PONE-D-23-16392Magnitude of consistent condom use and associated factors among peoples living with HIV/AIDS in Ethiopia: Implication for reducing infections and re-infection. A systematic review and meta-analysisPLOS ONE

Dear Dr. Bekele,

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https://link.springer.com/article/10.1186/s12889-019-8133-y

https://www.researchgate.net/publication/354994362_Prevalence_of_Consistent_Condom_Use_and_Associated_Factors_among_Serodiscordant_Couples_in_Ethiopia_2020_A_Mixed-Method_Study

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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: Partly

Reviewer #2: Partly

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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?

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Reviewer #1: No

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: - Thank you for requesting my opinion on this work. The authors conducted a systematic review and meta-analysis to determine the magnitude of consistent condom use and associated factors among people living with HIV/AIDS in Ethiopia and their implications for reducing infections and re-infection. However, several distinct systematic reviews and meta-analyses regarding risky sexual behaviour among HIV/AIDS patients have been conducted in Ethiopia. These studies used a similar operational definition and cited inconsistent condom use as a risky sexual practise. Additionally, I was unable to gain any new information or insights from this study, and the authors were unable to present concrete evidence that there was a literature gap or any other factors that made the current research different from previously published publications.

- The authors used the terms "adherence to self-care" and "consistently used condoms" interchangeably; I'm not sure these terms are similar, and I believe they have different meanings in this context. Consistent condom use may be one self-care practise that people with HIV/AIDS engage in, and self-care is a holistic approach. I advise the authors to employ one of them consistently throughout the whole paper.

- What are the gaps? I've noticed that the introduction is very poor and insufficient, and there is no clear, updated context about the current situation of HIV/AIDS in Ethiopia. Moreover, the report fails to explain how it differs from earlier comparable systematic reviews and meta-analyses. Additionally, most of the references are incorrectly cited. For instance, the authors used reference number 3 to illustrate the prevalence of HIV/AIDS in Ethiopia, but the cited study was unable to provide this data; as a result, the correct data for this information can be found in this article/Ababa A. Ethiopia. Abstract available from: https://wfpha.confex.com/wfpha/2012/webprogram/Paper10587.html. 2013.

- The author said that the review procedure was registered on PROSPERO CRD430396 in the method section. However, the registration digits were missing; therefore, if the review was registered, I advise the author to supply the whole registration number.

- Search strategies: It would be good practice to include the search strategies and the number of hits for each line as an appendix or supplementary material.

- If possible, could you elaborate on the inclusion and exclusion criteria under the heading "Eligibility criteria" for the review? How about the primary study's choice of study design?

- The Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument (JBIMAStARI) was used by the authors to evaluate the quality of their work; however, they were unable to describe how to utilise it. no explanation of the criteria used for assessing quality. When do you say good quality article?" Could you please describe how to use the tool? How many reviewers, for instance, completed the quality assessment? Additionally, I didn't see any reports about quality evaluation in the results section.

- In this final method part subheading, authors wrote about the risk of bias. I'm not sure what the authors are saying, it sounds like personal opinion. Please provide concise support and write it better in the analysis portion with the proper reference.

- The data analysis and synthesis sections were extremely short, and all the plans utilised were not cited. In addition, the authors didn't specify which model to apply (fixed effect or random); what about the pan-sub-group and sensitivity analyses? What is the evidence for claiming heterogeneity at a p-value of 0.05?

- in the result, according to the criteria in the method section, your study's heterogeneity was moderate. What does it stand for? Describe it in detail, please. Describe the probable effects of this moderate degree of heterogeneity on the pooled prevalence estimate and discuss any possible causes of this moderate level of heterogeneity.

- In discussion section, how did the authors ensure that, to the best of their knowledge, this meta-analysis and systematic review are the first of their kind to be conducted at the national level in Ethiopia to estimate the magnitude and identify the factors associated with consistent condom use among HIV/AIDS patients, despite the fact that many other studies of a similar nature have been carried out in Ethiopia?

- The discussion portion is too short and lacks comparison of the details with the existing evidence. The authors failed to highlight the clinical implications, and I was unable to locate the implications of this study for stakeholders and policymakers. They also made no recommendations for these groups of people.

- Finally, I advise the author to thoroughly review every area of the work and seek the advice of professionals in grammar and language.

Reviewer #2: This paper explores extent of consistent condom use and factors associated with consistent condom use among people living with HIV in Ethiopia. Although the topic is important, there are several issues in presentation of the data. There has been inconsistent use of the language, and language appropriateness. Overall, Although methodologically correct, It needs to be thoroughly reviewed by an English speaker. Below are few examples of the areas need to be revised, however, there is a lot more than what I singled out.

Comments

Abstract:

Results section there is a sentence “ the pooled estimate of self-care (What is self-care? It has never been defined earlier. I expected pooled prevalence of consistent condom use instead of self-care)

Conclusion: This study shown that (it should be showed)

“telling their sexual partners about their” Disclosing HIV status is better than telling their partners…..

Background:

…..is dependent on the consistent and proper use of condoms(2, 4-6). However, people who started (There is no connection with the use of word however here.)

Sub-Saharan Africa, especially Ethiopia, has a very high incidence of the problem (2). (Better state it explicitly instead of referring it as a problem

Despite a variable reports of magnitude and…… (Grammatically incorrect)

Methods

The objective of the review was to conclude the magnitude and associated factors of consistent

condom use among peoples living with HIV/AIDS in Ethiopia (This needs revision such as ……..magnitude of consistent condom use and factors associated with consistent condom use……..)

MESH term for the database is ( should be MESH term for the database were…..)

Discussion

The rate of adherence ….. (Adherence to what? better use same word consistent cdm use.)

patients who reported their status (disclosed? reported to who?)

