PONE-D-23-37025Dietary Diversity and Nutritional Status of People Living with HIV (PLHIV) During the COVID-19 EraPLOS ONE

Dear Dr. Abdulai,

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 14 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'.
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• 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,

Werku Etafa

Academic Editor

PLOS ONE

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2. We are unable to open your Supporting Information file "kasim_Data_Modified - Cape Coast.sav". Please kindly revise as necessary and re-upload.

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: No

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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

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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: Abstract

• Re-arrange statements under the introduction section of the abstract to indicate the objective of the study at the end “The Covid-19 pandemic has brought about unique challenges and uncertainties in healthcare and nutrition, particularly for PLHIV. Understanding their dietary patterns and nutritional status is crucial for developing targeted interventions and improving overall health outcomes. The study aimed to assess the dietary diversity and nutritional status of individuals living with HIV (PLHIV) during the Covid-19 era.”

• The method section of the abstract should answer; What?, When?, Where? And how? Questions and should have been written in a sequence.

• On Line 26, 28, 29. In the Result section of the abstract no need of expressing variables as more likely or less likely, rather put the variables and indicate the AOR,95% CI as it is self-explanatory.

• I did not see any conclusion and recommendation here under abstract.

Background

• In the introduction section your area of interest particularly Dietary Diversity and Nutritional Status was not well addressed.

• The gaps weren't stated well, especially by relating Dietary Diversity, Nutritional Status of People Living with HIV (PLHIV) and the COVID-19 Era, even though the introduction was written well. Three key considerations need to be made in this instance;

o Principles and practices

o Gaps, which discuss what was and wasn't known

o Filling the gaps

Methods

• The method section should be structured as per the plose manuscript submission guide rather than just putting without sequential order of sub headings. Some important contents have been missed such as Population, sample size and sampling techniques, operational definition….,

• Study Design and settings :

-Line 99-100; please rephrase statements written as we…’ We employed a facility-based cross-sectional study design to conduct our research, which spanned from 15th September, 2021 to 30th 100 to October, 2021”.

-Line 105-16; “We randomly selected 220 PLHIV who met the inclusion criteria and who consented to participate in our research”. Miss placed, please give appropriate sub heading and re-phrase it again.

• Inclusion Criteria

-Was there no anyone that researcher exclude? What does ‘eligibility hinged on the confirmation of a sero-positive diagnosis for HIV’ mean? Was this not included from the beginning? Why inclusion of sero-positive which was already included initially. Rather you have to worry about who have been excluded from those the researchers have included.

-Is Inclusion Criteria or Eligibility criteria is an appropriate heading for this?

• Please put your operational definition next to study variables as you have operationalized those variables in the way you have measured. Then, put data collection methods and procedures next to that.

• How you managed recall bias while you collect data dietary intake of participants?

• Line 129; omit redundant terms “participants”.

• Line 142; is your intention about dietary diversity or quality, and nutrient sufficiency? Please make it clear here because dietary diversity and dietary quality are different things.

• Data entry was done by what before exported to IBM SPSS Statistics 20?

Result

• I did see “Result” heading.

• It could be better if you describe Socio-demographic Characteristics and Health-related Behaviors of the Participants independently (table 1 and the text too).

• Give full description of table name” Table 1: Socio-demographic Characteristics and Some Health-related Behaviors of the Study Participants”. This should be applicable for the all tables been mentioned.

• In table 1, replace ‘factors’ by ‘variables’

• What by mean Cohabiting forb Marital Status? What by mean none for level of education? Express ‘Others’ by key under the table for table 1.

• Figure 1: Diversity of Study Participants …. Should be written well/full description. Also for figure 2.

• It could be better if you cite tables and figures after text description in the result section.

• Line 202, Replace “Dietary Diversity and the Associated Factors among Study Participants” by “factors associated with Dietary Diversity”.

• Line 217, Replace “Nutritional Status of Study Participants and Associated Factors” by “factor associated with Nutritional Status”.

• Line 206; omit “N = 220” and throughout the document.

• Line 233-239, re-write it again.

• Table 4 and 5 are not clear. Rather than describing as such better if you consider one table or dietary diversity having COR and AOR and also for Nutritional status.

Discussion:

• Line 256,start as the study was conducted to investigate,….rather than...We conducted this study to

• As per your objectives, the discussion section ought to center around the relevant findings that emerged from the result section. Modifications are necessary to the way it has been discussed.

• Also, discussion should be based on your objectives.

• Pints that have been mentioned under your discussion as a recommendation have to be mentioned under Conclusion and recommendation section and should be based on your findings which were emanated from your result rather than general recommendation. Eg. Training that have been mentioned.

Conclusion

• I felt that your findings and recommendation in this section were in conflict with one another. Your recommendation should therefore be based on your relevant findings and should be appropriate.

• While you conclude again based on your objective rather than simply starting from factors.

• What is the intention of writing recommendation under both discussion and conclusion?

Generally

• The manuscript needs to be re-narrated in clear, concise English consistently and coherently.

