PONE-D-24-00224Spatial variation and predictors of inadequate HIV/AIDS knowledge among Ethiopian Women: A spatial and multilevel analyses of the 2016 Demographic Health SurveyPLOS ONE

Dear Dr. Habte,

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 28 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,

Clement Ameh Yaro, Ph.D

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. For studies involving third-party data, we encourage authors to share any data specific to their analyses that they can legally distribute. PLOS recognizes, however, that authors may be using third-party data they do not have the rights to share. When third-party data cannot be publicly shared, authors must provide all information necessary for interested researchers to apply to gain access to the data. (https://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-access-restrictions)

For any third-party data that the authors cannot legally distribute, they should include the following information in their Data Availability Statement upon submission:

a) A description of the data set and the third-party source

b) If applicable, verification of permission to use the data set

c) Confirmation of whether the authors received any special privileges in accessing the data that other researchers would not have

d) All necessary contact information others would need to apply to gain access to the data

3. We note that Figures 2,4,5,6,7,8,9,10,11 and 12 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright.

We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission:

a. You may seek permission from the original copyright holder of Figures 2,4,5,6,7,8,9,10,11 and 12 to publish the content specifically under the CC BY 4.0 license. 

We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text:

“I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.”

Please upload the completed Content Permission Form or other proof of granted permissions as an "Other" file with your submission.

In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].”

b. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only.

The following resources for replacing copyrighted map figures may be helpful:

USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/

The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/

Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html

NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/

Landsat: http://landsat.visibleearth.nasa.gov/

USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/#

Natural Earth (public domain): http://www.naturalearthdata.com/

[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: Partly

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #3: Yes

Reviewer #4: 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: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: If the authors address all the comments and suggestions provided, the paper has the potential to become significant for publication and beneficial for readers. However, if the recommendations are not adequately addressed, it may be advisable to decline the paper. Ensuring that all comments are thoroughly incorporated can significantly enhance the paper's quality, relevance, and contribution to the field. Therefore, it is essential for the authors to carefully consider and implement the suggested revisions to maximize the paper's impact and value for both the scientific community and readers.

Reviewer #2: Abstract

The abstract section you provided appears to be generally well-written and provides a clear overview of the study's objectives, methods, and findings. However, there are a few areas where the abstract could be improved:

Background: It would be helpful to include more detailed information in the background section regarding the research that have been done on Ethiopian women's awareness of HIV/AIDS. It would be useful to specify the number of studies, their scope, and any important conclusions or limits rather than just saying that "some studies" were undertaken. If your goal is to investigate the gaps in your knowledge, then please be content with that.

Objective: Where are the predictors found by the regression analysis in this case that the author stated, "Consequently, this study attempted to assess the prevalence, geographical variation (Hotspots), spatial predictors, and multilevel correlations of inadequate HIV/AIDS awareness among Ethiopian women"? Because of this, the spatial regression method was used to identify your predictors instead of the multilevel regression analysis. What does little understanding of HIV/AIDS mean in terms of multilayer correlates? The writers must choose the appropriate regression model and have a well-defined target.

Methods: Although the study's use of data from the 2016 Ethiopian Demographic and Health Survey is noted, it would be beneficial to include a brief overview of the survey's methodology and sampling plan. This would provide readers a clearer picture of the sample's representativeness and the source of the data.

Results: The prevalence of inadequate knowledge about HIV/AIDS among Ethiopian women is presented in the abstract; nonetheless, it would be helpful to give a brief overview of the main multilevel and spatial correlates of inadequate knowledge. This would help readers understand the causes of insufficient knowledge and the extent of their impacts.

Which source did you use to get the reference group variables?

Conclusion: Expanding the conclusion section to include more detailed suggestions based on the data would be beneficial. For instance, it might outline the precise treatments or tactics that could be used to close the observed knowledge gaps, rather than just recommending the need for customized health education and awareness campaigns.

Introduction

The introduction section you provided contains valuable information about the global and Ethiopian context of HIV/AIDS and the importance of comprehensive knowledge for prevention efforts. However, there are a few areas where the introduction could be improved:

Structure: There is room for improvement in the introduction's structure. Think about breaking up the section into paragraphs that each focus on a different facet of the subject. The content would flow more easily for readers as a result.

Citations: It would be beneficial to give precise citations for each piece of material, even though you have included some references to back up the claims stated in the introduction. This will guarantee the accuracy of the material provided and allow readers the chance to go further into the research that are cited for further details.

Clarity and Conciseness: The introduction has a few long and complicated sentences that may be challenging to grasp. To make the text easier to understand, try to make the language simpler and divide longer, more complicated statements into shorter, more direct ones.

