example – “Data collection was achieved through three different mechanisms – questionnaire-based interview, blood collection, and biomarker testing for HIV, HCV and VL.” A chronology that presents the process followed in the field to a greater extent would provide more clarity.

• Line 83 – did the authors mean to say, “obtaining informed consent”? It feels like informed consent written alone does not say what was done.

Ethical considerations

Line 121 – I think the authors are missing the word “be” in the following phrase: “procedures and was determined to research”

Results

Line 215 – In presenting results on wage earning, it is important to be clear when mention is made of low or high wage. The tables (1 and 2) are clear of the income/wage classifications. Thus, if by “low monthly income” on line 215, the authors meant to say, “monthly income below minimum wage”, then using the right descriptor would help the reader more. This issue is observed in other parts of the paper for the authors’ consideration.

Lines 261/262 – It is not clear, the message that these phrases sought to convey – “had average monthly income in reference to lower income level” and “had any educational level than completed school”. The authors should kindly review and provide better clarity as necessary.

Discussion

Line 286 – While it is accurate that more than 11.1% of all PWIDs were reported to have DV in this paper, when compared to the actual reported estimate of 11.4%, this statement could lead the audience to wrong conclusions. Authors should consider revising this statement to avoid such risks.

Lines 316-319 – The two sentences here can be improved upon (Nearly 73% of HIV-positive PWID with DV generally did not engage in ART. This proportion among the young age group (<35 years old), subgroup with low education level, and those who reported about monthly income higher than on average ranged from 81%-85%.). Consider instead the following:

“Nearly 73% of HIV-positive PWID with DV generally did not engage in ART. Of this group, 81%-85% on average is characterized by young persons (<35 years old), those with low education, and those with reported higher than national average monthly income”

This is how I am reading the two sentences. The authors should consider the most appropriate revision though.

Lines 369/370 – This phrase in the last sentence can be revised for better clarity “treatment service to sensitize their approaches to access populations with greater needs.”

Reviewer #2: The manuscript was well structured and just has some minimal adjustments required to make it better.

1. Line 46 – Add a sentence on the total number of PLHIV who are on ART.

2. Line 52 – Give an estimate of the total number of PWIDs in Ukraine before you write the proportion of these PWIDs that have HIV.

3. Line 70 – State the selection criteria and sampling methods used to select these 30 cities.

4. Data collection – State the protocol used for the data collection for PWIDs who already knew their HIV status and were already on ART. Did you repeat HIV rapid tests for them?

5. Results – For clients with detectable viral loads, compare if duration of ART treatment has a significant relationship with the level of viremia.

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Reviewer #1: No

Reviewer #2: Yes: ODUME BETHRAND (DR)

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Attachments

Attachment

Submitted filename: PONE-D-23-05654 Review Comments VLS in Ukraine.docx

Population-level prevalence of detectable HIV viremia in people who inject drugs (PWID) in Ukraine: implications for HIV treatment and case finding interventions

PONE-D-23-05654R1

Dear Dr. Sazonova,

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.

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Kind regards,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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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 #3: Yes

Reviewer #4: Yes

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

Reviewer #3: Yes

Reviewer #4: I Don't Know

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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 #3: Yes

Reviewer #4: Yes

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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 #3: Yes

Reviewer #4: 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 #3: The manuscript is technically sound and the authors have addressed all the comments raised by reviewer 2 in the earlier submission. The manuscript is now fit for acceptance and publication.

Reviewer #4: (No Response)

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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 #3: No

Reviewer #4: No

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