Reviewer #2: Totally, comments and questions raised were not addressed appropriately. specially the methodology part was not mentioned as much as required. For example, how many health facilities are providing ART service in the area? How did you select the two hospitals? How did you calculate sample size to get 220 study participants?

The topic by itself is not specific. It is general which is not limited by target population in age wise. Therefore, for the future study, try to follow the submission guideline before submitting.

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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: No

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Attachments

Attachment

Submitted filename: Peer reviewed plos one.docx

PONE-D-23-37025R1\\Dietary Diversity and Nutritional Status of Adults Living with HIV During the COVID-19 EraPLOS ONE

Dear Dr. Abdulai,

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 provide the responses in the appropriate manner for reviewer #2.
• Follow the journal author's guidelines for all matters.  

Please submit your revised manuscript by May 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,

Werku Etafa

Academic Editor

PLOS ONE

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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: (No Response)

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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

**********

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

Reviewer #1: Yes

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 #1: Yes

Reviewer #2: No

**********

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

**********

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 reviewed this paper exhaustively from the beginning. Hence, this paper has no dual publication, has no problem of research ethics, or publication ethics and the authors answered in good manners for my concerns. So, I declare the paper for Publication.

Reviewer #2: You have tried to to address many prior comments. But, things that are highly important were not addressed appropriately. Try to do again on another issues and submit it to this journal by fulfilling every thing required. You can see the following comments.

Comments

1. On the line, 117 & 118; you have calculated the sample size to get 217; you rounded to 220. Why? How do you deviate from the formal rule?

2. On the line 131, what do you mean to say A total of 220 participants were recruited from two hospitals?

3. On the line 133, you have stated the approximated number of active patients were 1300 and 850. What does it mean by active patients? Why did you say approximated? Don’t you know your source and target population? If so, your sample can not represent unknown population.

4. On the line 138, you have said to meet the quota… Is your research qualitative or quantitative?

5. On line 158, you said information was gathered through the administration of a questionnaire. Was data or information gathered? By whom?

6. On line 191, what you mean to say multivariable ordinal logistic regression model? Is this model present?

7. You have not checked model fitness for your study

8. You have not checked for confounding factors for which I have not seen the value

9. You did not mention the confidence interval of Dietary diversity as well as nutritional status finding that might enable you discuss comparing with that of other findings.

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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

**********

[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-23-37025R2Dietary Diversity and Nutritional Status of Adults Living with HIV During the COVID-19 EraPLOS ONE

Dear Dr. Abdulai,

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 Jun 27 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,

Werku Etafa

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.

Additional Editor Comments:

Comments

Abstract

1. The abbreviation for COVID-19 should be consistent throughout the document. Avoid using “Covid-19”. Use caps lock as it is an abbreviation and when expanded, give another term/phrase.

2. Use the appropriate term “ Background” rather than “Introduction” under the abstraction section. In the next section, use the proper term “Introduction” and remove “background”.

3. Throughout your document, you is recommended that you prepare your document alignment in line with PLOS ONE protocol. At the beginning of each paragraph, you have used that central alignment. Please use left alignments.

4. Expand all abbreviations used for the first time in the abstract (check if they are used without expanding throughout your document).

5. Objectives under the abstract section should be avoided as it currently appear. Merge the aim of your study at the end of the background section under the same section.

6. In the results section under the abstract, please clarify that

• Aged 40 to 59 years were more likely to exhibit higher dietary diversity (AOR = 1.966, 95% CI: 1.045–4.987).

• Factors associated with undernutrition included females (AOR = 1.829, 32, 95% CI: 1.294, 3.872) and first-line ART (AOR = 1.683, 95% CI: 1.282–2.424).

7. Add odds ratio for “Employed participants were also more likely to have a high IDDS compared to 31 unemployed participants”.

8. Add the conclusion of your study after the results section.

Methods

In sample size determination, you have used 17% as the proportion of malnutrition. Identify whether it is undernutrition or overnutrition. Explain why you did not consider the nonresponse rate in your study.

Discussion

Make your writing scientific and neat. Several minor mistakes are noted. Read line by line and you could get them.

Mention the study's weakness and strengths

Recommendation

Merge your recommendation under the conclusions. Please try to adhere to the guidelines.

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[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-23-37025R3Dietary Diversity and Nutritional Status of Adults Living with HIV During the COVID-19 EraPLOS ONE

Dear Dr. Abdulai,

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:

• In the abstract section, expand the acronym COVID-19 properly. Presently, you have expanded it wrongly. 
• Include all subsections of the abstract: Background, methods, results, and conclusions
• You have not concluded your study findings. Be sure that your conclusion is scientific.

==============================

Please submit your revised manuscript by Jul 12 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,

Werku Etafa

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

[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.

Dietary Diversity and Nutritional Status of Adults Living with HIV During the COVID-19 Era

PONE-D-23-37025R4

Dear Dr. Abdulai,

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.

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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,

Werku Etafa

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: