PONE-D-23-33823Characteristics associated with viral suppression among HIV-infected children aged 0-14 years in Mozambique, 2019PLOS ONE

Dear Dr. Fataha,

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 [This study was possible due the financial support for FETP coordinated by the National Institute of Health of Mozambique through the PEPFAR Cooperative Agreement 5U2GGH000080.].  

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Additional Editor Comments:

This is an important report on viral suppression among children and adolescents using a large and nationally representative dataset of viral load testing in Mozambique during 2019. The data reported here is informative and can help shape better policies for HIV control. Few issues:

1. Revise the aims statement. To me, there are 2 aims here: first is the reporting of the level of viral suppression. The second is finding the factors. This second aim is quite limited, given that you have a narrowed set of variables. Therefore, not including the first aim removes the relevance of this report.

2. How is DISA related to the entire information system in Mozambique? Are all samples collected for viral load in these age groups in Mozambique end up in DISA? Please provide more description on this.

3. About the time on ART variable. Children with less than 6 months of ART should not be mixed with other children. So, on every table, including the ART time variable, please subdivide the 0-2 years into 0-5 months, 6 to 11 months, and 12 to 23 months at least.

4. In tables 1 to 3, what is the difference between "non-specific" and "not reported categories" in the reasons for requesting a viral load test.

5. In the results section:

- Please describe the odds ratios. It is not enough to say something is associated. We need the magnitude and direction of the association.

- As a sensitivity analysis, another analysis like in table 2 should be added to the supplements excluding children with less than 6 months of ART.

- The current analysis in table 2 is problematic. First, why was Tete province chosen as a reference? A justification is needed. Second, why did some province dummy codes disappear on the adjusted analysis?

- Please change from "multivariate" to "multivariable."

6. About the log10 boxplots:

- What was done for undetectable viral loads?

- What was done if a viral load came with a zero value?

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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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

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

Reviewer #1: 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

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

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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: Congratulations to the authors for an informative study. I have the following comments:

1) In the abstract result section: ''...or being on ART for 2-5 years [AOR= 0.72 (95% CI: 0.61-0.85, p<0.001)] versus 11-14 years were associated with not being virally suppressed'' --> does the years refer to age groups of the children, or the number of years on ART? The children included in the study are aged 0 to 14 years.

2) Methods section under study population: Please correct this sentence ''Therefore, individual patients who tested more than one time in the same year 'were be' represented multiple times.''

3)Could you please clarify under data collection procedures, where the secondary clinical data was extracted from - whether it is from the VL request form or from the HIV program database?

4) Could you provide the IRB approval reference number in the ethics consideration section?

5) The discussion section could be improved - i think there could be more discussion around the lack of child friendly formulations for children, challenges of status disclosure in children and adolescents, lack of child and adolescent friendly corners or support groups...and how all this could affect the viral suppression.

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Reviewer #1: No

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Characteristics associated with viral suppression among HIV-infected children aged 0-14 years in Mozambique, 2019

PONE-D-23-33823R1

Dear Dr. Abdul Fataha,

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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Kind regards,

Jason T. Blackard, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

None

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

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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: Yes

Reviewer #2: (No Response)

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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: Yes

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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 have no further comments. All comments have been addressed fully and the manuscript has been improved.

Reviewer #2: The authors have addressed all the reviewer comments and no further comments from me. I therefore recommend that the manuscript be accepted for publication

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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: No

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