Time from treatment initiation to HIV viral suppression in public care facilities  in Brazil: a nationwide linked databases cohort

PONE-D-24-20580

Dear Dr. Nemes,

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 [CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico | 

National Council for Scientific and Technological Development) - U$D 9,600.00 (MIBN)

https://www.gov.br/cnpq/pt-br

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USP (Universidade de São Paulo | University of São Paulo) – U$D 6,360.00 (APSS)

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Additional Editor Comments:

The article is a well-designed study with adequate methods, presenting results in a clear and concise manner. The discussion  addresses both the broader implications and the limitations of the study. The data offer valuable insights for public health policies in Brazil and can be instrumental in planning and implementing these policies.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: The quality of the manuscript is very high and the methodology is appropriate, considering an observational study and a national database. The results are consistent with other published articles. However, there are limitations to measuring treatment adherence because it is based on the date of dispensation. Some information such as tuberculosis, race/color, sexual orientation and education level depend of filling out a specific antiretroviral form in general by a health worker with only a little time to complete it and can determine a bias of this information. Presence of tuberculosis and race/color was associated with outcomes. A longer time until viral load supression was associated with antiretroviral regimen with a low genetic barrier, however there is no report as to whether a genotyping test was performed before the start of treatment and transmited resistance could also determine bias.

Reviewer #2: The presented work is scientifically sound and addresses an important issue, the influence of characteristics of HIV health care clinics to time from ART initiation to VS. It is a nationwide study, with strong potential to positively influence stakeholders and decision makers to foster strategies to improve HIV continuum of care in Brazil.

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Reviewer #1: Yes: Ronaldo Campos Hallal

Reviewer #2: No

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