High STI burden among a cohort of adolescents aged 12–19 years in a youth-friendly clinic in South Africa

Matt A. Price; Monica Kuteesa; Matthew Oladimeji; William Brumskine; Vinodh Edward; Heeran Makkan; Funeka Mthembu; Vincent Muturi-Kioi; Candice Chetty-Makkan; Pholo Maenetje

doi:10.1371/journal.pone.0306771

Peer Review History

Original SubmissionAugust 2, 2023
4 Jan 2024 Decision Letter - Tinashe Mudzviti, Editor PONE-D-23-24060High STI burden among a cohort of adolescents aged 12-19 years in a youth-friendly clinic in South AfricaPLOS ONE Dear Dr. Price, 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 Feb 18 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. 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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. Did you know that depositing data in a repository is associated with up to a 25% citation advantage (https://doi.org/10.1371/journal.pone.0230416)? If you’ve not already done so, consider depositing your raw data in a repository to ensure your work is read, appreciated and cited by the largest possible audience. You’ll also earn an Accessible Data icon on your published paper if you deposit your data in any participating repository (https://plos.org/open-science/open-data/#accessible-data). 3. Thank you for stating in your Funding Statement: “This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at http://www.iavi.org. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.” Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. 4. Thank you for stating the following in the Acknowledgments Section of your manuscript: “This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at http://www.iavi.org. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.” We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at http://www.iavi.org. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 5. We note that you have included the phrase “data not shown” in your manuscript. Unfortunately, this does not meet our data sharing requirements. PLOS does not permit references to inaccessible data. We require that authors provide all relevant data within the paper, Supporting Information files, or in an acceptable, public repository. Please add a citation to support this phrase or upload the data that corresponds with these findings to a stable repository (such as Figshare or Dryad) and provide and URLs, DOIs, or accession numbers that may be used to access these data. Or, if the data are not a core part of the research being presented in your study, we ask that you remove the phrase that refers to these data. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments (if provided): Major comments: 1. The title of the paper and the objectives described are not sufficiently relatable. The title has a focus on STI burden whilst the aim described in the paper is looking at the feasibility and acceptability of recruiting and enrolling adolescents. The results presented are thus unrelated to the objectives set and thus cannot be thoroughly evaluated. 2. Authors must clearly describe the study setting. Initially (line 76) this is defined as, " Aurum Institute’s Clinical Research site in Rustenburg, Northwest Province." However, line 82-83 then lists additional study sites. 3. By restricting participants eligible to enrol for the study (pregnant, not willing to use contraceptive, diagnosis of HIV) the external validity of the results obtained is significantly reduced. Authors must then define to which population these results are generalizable. Minor comments 1. The sentences in line 46 - 47 need references and those in line 48 need references that are more recent and not from 2018 (these are already 5 years old) 2. line 64: Define IAVI first before using the acronym. 3. line 125: should read, viral "load" 4. Please be consistent with terminology. The phrases, "young people, young women or young men" are not interchangeable with the word, "adolescent." [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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: No ****** 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: The authors report on the high prevalence and incidence of sexually transmitted infections among adolescents from one clinic in South Africa. The authors also show that with the provision of youth friendly services, enrolment and retention of adolescents in studies related to sexual health can be very good. I only have a few minor comments. Can the authors comment on the reasons why there were more female than male participants. Also discuss the reasons why females had a higher prevalence and incidence of STIs than males. Can you also describe in more detail what makes the setting youth-friendly? Lines 46-47 add reference to the statement Line 58 clarify what is meant by simulated vaccine trials Line 76 can the authors provide some data with regards to the catchment population size for the clinic/ adolescent population size Line 119 Given that adolescents may be reluctant to talk about issues relating to sexual health with their parents, can the