Research Gap: Although the introduction notes that earlier research on Ethiopian women's comprehensive knowledge of HIV/AIDS was small in scale and scope, it would be helpful to highlight the particular research gap that this study attempts to fill. Indicate exactly how this study is different from the others and what special contributions it will make. In comparison to other earlier studies, the research gap was not often addressed or stated very clearly.

Significance: The study's possible ramifications for community empowerment, policy decisions, and focused interventions are touched upon in passing in the introduction. Explain the wider significance of filling the identified research gap as well as any possible practical ramifications in order to strengthen this section.

The introductory section can be improved to give a more condensed and targeted summary of the background, purpose, and importance of the study by taking these ideas into consideration.

Regarding SDG 3, the references 3 and 4 were incorrect. Kindly make use of the primary source for your information.

Some of the references are outdated (e.g. reference 13 was published since 1997)

Although the author claimed that references 20 and 23–25 were narrow in scope and did not examine the elements at the person and community levels, these references are not as narrow as the author claimed.

There are instances of misspellings, acronyms, and capitalizations throughout the entire document. Therefore, kindly make the necessary revisions.

Methods

First create an independent section about the study setting, and period, before you go to the data and population section.

Data and population

Women who have missing data about their residential area locations via the geographical positioning system (GPS) were excluded from the spatial analysis. How did you do it? Does this meet the proper exclusion criteria for your study over the other criteria? Create an independent section titled “Source and Study Population," and then you might narrate the criteria for your study.

Sampling procedures

Please kindly include more depth information about it for readers. We did not expect to ready your references always. Put them according to the previous studies or the DHS information (for illustration urban versus rural household allocations, and total EAs in Ethiopia were not addressed). Furthermore, the authors did not inform us about data collection tools, however, they put it in the title as a subsection in the methods

References 21, 27, and 28 are not your appropriate evidence. Moreover, the publication data (1998) and the information inside it are quite different with regard to your interest. Kindly revise them.

Measurement of variables of the study

The author should see it again in this section. First, the outcome ascertainment should be based on the guide to DHS, not on the interest of the author. Second, utilizing “mean” on compressive knowledge is not recommended by the guidelines; however, the author did it. Why? Based on what criteria or reference they used, Third, adequate and inadequate categorization should be read again by the author. Fourth, there are also attitude- or practice-related questions in their tool; however, they treated them for knowledge, and this should be taken into consideration. Finally, the author provided a reference for their outcome classification (reference 29); however, this reference was not the right reference for the outcome of interest. Outcome ascertainment is the heart of every research project and should be corrected properly before going to the next step.

Explanatory variables

The author missed some important variables such as working or employment status, ANC, place of delivery, health visits, modern contraceptive utilization (the given contraceptive utilization should be clearly defined rather than using any methods), sex of the given household head, breastfeeding status, and other individual-level factors. Fortunately, all these variables are available in the EDHS 2016 dataset. Furthermore, the author failed to include important community-level factors, such as community women's wealth, community women's education level, community-level ANC coverage, community-level women's mass media exposure, and so on. Kindly include all these and other important variables in your outcome.

Variable selection and categorization should be done in an acceptable manner. For instance, media exposure was better classified into either of the three types (TV, radio, or newspapers). Having a mobile phone or not will not have a great implication in the context of Ethiopia. (Assume your data collection period.)

Data management and statistical analysis

Why used weighting factor v005/1000000, why not other numbers like 1000, or 10000000

If you used GWR, why did you use a multilevel analysis again? or you did not do GWR. The GWR is the regression component for the spatial analysis, and if you applied the GWR, then your probability of coming back again to the multilevel analysis is not feasible. Spatial and multilevel analyses are quite different approaches, and the best regression for you is GWR rather than GLMM.

Use associated factors, or determinants instead of predictors

May the author show us the dataset of outcome variable ascertainments, and the performance of the OLS, and GWR regressions or the do file?

Use the phrase multilevel or mixed effect analysis separately, they are the same thing. Don’t use them as multilevel mixed effect analysis

The outcome variable categorization should be the same for the spatial and regression analyses, either inadequate or adequate knowledge about HIV/AIDS

Use either AIC, or BIC. These two are have different assumptions and working correlation regarding the complexity and parameters of the given model

Although the data has missing values, the author failed to inform how they managed the missing values.

