PONE-D-23-29770Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: a mixed-methods evaluation.PLOS ONE

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: This feasibility study on the implementation of Advanced HIV disease care package on 1392 PLHIV was very well conducted. The outcome of this study will be useful for the country programs when AHD is getting implemented.

Reviewer #2: In this implementation science study, Gils et al implement the AHD package of care into a TB case finding setting.

Overall this study is well conducted and well explained.

1. I would recommend the authors add further detail regarding the characteristics of the clinic and laboratories that wer e included in this study.

Study setting is only briefly mentioned in lines 93-94.

Please clarify what a "container-based clinic" refers to. And what is meant by a 'mobile unit' (line 94).

What types of clinics were these. On average how many patients are seen per day/week/year. What type of laboratory did they have. How many lab staff were available, and what other types of tests were being performed at the same time? This will help us to better understand implementation of the AHD package of care in context.

Are these busy, high volume clinics/labs that run many other tests? Or are these rural, low volume sites where they have a dedicated lab worker to run the Visitect test?

2. I strongly suspect that you have inaccurate Visitect results (meaning that there are many people with CD4>200 who were misclassified as having a CD4<200), as the authors have suggested in the Discussion. Which would explain high survival (low mortality) among the population with AHD.

As such, I would recommend softening your conclusions (in the paper and in the abstract), accounting for this critical limitation. Specifically in lines 47-48: "AHD nor TB were associated with survival suggesting adequate management referral". I think the lack of association with reduced survival suggests false positive Visitect results contaminating your AHD population. I would add that to your abstract. I find the wording of lines 47-48 to be confusing, with the word "nor" but "neither".

I think the issue of inaccurate Visitect results is so important in accounting for any conclusions, I would include it at the end of the first paragraph of your Discussion. Without that context, people might conclude that people with AHD have good survival and there's really no reason to perform additional interventions/dedicate additional resources here. Which I believe is incorrect.

Minor point:

The Tables appear to be mislabeled. Two tables are labeled as 'Table 2'.

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Reviewer #1: No

Reviewer #2: No

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Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: a mixed-methods evaluation.

PONE-D-23-29770R1

Dear Dr. Gils Tinne,

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,

Lynn S Zijenah, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: