PONE-D-23-22669Hepatitis B and C viral coinfection and associated factors among HIV positive patients attending ART clinics of Afar regional state, northeast EthiopiaPLOS ONE

Dear Dr. Hagos,

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PLOS ONE

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Additional Editor Comments:

This is a cross-sectional study of hepatitis B and hepatitis C in HIV positive persons in Ethiopia.

The study design is standard.  The manuscript should be revised by a native English speaker and/or a professional editing service.

The patients are presenting to several ART clinics; yet, information on specific ART regimens is never provided.  Since some HIV regimens are active against HBV, this is important information to include.

A number of studies related to HBV and HCV prevalence have been conducted in Ethiopia and cited by the authors.  It is quite unclear why another such study was needed and how the current manuscript is similar to or distinct from those previous studies.

The study limitations should also state that HBV DNA and HCV RNA levels were not evaluated.

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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: No

Reviewer #2: Yes

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

Reviewer #1: No

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: No

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: 1.The paper needs to be revised for English and grammar editing (e.g., line 105-108, 184, 208).

2.Line 94 samara should be written in capital letter (southwest of Samara)

3.Line 96 and 98 clients should be changed to participants or patients.

4.Line 106: It is not clear what is meant by Source population.

5.Line 105-108-The paragraph need to be rephrased.

6.It is not clear how long the participant was on ART and whether their medications included treatment that can treat HBV.

7.Line 127: It is not clear why vaccinated individuals were excluded from the study since they did not check for other serological markers. Kindly clarify in the manuscript whether participants’ vaccination history was self-reported only or confirmed using clinical records. The limitations of relying on self-reported clinical history / patient recall, should be adequately addressed in the manuscript where appropriate.

8.The authors allude to the use of a questionnaire in collecting relevant participant data. For validation purposes, kindly indicate of this questionnaire was piloted. Was a previously published questionnaire used during this study (in which case it should be appropriately cited and referenced) or if a study specific one was developed, can a template be provided as part of supplementary material.

9.The statistical analysis is not in deep described and is not clear which statistical analysis was performed for descriptive analysis.

10.Line 198-199: It is not clear whether the patient who tested negative by ELISA was HCV or HBV positive by rapid. The author should include the rapid results first.

11.Did the authors investigate whether those who have multi-sexual were commercial sex workers or not?

12.Table 1: p value of 0.206 in the variable scarification variables is more than 0.2; Second. & above should read secondary in the educational level variable; Indicate how many were commercial sex worker since it is a high risk for infection under the occupation variable.

13.Write all the abbreviations in full

14.Line 272: It is not clear if Egypt screened blood transfusion for HBV/HCV/HIV. If it is done, when was it introduced? Did the participant indicate when they were transfused? If blood is screened for viruses there might be the reason why HCV is low.

15.Line 276-282: There was no statistical significance with age and educational level.

16.The discussion section should be reorganized. Discussion section should relate to the literature review and research questions and making an argument in support of the overall conclusion.

Reviewer #2: The study entitled “Hepatitis B and C viral co-infection and associated factors among HIV positive patients attending ART clinics of Afar regional state, northeast Ethiopia” was aimed to describe the

prevalence of HBV and HCV coinfection and associated factors among HIV-positive patients in the region of Ethiopia.

The authors are commended on their succinct and foundation of evidence for hepatitis B and C in HIV co-infected patients in a region in Ethiopia.

Introduction:

It is recommended that the introduction should include more on the testing practice for viral hepatitis B and C in the country, some information on the vaccine policy and coverage for hepatitis B and treatment accessibility for hepatitis B and C, mono-infected and co-infected patients in the country. The added information will lead to an understanding to the findings and discussion in relation to age groups, gender and risks.

There were a few grammatical errors in the document and it is suggested that the authors go through and correct.

Page 3, line 44 and 46, change “peoples” to people

Page 6, line 94, use capital “S” fro Samara

Page 7, line 112, is the estimated 6.1% prevalence for HIV? HBV? HCV? Or co-infections?

Page 9, line 137, Is “multi-sexual practice” homosexual and heterosexual practice with multiple partners? Please may you define or provide reference to this?

Page 10, line 148, add “a” to test tube

Page 17, line 243, “O” in “our” should be in small letter “o”.

Page 18, line 252, our results ‘were” however….

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Reviewer #1: No

Reviewer #2: No

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Hepatitis B and C viral coinfection and associated factors among HIV-positive patients attending ART clinics of Afar regional state, northeast Ethiopia

PONE-D-23-22669R1

Dear Dr. Hagos,

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,

Jason T. Blackard, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

None

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 #2: 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 #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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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 #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: Yes

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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: The author has addressed all the comments satisfactorily and the manuscript should now be accepted for publication.

Reviewer #2: most of the pertinent comments by the reviewers were addressed by the authors. there are several limitations which were outlined by the authors. It is still difficult to determine the extent of risk of transmission as numbers were small, as alluded by the authors. However, the association output was interesting findings for the region.

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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 #1: No

Reviewer #2: No

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