authors comment on how this was handled in the study? Line 133: Neisseria and Chlamydia are organism names and should be capitalised and written in italics Table 3: please also include any STI as a category Reviewer #2: In this prospective observational cohort study, the authors report a high prevalence of incident sexually transmitted infections and pregnancy in adolescents in Rustenburg, South Africa. The authors describe an adolescent friendly service, effective methods of adolescent recruitment and high retention in this hard-to-reach population. The data is well presented and tables are clear. The findings support previous literature reporting high rates of STIs in adolescents in Sub-Saharan Africa. My main concern is regarding the general style of the scientific writing throughout the paper, it is often informal and inconcise. The first sentences of the discussion and conclusion are clear examples. Table headings should be reviewed and shortened (e.g table 3 ‘among everyone overall’) , use of phrases such as ‘on the other hand’, ‘in a study mentioned above’ should be avoided. These data are important but may be better suited to an STI focused journal, the authors are advised to review the scientific writing style. ****** 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: Yes: Ioana D Olaru 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. https://doi.org/10.1371/journal.pone.0306771.r001
Revision 1
2 Jun 2024 Author Response Journal requirements, Reviewers’ comments and authors’ replies: 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. … Author reply: Thank you for these links, we have updated a few elements of our manuscript to match these requirements. 2. Did you know that depositing data in a repository is associated with up to a 25% citation advantage ... Author reply: While we appreciate this advantage, we enrolled adolescents, and as part of the consenting process we made clear that protecting data and participant anonymity was very important. Since this is a protected population and sensitive data were collected, we will not be able to make these data freely available. 3. Thank you for stating in your Funding Statement: “This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at https://url.avanan.click/v2/___http://www.iavi.org___.YXAzOmlhdmk6YTpvOjRjOWRmZTI2ZWU3MTI1YjIxNjA2OGY0N2IwNzcxZWY5OjY6NWUyMjo3ZjVkZmE5ZGI4NjA2MzNjMzliZjhlZTYxOTJiMTJiZWJiOWIzZjUxYzhjN2YwNWZmMTFiNjdjYmMyNDlhOTE1OnQ6VA. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.” Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at https://url.avanan.click/v2/___http://journals.plos.org/plosone/s/submit-now.___.YXAzOmlhdmk6YTpvOjRjOWRmZTI2ZWU3MTI1YjIxNjA2OGY0N2IwNzcxZWY5OjY6NjVlMDpiMzM1ZjQwNzcyNDI5NzJlMzA4Y2QyMTQyOWE1NmZhYzFmZjJlNDI4MjIzNTUxZTk0MzUyODAxY2I5MTU1ODUwOnQ6VA Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. Author reply: Thank you for your comments on our funding and acknowledgements statement. We have revised them as follows: Acknowledgements We thank the staff of the Youth Friendly Services clinic for their help and dedication to improving the health and wellbeing of South African adolescents. Funding Statement This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at http://www.iavi.org. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government. We also wish to acknowledge the support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH123256. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There was no additional external funding received for this study. 4. Thank you for stating the following in the Acknowledgments Section of your manuscript: “This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at http://www.iavi.org. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.” We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “This work was funded by IAVI and made possible by the support of many donors, including United States Agency for International Development (USAID). The full list of IAVI donors is available at https://url.avanan.click/v2/___http://www.iavi.org.___.YXAzOmlhdmk6YTpvOjRjOWRmZTI2ZWU3MTI1YjIxNjA2OGY0N2IwNzcxZWY5OjY6NDRmNDozYWMwMDc4ZjA5ZDRlZGMxZWNlNjE0ZDE5MjgxZDVkZGI2MGU4ZGE0MjllYzg5OTFmZDMzZjE0Mjg2OTY5MjM1OnQ6VA The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. Author reply: Thank you, please see our reply to #3 immediately above. 5. We note that you have included the phrase “data not shown” in your manuscript. Unfortunately, this does not meet our data sharing requirements. PLOS does not permit references to inaccessible data. We require that authors provide all relevant data within the paper, Supporting Information files, or in an acceptable, public repository. Please add a citation to support this phrase or upload the data that corresponds with these findings to a stable repository (such as Figshare or Dryad) and provide and URLs, DOIs, or accession numbers that may be used to access these data. Or, if the data are not a core part of the research being presented in your study, we ask that you remove the phrase that refers to these data. Author reply: We have revised our methods section, and removed this statement as it is no longer relevant. