Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspective

Robert Kogi; Theresa Krah; Emmanuel Asampong

doi:10.1371/journal.pone.0304592

Peer Review History

Original SubmissionJanuary 19, 2024
6 Mar 2024 Decision Letter - Ibrahim Jahun, Editor PONE-D-24-02076Factors influencing patients on antiretroviral therapy lost to follow up in Asunafo South District of Ahafo Region, GhanaPLOS ONE Dear Dr. Kogi, 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. ============================== ACADEMIC EDITOR: The manuscript is well written and the findings will be of immense importance toward improving retention on ART and VL suppression among people living with HIV in the study locality. To strengthen the manuscript, please respond to the following comments in addition to reviewers comments below. Data availability: Please indicate that data is submitted under "additional documents" Material and methods – please define “retention” and “LTFU" in the context of this study, using reliable references for the definitions. Sampling method and sample size: Purposive sampling used - what criteria used in the selection of the participants (both patients and healthcare providers) Data analysis – please indicate what coding approach was used (deductive vs inductive). Discussion – line 555: what does “Major challenges in carrying out lost to follow up” mean? Please adjust the phrase. Please submit your revised manuscript by Apr 20 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. We look forward to receiving your revised manuscript. Kind regards, Ibrahim Jahun, MD, MSC, PhD 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. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. 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. 4. 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. 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A 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: Yes ****** 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: There may be concerns about the novelty of the findings, but I believe that, as far as the Ahafo region of Ghana is concerned, this study speaks to challenges encountered by the HIV treatment and care system in the execution of its responsibilities. The methodology is sound and simple enough to address the issues identified. I do have some concerns about language (grammar, etc.), but these are minor and revisions have been recommended. Reviewer #2: This is a very interesting paper. The authors should consider the following recommendations: First, the study participants is a mix of healthcare workers and patients on antiretroviral therapy (ART). These two groups have different perspective on factors that influence loss to follow up. Also, considering the non-probability sampling technique that has a higher representation of healthcare workers. The paper will be better focussed if the perspectives of one group either the healthcare workers or patients on ART is presented in this qualitative research. Secondly, the title should be modified to reflect the study participants see suggestion: "Factors influencing patients on antiretroviral therapy loss to follow up: a qualitative analysis of healthcare workers perspective." ****** 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: Yes: Matthias Alagi ******** [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. https://doi.org/10.1371/journal.pone.0304592.r001
Revision 1
13 Mar 2024 Author Response Academic Editor’s comments Data availability: Please indicate that data is submitted under "additional documents: I have added that “the data is submitted under additional documents” in the submission system Material and methods – please define “retention” and “LTFU" in the context of this study, using reliable references for the definitions: I have defined retention on care as “patients who, in the 12 months preceding this study, made at least 4 appointments, with at least 1 visit per quarter (14), and patients who are alive and receiving highly active antiretroviral therapy by the time of conducting this study (15).” And LTFU as “patient(s) not being on ART for more than one month (16)” with their appropriate references in page 6. Sampling method and sample size: Purposive sampling used - what criteria used in the selection of the participants (both patients and healthcare providers): I have stated the criterion for selecting the respondents (healthcare providers) as “purposive sampling was used to identify the health workers based on their knowledge and role in the management of HIV patients” in page 6. However, that of the patients was left out because of the exclusion of the patients from the entire work as suggested by Reviewer #2 Data analysis – please indicate what coding approach was used (deductive vs inductive): I have stated that “We used both deductive and inductive coding approaches in this study. Deductive coding was done with predefined codes or categories being applied based on existing theory or literature (in the basic and organizing themes), while elements of inductive coding was done with themes and patterns allowed to emerge directly from the data (labelled codes) in Table 1.” In page 7 Discussion – line 555: what does “Major challenges in carrying out lost to follow up” mean? Please adjust the phrase: This was addressed as “Challenges facing conduct of patient loss to follow-up exercise” We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match: The Financial Disclosure has been revised and added to the Cover Letter as "Funding for this project was provided by Access and Delivery Partnership (ADP), supported by the Government of Japan and led by the United Nations Development Programme, in collaboration with the World Health Organization’s Special Programme for Research and Training in Tropical Diseases (TDR) and PATH (Grant number: UGSPH/CIRT-M/003)." 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. Data for this study is attached as an additional file to supporting information in this manuscript submission. Reviewer #1 I do have some concerns about language (grammar, etc.), but these are minor and revisions have been recommended. The manuscript has been revised entirely to correct minor identified grammar as indicated throughout the content Reviewer #2 First, the study participants is a mix of healthcare workers and patients on antiretroviral therapy (ART). These two groups have different perspective on factors that influence loss to follow up. Also, considering the non-probability sampling technique that has a higher representation of healthcare workers. The paper will be better focussed if the perspectives of one group either the healthcare workers or patients on ART is presented in this qualitative research. Secondly, the title should be modified to reflect the study participants see suggestion: "Factors influencing patients on antiretroviral therapy loss to follow up: a qualitative analysis of healthcare workers perspective." The content of the manuscript has been appropriately revised to focus on healthcare providers only. The title has also been modified as follows: “Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspective” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0304592.r002
