PONE-D-24-14899Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in NigeriaPLOS ONE

Dear Dr. Kanki,

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 Jul 18 2024 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,

Hlengani Lawrence Chauke, PhD, MBCHB, BTh, Dip HIV Man, FCOG, MMED (O &G), MSc

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

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

2. In this instance it seems there may be acceptable restrictions in place that prevent the public sharing of your minimal data. However, in line with our goal of ensuring long-term data availability to all interested researchers, PLOS’ Data Policy states that authors cannot be the sole named individuals responsible for ensuring data access (http://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-sharing-methods).

Data requests to a non-author institutional point of contact, such as a data access or ethics committee, helps guarantee long term stability and availability of data. Providing interested researchers with a durable point of contact ensures data will be accessible even if an author changes email addresses, institutions, or becomes unavailable to answer requests.

Before we proceed with your manuscript, please also provide non-author contact information (phone/email/hyperlink) for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If no institutional body is available to respond to requests for your minimal data, please consider if there any institutional representatives who did not collaborate in the study, and are not listed as authors on the manuscript, who would be able to hold the data and respond to external requests for data access? If so, please provide their contact information (i.e., email address). Please also provide details on how you will ensure persistent or long-term data storage and availability.

3. 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.

Additional Editor Comments:

Thank you very much for submitting your study to PLOSONE. This is an important study that evaluated ARVs retention, adherence and viral suppression among postpartum women in Nigeria. You raise an important justification for conducting the study, i.e. that there are very few studies that focus on this important period of pregnancy. This is a retrospective study involving a review of data previously collected for the APIN Public Health Initiatives HIV program at JUTH, an initiative that was supported by PEPFAR. A total of 1535 women living with HIV were reviewed ,1497 of whom were on ART. This study not only provide information on ART retention, adherence and viral suppression but also important information on the risk factors for loss of follow up during this important period. Your conclusion is valid and on point. There is a need for prospective studies that focus on providing solutions on how to improve ART retention among postpartum women including qualitative studies to further enlighten us on this topic. The design of the study is appropriate for the research questions and objectives. The same applies regarding the choice of statistical measures. Overall, the manuscript is scientifically sound and well written. The following suggestions are recommended to further improve the paper:

1)Consistency with terminology: Please consider using women living with HIV (WLHIV) or HIV Positive women and not both

2) If possible, consider creating sub-categories under the <1000 bin (e.g. <200 and 200 – 1000) because of the differences in the definition of viral suppression between different regions/countries as well as the differences between Nigeria and US/WHO guidelines. This is important for the international readership and other researchers who might want to replicate the study in their settings. Kindly also respond to the additional comments (attached)  from the reviewers.

Thank you once more for sharing your work

[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: Yes

**********

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

Reviewer #1: Yes

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: Yes

Reviewer #2: No

**********

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

**********

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: Thank you for the opportunity to review this well-written manuscript. It was a pleasure to read and highlights a very real problem in maternal and postpartum HIV care.

The authors conducted a retrospective review of data previously collected as part of the APIN Public Health

Initiatives HIV program at JUTH, supported by PEPFAR. In their study 1535 women living with HIV were reviewed and 1497 were on ART and thus eligible for further review in terms of viral suppression and loss to follow-up analysis. The authors showed that medication adherence (through medication possession ratio) declined from delivery through to 24 months postpartum and that close to 90% of women remained enrolled in care at 24 months post-delivery. Furthermore, the study adds to the literature by highlighting risk factors for loss to follow-up amongst postpartum women.

The authors raise a valid point in that further studies are needed to evaluate solutions for postpartum retention in care and the need for well-designed prospective studies to evaluate these variables. Furthermore, they highlight the need for qualitative studies in this field, something that is often shied away from.

I feel that the manuscript can be strengthened with two minor changes:

1) Please be consistent in your terminology – either “women living with HIV” or “HIV-positive women”

Page 3, Line 34: “ART coverage among pregnant and breastfeeding women with HIV…”

Page 3, Line 38: “among pregnant women with HIV…”

Page 4, line 59: “The study population included 1535 HIV-1-positive pregnant women”

2) In table 1, would it be possible to include a subcategory under the <1000 bin (e.g. <200 and 200 – 1000)? Nigeria seems to have a more liberal definition of viral suppression (1000cp/ml) compared to the US and WHO guidelines of 200cp/ml, so this may aid international readers in understanding the burden of HIV in Nigeria and this data could be compared to other international studies in the future

Thank you again for the opportunity to review your manuscript.

Reviewer #2: The manuscript is well written and makes an important contribution to the literature postpartum viral suppression in women living with HIV.

The are some minor questions that the authors need to address.

**********

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.

Attachments

Attachment

Submitted filename: PONE-D-24-14899.pdf

Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria

PONE-D-24-14899R1

Dear Dr.  Kanki, Phylis, J

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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,

Hlengani Lawrence Chauke, MBCHB, BTh, Dip HIV Man, FCOG, MMED (O &G), MSc

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I would like to confirm that all the issues have been satisfactorily addressed. Thank you once again for all your effort.