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: https://url.avanan.click/v2/___http://journals.plos.org/plosone/s/supporting-information___.YXAzOmlhdmk6YTpvOjRjOWRmZTI2ZWU3MTI1YjIxNjA2OGY0N2IwNzcxZWY5OjY6NDkwZjo1NzhhMGVkMzI1ZjgyZGVlNzRiOWI4ZWQ1Yjg1YTcyMTAwNTllMDgwOWZkMGFhMDM0MGYzMWYzY2YyYzk5MGY1OnQ6VA. Author reply: I presume this doesn’t apply to our manuscript; we include no supplemental / supporting files or data at the end of our manuscript. Additional Editor Comments (if provided): Major comments: 1. The title of the paper and the objectives described are not sufficiently relatable. The title has a focus on STI burden whilst the aim described in the paper is looking at the feasibility and acceptability of recruiting and enrolling adolescents. The results presented are thus unrelated to the objectives set and thus cannot be thoroughly evaluated. Author reply: Thank you for this comment, we have revisited our objectives (last paragraph of the introduction) to better match the data we present here. This is the first manuscript in a series of related publications from this study, some of the other papers will go into greater depth on topics more directly related to strategies to recruit and retain younger study participants. 2. Authors must clearly describe the study setting. Initially (line 76) this is defined as, " Aurum Institute’s Clinical Research site in Rustenburg, Northwest Province." However, line 82-83 then lists additional study sites. Author reply: We have clarified our methods (lines 87-88). In brief, the study was conducted at our research clinic, while recruitment, information sessions, and awareness raising was conducted at those locations noted in lines 82+ 3. By restricting participants eligible to enrol for the study (pregnant, not willing to use contraceptive, diagnosis of HIV) the external validity of the results obtained is significantly reduced. Authors must then define to which population these results are generalizable. Author reply: This is a good point. Our eligibility criteria were chosen to mimic what might be employed for a future clinical trial, e.g., an HIV vaccine trial, and was not necessarily intended to be generalized to a wider population than that. We have added a statement to that effect in our “limitations” paragraph (line 358). Minor comments 1. The sentences in line 46 - 47 need references and those in line 48 need references that are more recent and not from 2018 (these are already 5 years old) Author reply: Thank you for catching this omission. We have added references where indicated. 2. line 64: Define IAVI first before using the acronym. Author reply: IAVI is no longer an acronym, it is the name of our organization (akin to KAVI, a partner organization that is also no longer an acronym). We have made note of this. 3. line 125: should read, viral "load" Author reply: Thank you for catching this typo. We have corrected it per your comment. 4. Please be consistent with terminology. The phrases, "young people, young women or young men" are not interchangeable with the word, "adolescent." Author reply: You are correct, though in the context of our study, all participants were adolescents, as defined by the WHO and others. However, we have tried to be careful when using those two terms, and refer to “adolescents” as all study participants, and “young women/men” as study participants/adolescents who are ages 18 and 19. We only referred to “young women/men” once (line 184), and I was unable to find any examples where this might be unclear; if you’re able to provide specific lines, we can revisit this, but at the moment, I have not made any edits. Reviewer #1: The authors report on the high prevalence and incidence of sexually transmitted infections among adolescents from one clinic in South Africa. The authors also show that with the provision of youth friendly services, enrolment and retention of adolescents in studies related to sexual health can be very good. I only have a few minor comments. Can the authors comment on the reasons why there were more female than male participants. Author reply: Thank you for your comment. We had hoped to have roughly equivalent enrollment, between males and females, but more females came for screening. Due to time constraints, we were not able to extend enrollment to allow for more males to join the study. We have made a note of this in the discussion section, under limitations. Also discuss the reasons why females had a higher prevalence and incidence of STIs than males. Author reply: It’s well documented in the literature that STI and HIV rates are higher, sometimes by quite a lot, among AGYW compared to their male counterparts. We discuss this in the second paragraph starting on line 267 in the Discussion. No further edits have been made in regard to this comment. Can you also describe in more detail what makes the setting youth-friendly? Author reply: We adopted South African Department of Health standards and guidelines for working with and providing