This result was at odds with the research on Cameroon (I don’t understand what is meant here)

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Magnitude of consistent condom use and associated factors among peoples living with.docx

PONE-D-23-16392R1Magnitude of consistent condom use and associated factors among peoples living with HIV/AIDS in Ethiopia: Implication for reducing infections and re-infection. A systematic review and meta-analysisPLOS ONE

Dear Dr. Negera,

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 Mar 08 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,

Nagasa Dida, MPH

Academic Editor

PLOS ONE

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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.

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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: (No Response)

Reviewer #2: (No Response)

Reviewer #3: 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: Partly

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #3: 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: No

Reviewer #3: 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 #1: I appreciate the editors asking me to assess the article once more; the authors did a good job of improving it. Before accepting the article for publication, I offered a few comments and suggestions that needed to be addressed.

- The authors noted that there was conflicting evidence available in Ethiopia about the prevalence and correlates of frequent condom usage in the abstract portion of the paper. Keeping this in mind, how do the authors address these problems? How do they generate fresh evidence? What were the conflicting issues that appeared in earlier literature?

- The abstract's method section has to be updated in light of the objectives: How was consistent condom usage measured and reported? How were the factors associated with condom use described and their statistical significance determined? How about sub-group analysis carried out by region or any other criteria, too? How was the objective publication bias determined?

- The numbers on the number of people living with HIV/AIDS needed to be reported along with the year, as stated in the first and second paragraphs of the introduction. At what time did this report occur?

- In the introduction section, the authors noted that different countries use condoms at varying rates. To get a better general picture of condom usage among HIV/AIDS patients, I asked the authors to describe the prevalence of condom use among people living with the disease elsewhere in the world, with a focus on sub-Saharan Africa and Ethiopia.

-be more appropriate to cite the prior comparable reviews and analyses that have concentrated on risky sexual activity, which is different from your work on regular condom use? Could you offer any alternative suggestions to the ones found in the earlier studies? On the other hand, tackling risky sexual behavior entails encouraging frequent condom usage, right? Could there be different results? I believe that all of your research and earlier studies focused on preventing HIV/AIDS and re-infection.

- on objectives: The objective of the review was to conclude the magnitude and associated factors of consistent condom use among people living with HIV/AIDS in Ethiopia. It is better to say to detrmine instead of to conclude.

- on search strategies: It would be best practice to include the search methods and the quantity of results for each database as an appendix or supplemental material. However, the authors either didn't do that or we don't have access to the supplemental table outlining the search methods and findings for each database.

- Why a publication year-based subgroup analysis? Does it affect the study in any way?

- The discussion part still requires improvement and a more thorough comparison with past similar reviews and meta-analyses conducted worldwide. The comparison between this pooled prevalence and other studies' point prevalence was the authors' sole focus. When comparing the pooled data with point prevalence, is it good?

- On the other hand, the authors calculated the pooled odds ratio of factors affecting consistently using condoms in Ethiopia. then continue comparing the findings to those of another study done in Ethiopia (Dessie)? What caused it? What's the point? They neglected to include this study in their evaluation.

- in relation to the study's implications. Pharaphrasing and citations are necessary.

- The authors needed to describe the sub-group analysis by region in the discussion section for better clarity, policy implications, and to identify the region of requirements (regional variance). can explain the differences as well as make recommendations for areas with low prevalence?

- In the limitation section? Does your study represent the whole region of Ethiopia? Are all regions of Ethiopia represented?

- The conclusion is far too short. Try to address all of the key findings and make workable suggestions.

Good luck.

Reviewer #2: Title; Change peoples to people

Abstract: More than one million peoples…. (change peoples to people)

….among HIV patients…., change it to people living with HIV or people with HIV

We have used four databases such as PubMed, when you say such as is like you are giving examples of the databases but not exact databases you searched information. Revise this sentence because those databases are the one you sought information

Main text

Methods: …Accordingly, the articles was (should be article was or articles were)

Results …majority of the participant was female in all articles ( should be majority of participants were..)

….who were disclosed their status was 5.61 time … (should be who disclosed their status…)

…patients who were live in urban area was 3.46 time (should be … who live in urban area were 3.46 times … or who are living in urban area were …..)

…patients who were married was 67% times ( should be patients who were married were 67% times…)

In addition, the measure of effect used was odd ratio, however, the interpretation is like risk ratio.

It should be something like people living in urban areas have higher odds or reporting consistent condom use compared to rural areas. Not saying people living in urban areas are more likely reporting consistent condom use compared to rural areas.

Reviewer #3: Thank you for addressing the points highlighted in the previous review. The manuscript reads well and is technically sound.

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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

Reviewer #3: No

**********

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Attachments

Attachment

Submitted filename: Comments_11NOV2024.docx

Magnitude of consistent condom use and associated factors among people living with HIV/AIDS in Ethiopia: Implication for reducing infections and re-infection. A systematic review and meta-analysis

PONE-D-23-16392R2

Dear Dr. Firomsa Bekele, MSc

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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Yimam Getaneh Misganie, PhD

Academic Editor

PLOS ONE

Additional Editor Comments:

o Contextualization: Provide context for the prevalence of consistent condom use in Ethiopia. How does it compare to other regions or global estimates? And Discuss the sociocultural factors that may influence condom use in the Ethiopian context.

o References: Ensure that all references adhere to the PLOS ONE citation style. Cross-check DOI numbers, journal titles, and page numbers for accuracy.

o Policy and Practice Implications: Highlight practical implications for public health programs. How can the findings inform interventions to promote consistent condom use? Remember to provide specific examples and actionable suggestions to help the authors improve their manuscript.