Results

Somalia Vs Somali, should be corrected

The results sections seem discussion due its lot interpretation

Put number before the percentage. For instance, (876 (34.3%)

There is inconsistency of variables utilization throughout the manuscript. Variables from the regression table should be incorporated in the descriptive sections first

Put the PCV, and MOR

Please interpret and talk about the OLS model Diagnosis in your article

Explain the random variation in better please

Use either AOR or aOR, including the abstract section

Discussion

Overall, the discussion section provides a comprehensive analysis of the study's findings and their implications. However, there are a few areas where the discussion could be improved:

Interpretation of Findings: The discussion primarily presents the findings without delving into their underlying causes or providing in-depth interpretations. For example, when discussing the determinants of inadequate comprehensive knowledge, it would be beneficial to explore the mechanisms through which factors such as education, wealth quintile, autonomy, and media exposure influence knowledge levels. Providing a more nuanced understanding of these relationships would enhance the discussion.

Comparison with Other Studies: The discussion includes comparisons with studies conducted in other countries, highlighting differences in knowledge levels. However, it would be helpful to provide more context by discussing potential reasons for the variations observed. What are the specific factors that contribute to higher or lower knowledge levels in different countries? This would allow for a more meaningful comparison and a deeper understanding of the factors influencing knowledge levels.

Implications and Recommendations: While the discussion briefly mentions the need for tailored interventions and policy initiatives, it could benefit from more concrete recommendations based on the study's findings. For instance, how can public health campaigns, education programs, and policy initiatives be designed to address the identified determinants of inadequate knowledge? What specific strategies can be employed to improve access to education, healthcare, and media exposure? Providing practical recommendations would enhance the applicability of the study's findings.

Limitations: The discussion mentions the limitations of the study, such as the cross-sectional nature of the data and the potential for recall and social desirability biases. However, it would be beneficial to discuss these limitations in more detail and consider their impact on the study's findings. Additionally, it would be helpful to suggest avenues for future research that could address these limitations and provide a more robust understanding of HIV/AIDS knowledge among Ethiopian women.

By addressing these suggestions, the discussion section can be improved to provide a more thorough analysis of the study's findings, their implications, and recommendations for future interventions and research.

Conclusion

Try to include the implication of your study briefly.

Reviewer #3: This is very interesting paper as it incorporates different statistical approaches to identify factors associated with inadequate HIV/AIDS knowledge among Ethiopian women

Methodology

1.The prevalence of inadequate HIV/AIDS knowledge among Ethiopian women was reported 48.9%. Considering the cross-sectional nature of the data and the large prevalence of the outcome variable, odds ratio might overestimate the association between the dependent and independent variables. Therefore in my view multilevel Poisson regression analysis with robust variance would be preferable.

2.To show the scale of spatial variation in the relationship between the outcome and predictors, the GWR bandwidth (whether adaptive or fixed) should be reported.

Results

1.In the Satscan analysis, the map with circular windows should be mapped

2.In the interpretation of figure 10, 11 and 12, negative coefficients needs to be interpreted. The authors should also consider demonstrating what positive or negative coefficients mean.

Discussion

1.The GWR analysis, which is the major part of the study was not discussed. Authors should discuss the findings well.

Reviewer #4: I would like to say thank you for considering me to review your paper which is current issue entitled as “Spatial variation and predictors of inadequate HIV/AIDS knowledge among Ethiopian Women: A spatial and multilevel analyses of the 2016 Demographic Health Survey”.

Generally, it is interesting title, information is current issue in the world and the information is so far limited, however the data source is too outdated. Saying this the following massage and question should be addressed.

1.You should revise the manuscript based on Plose one manuscript preparation guideline

2.In your manuscript, you have used abbreviation in title and abstract part. Do you believe this is appropriate and advisable in scientific research journal?

3. Should write the study design clearly you used from your data source?

4.What is the importance of doing geographically weighted regression and logistic regression simultaneously? I think geographically weighted regression is strong enough to generate your evidence?

5.

**********

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: Bewuketu Terefe

Reviewer #3: No

Reviewer #4: 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: comments.pdf

Attachment

Submitted filename: Peer review for HIV knowledge.docx

Attachment

Submitted filename: PONE-D-24-00224_reviewer commenet.pdf

Attachment

Submitted filename: Reviewing of paper (2 Ethiopia).docx

PONE-D-24-00224R1Spatial variation and predictors of inadequate HIV/AIDS knowledge among Ethiopian Women: A spatial and multilevel analyses of the 2016 Demographic Health SurveyPLOS ONE

Dear Dr. Habte,

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 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.

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,

Clement Ameh Yaro, Ph.D

Academic Editor

PLOS ONE

[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 #2: (No Response)

Reviewer #4: 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

Reviewer #4: Yes

**********

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

Reviewer #2: No

Reviewer #4: 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

Reviewer #4: 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

Reviewer #4: 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: I beg you to disagree about your outcome ascertainment technique. I have seen the guidelines for DHS statistics, and they do not support your methods of outcome ascertainment.