services to adolescents. We recommend the reviewer revisit lines 100-111 for additional details. We haven’t added any additional details in our resubmission. Lines 46-47 add reference to the statement Author reply: We have added references to support the first sentence in the introduction. Line 58 clarify what is meant by simulated vaccine trials Author reply: I have added a comment to clarify what we mean by this. Line 76 can the authors provide some data with regards to the catchment population size for the clinic/ adolescent population size Author reply: We have updated our methods section with additional details Line 119 Given that adolescents may be reluctant to talk about issues relating to sexual health with their parents, can the authors comment on how this was handled in the study? Author reply: This is always a sensitive and sometimes challenging topic! Adolescents and youth were not seen together with their parents/guardians (see line 119, see also the “limitations” paragraph in the discussion, around line 355). This was also a topic that was addressed in the focus group discussions, and will be published soon. We don’t present any data from the parent/guardian group in this paper. Line 133: Neisseria and Chlamydia are organism names and should be capitalised and written in italics Author reply: Thank you, we have made this change. Table 3: please also include any STI as a category Author reply: We have added this to Table 3. Reviewer #2: In this prospective observational cohort study, the authors report a high prevalence of incident sexually transmitted infections and pregnancy in adolescents in Rustenburg, South Africa. The authors describe an adolescent friendly service, effective methods of adolescent recruitment and high retention in this hard-to-reach population. The data is well presented and tables are clear. The findings support previous literature reporting high rates of STIs in adolescents in Sub-Saharan Africa. My main concern is regarding the general style of the scientific writing throughout the paper, it is often informal and inconcise. The first sentences of the discussion and conclusion are clear examples. Table headings should be reviewed and shortened (e.g table 3 ‘among everyone overall’), use of phrases such as ‘on the other hand’, ‘in a study mentioned above’ should be avoided. Author reply: While I do appreciate that there are many ways to write a scientific manuscript, I must beg to differ with this reviewer’s comment. I have revisited the first paragraph of the discussion, and our conclusion paragraph, and respectfully disagree. I am also of the school of thought that Table and Figure legends should be comprehensive. I teach my students that if their Table or Figure was to fall to the ground by itself, that anyone could pick it up and know what was being presented because of clear and complete legends, titles, axis labels, etc. I do thank you for the comment, but I have not made any edits in response to this comment. These data are important but may be better suited to an STI focused journal, the authors are advised to review the scientific writing style. Author reply: I do appreciate the comment, but we feel PLOS ONE is well suited to this manuscript (see for example the recent publication in PLOS ONE: Monteiro IP, Azzi CFG, Bilibio JP, Monteiro PS, Braga GC, et al. (2023) Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon. PLOS ONE 18(6): e0287633. https://doi.org/10.1371/journal.pone.0287633). We have re-read and reviewed the manuscript, and have made modest edits throughout to tighten the language. https://doi.org/10.1371/journal.pone.0306771.r002
18 Jun 2024 Decision Letter - Tinashe Mudzviti, Editor PONE-D-23-24060R1High STI burden among a cohort of adolescents aged 12-19 years in a youth-friendly clinic in South AfricaPLOS ONE Dear Dr. Price, 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 term young women/men was used in the following lines: 97, 178, 266, 269. The notation needs to be consistent to read adolescents. ============================== Please submit your revised manuscript by Aug 02 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, Tinashe Mudzviti, MPhil(MD) 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: 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.0306771.r003
Revision 2
20 Jun 2024 Author Response We have made the requested edits, thank you https://doi.org/10.1371/journal.pone.0306771.r004
25 Jun 2024 Decision Letter - Tinashe Mudzviti, Editor High STI burden among a cohort of adolescents aged 12-19 years in a youth-friendly clinic in South Africa PONE-D-23-24060R2 Dear Dr. Price, 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, Tinashe Mudzviti, MPhil(MD) Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0306771.r005
Formally Accepted
28 Jun 2024 Acceptance Letter - Tinashe Mudzviti, Editor PONE-D-23-24060R2 PLOS ONE Dear Dr. Price, 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. Tinashe Mudzviti Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0306771.r006

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