29 Apr 2024 Decision Letter - Ibrahim Jahun, Editor PONE-D-24-02076R1Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspectivePLOS ONE Dear Dr. Kogi, Thank you for submitting your manuscript to PLOS ONE and for addressing most of the comments shared with you during initial review. After careful consideration, we feel that there are few areas that require your attention as indicated by reviewer #2. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised by reviewer 2. You may also notice that we invited additional reviewer (expert in qualitative methodology) to review the methods section, and the reviewer has cleared the methods section. Please submit your revised manuscript by Jun 13 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. We look forward to receiving your revised manuscript. Kind regards, Ibrahim Jahun, MD, MSC, PhD Academic Editor PLOS ONE Journal Requirements: 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. [Note: HTML markup is below. Please do not edit.] 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 Reviewer #3: All comments have been addressed ******** 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 Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A 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 ****** 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 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: This paper is now ready to be published. It is interesting work and I look forward to seeing how it is platformed to improve HIV services in the area. Reviewer #2: Thank you for addressing the earlier review comments. However, the following minor revisions are required: 1. Sampling method and sample size are not described under the methods and materials section. Kindly revise with a brief description of the sampling method and sample size of participants interviewed. 2. Lines 107 - 109 reads "Eligible HIV patients on ART, as well as those on ART but lost to follow-up, were contacted via phone calls by ART nurses to explain the study, and those who accepted were scheduled for face-to-face structured interviews." Kindly delete or explain why patients are being interviewed. 3. Most of lines 105 - 126 describes the study procedure. Kindly consider "Study Procedure" as a more appropriate subheading. 4. The result section should present sociodemographic and occupational characteristics of the healthcare workers interviewed as participants in this study. Thank you once more for paying attention to details. Reviewer #3: (No Response) ****** 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: Yes: Alagi, Matthias Reviewer #3: 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. https://doi.org/10.1371/journal.pone.0304592.r003
Revision 2
8 May 2024 Author Response I would like to bring to your attention that I have responded to all the comments made on our manuscript based on reviewer #2 comments. The responses to the individual comments are appropriately reported in the table below for your consideration. Thank you. #1. Sampling method and sample size are not described under the methods and materials section. Kindly revise with a brief description of the sampling method and sample size of participants interviewed. Response: This section of the manuscript has been revised as follows: “The total sample used in this study was seven (7). This included one doctor, one physician assistant, three ART clinic staff, two community health workers (who were experienced in seeking patients in the community). Purposive sampling was used to identify the health workers based on their knowledge and role in management of HIV patients.” #2. Lines 107 - 109 reads "Eligible HIV patients on ART, as well as those on ART but lost to follow-up, were contacted via phone calls by ART nurses to explain the study, and those who accepted were scheduled for face-to-face structured interviews." Kindly delete or explain why patients are being interviewed. Response: The sentence "Eligible HIV patients on ART, as well as those on ART but lost to follow-up, were contacted via phone calls by ART nurses to explain the study, and those who accepted were scheduled for face-to-face structured interviews." Has been deleted from Lines 107-109. #3. Most of lines 105 - 126 describes the study procedure. Kindly consider "Study Procedure" as a more appropriate subheading. Response: A subheading in Line 110 has been added as "Study Procedure" #4. The result section should present sociodemographic and occupational characteristics of the healthcare workers interviewed as participants in this study. Response: Sociodemographic and occupational characteristics of the healthcare workers have been added in Lines 145-150 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0304592.r004
15 May 2024 Decision Letter - Ibrahim Jahun, Editor Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspective PONE-D-24-02076R2 Dear Dr. Kogi, 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, 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 #2: All comments have been addressed ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: 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 #2: Yes ****** 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 #2: 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 #2: (No Response) ****** 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 #2: Yes: Matthias Alagi ******** https://doi.org/10.1371/journal.pone.0304592.r005
Formally Accepted
21 May 2024 Acceptance Letter - Ibrahim Jahun, Editor PONE-D-24-02076R2 PLOS ONE Dear Dr. Kogi, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ibrahim Jahun Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0304592.r006

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