Reviewer #4: I could not agree more, I have no concern on the issue I raised before. So I believe it can considered for publication

**********

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: No

Reviewer #4: Yes: Abel Endawkie

**********

[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.

PONE-D-24-00224R2Spatial variation and predictors of comprehensive  HIV/AIDS knowledge, attitude and behaviours among Ethiopian Women: A spatial and multilevel analyses of the 2016 Demographic Health SurveyPLOS ONE

Dear Dr. Habte,

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 Apr 29 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,

Clement Ameh Yaro, Ph.D

Academic Editor

PLOS ONE

[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 #2: (No Response)

**********

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: No

**********

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: Review to the authors

Title changed

It is important to ensure consistency between the title of a research article and its content to accurately represent the study's focus and findings. In this case, it seems that the title was changed to incorporate the broader scope of the study, including not only HIV/AIDS knowledge but also attitudes and behaviors among Ethiopian women. However, if the content of the manuscript remains unchanged, including the spatial analysis, outcome variable, sample size, and other aspects, it may create confusion or misalignment between the title and the actual study. This could potentially lead to discrepancies or misunderstandings among readers. In this case the author changed their title without any justification. Please see previous published researches. If you your title has been published with similar outcome, model, and data. You can access them online. At this stage follow the guideline at least. I will not review this again, if you do not follow the guideline.

To address this issue, it is recommended that the authors carefully review the manuscript to ensure that any changes made in the title are appropriately reflected throughout the article. This includes updating relevant sections, such as the introduction, methods, and discussion, to align with the expanded scope of the study as reflected in the new title. Additionally, the authors may want to consider providing a brief explanation or justification within the manuscript, clarifying the reasons for the title change and emphasizing that the content of the study remains unchanged. This can help readers better understand the study's objectives and avoid any confusion arising from the inconsistency between the title and the manuscript's content.

Outcome variable

I repeatedly mentioned to you that the way the authors determined the outcome variable is not based on the guidelines; rather, it was generated based on the authors' own assumptions. Unless the authors used the DHS questionnaires for their study, they should also adhere to the methodology outlined in the guidelines for generating the outcome variable.

For your reference, I have attached the instructions from the guidelines to help simplify the process for you.

Comprehensive knowledge about HIV

Percentage of women and men who know that a healthy looking person can have HIV and reject local misconceptions about transmission or prevention of HIV

Definition

1) Percentage of women and men age 15-49 who know that a healthy looking person can have HIV.

2) Percentage of women and men age 15-49 who know that HIV cannot be transmitted by mosquito bites.

3) Percentage of women and men age 15-49 who know that HIV cannot be transmitted by supernatural means.

4) Percentage of women and men age 15-49 who know that a person cannot become infected by sharing food with a person who has HIV.

5) Percentage of women and men age 15-49 who say that a healthy-looking person can have HIV and who reject the two most common local misconceptions.

Indicators 2, 3 and 4 are surveys-specific and may refer to other local misconceptions.

Coverage:

Population base: Women and men age 15-49

Time period: Current status at time of survey

Numerators:

Number of women (or men) who indicate that they: 1) Know that a healthy-looking person can have HIV (women: v756 = 1; men: mv756 = 1)

2) Know that HIV cannot be transmitted by mosquito bites (women: v754jp = 0; men: mv754jp = 0)

3) Know that HIV cannot be transmitted by supernatural means (women: v823 = 0; men: mv823 = 0)

4) Know that a person cannot become infected by sharing food with a person who has HIV (women: v754wp = 0; men: mv754wp = 0)

5) Know that a healthy-looking person can have HIV (see Numerator 1 above) and reject the two most common local misconceptions about HIV transmission or prevention (these two most common misconceptions are footnoted in DHS 7 table 13.2). Survey specific but typically two of the following three (see Calculation below): a) HIV cannot be transmitted by mosquito bites (women: v754jp = 0; men: mv754jp = 0).

b) HIV cannot be transmitted by supernatural means (women: v823 = 0; men: mv823 = 0).

c) A person cannot become infected by sharing food with a person who has HIV (women: v754wp = 0; men: mv754wp = 0)

**********

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: 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: Review for HIV time.docx

Spatial variation and predictors of composite index of HIV/AIDS knowledge, attitude and behaviours among Ethiopian Women: A spatial and multilevel analyses of the 2016 Demographic Health Survey

PONE-D-24-00224R3

Dear Dr. Habte,

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,

Clement Ameh Yaro, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: