Achieving cervical cancer elimination: The simulated impacts of HPV vaccination and transitioning from liquid-based cytology to HPV-based screening test

Nur Zahirah Balqis-Ali; Jailani Anis-Syakira; Weng Hong Fun; Zakiah Mohd Said; Shazimah Abdul Samad; Norhaslinda Zainal Abidin; Jafri Zulkepli; Norazura Ahmad; Mohd Norazam Mohd Abas; Chee Meng Yong; Siti Norbayah Yusof; Nur Adila Daud; Sondi Sararaks

doi:10.1371/journal.pone.0307880

Peer Review History

Original SubmissionMarch 5, 2024
30 May 2024 Decision Letter - Yitagesu Habtu Aweke, Editor Dear Dr. Anis-Syakira, Thank you for submitting your manuscript titled " PONE-D-24-07127:From model to action: Simulating impact of transitioning from liquid-based cytology to HPV-based screening test on cervical cancer elimination" 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 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. 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However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Additional Editor Comments : In addition to reviewers' comment, I suggest you to re-check the impact models, and check your label for the subheadings 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 Reviewer #3: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: I Don't Know ****** 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 ****** 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: Yes Reviewer #3: 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: The authors have presented a well-conducted and important study. In addition to the data presented, it will be useful for the authors to highlight more studies done in other countries that have successfully made the transition from LBC to HPV testing as the primary cervical cancer screening. Reviewer #2: This study analyzed the impact of HPV vaccine coverage, transition of screening modalities, and screening coverage on the goal of eliminating cervical cancer. It quantitatively calculated the years to achieve the goal of cervical cancer elimination under different resource allocation scenarios, along with cost estimation. The study confirmed the importance of transitioning screening modalities comprehensively to HPV testing, providing a solid scientific basis for prioritizing policy support for HPV testing. However, several areas require further attention and improvement. 1.What would happen if the vaccine coverage rate increased to 95% or 100%? What would be the impact if the screening coverage reached 80% or above? The modeling and simulation study can provide a scientific basis for the government to set and adjust goals. 2.Since the selection of parameters is crucial for the model results, especially for parameters like vaccine efficacy obtained from references in other countries and unpublished parameters from expert consultations, could sensitivity analysis be conducted to enhance the study? Reviewer #3: Title should be changed since the vaccination is in the model. My suggestion is: Finding the best strategy for cervical cancer elimination-because In abstract: increasing screening coverage from which % MYR should be converted in US dollars because of international comparison In abstract (46th raw): I don't understand how much in MYR is difference between two models- related to results..unclear English should be more clear (exp. 110-111 raw) ****** 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 Reviewer #3: 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.0307880.r001
Revision 1
11 Jun 2024 Author Response Response to editor and reviewers Editor In addition to the reviewers' comments, I suggest you re-check the impact models and check your label for the subheadings. Response: Thank you for your constructive feedback on our manuscript. We sincerely appreciate your encouragement and have diligently addressed the valuable comments the editor and reviewers provided. Regarding the impact models, we have reevaluated the model, results, and interpretations, confirming that the findings are based on the simulations. Additionally, the subheadings have been reviewed. We acknowledge that PLOS One uses a non-numbering system for subheadings. However, due to the complexity of model development and analysis and multiple layers of subheadings, we believe retaining the current numbering system will enhance readability and facilitate understanding for readers. The font formatting of the subheadings is in accordance with PLOS One’s requirement. Reviewer #1: The authors have presented a well-conducted and important study. In addition to the data presented, it will be useful for the authors to highlight more studies done in other countries that have successfully made the transition from LBC to HPV testing as the primary cervical cancer screening. Response: Thank you for your constructive feedback on our manuscript. We sincerely appreciate your encouragement and have diligently addressed the valuable comments the editor and reviewers provided. In response to your suggestion, we have expanded the discussion section to include more studies that test the impact of transitioning from LBC to HPV test in screening for cervical cancer, along with their findings. Change: Page 24 - 25, Line 571 - 581, clean version The findings align with simulations conducted elsewhere, demonstrating the benefits of transitioning from LBC to HPV testing. This transition not only reduces the incidence of cervical cancer but also minimises the resources required for implementing the screening programme [51, 52]. For example, a simulation conducted for Australian women found that transitioning from LBC to HPV testing as the primary screening method would reduce the risk of cancer development by 33% for unvaccinated women and by 22% for vaccinated women [52]. Another simulation demonstrated that the transition initially caused a temporary increase in early-stage precancerous incidences. Still, these rates steadily declined, reducing precancerous incidences by 40-44% and invasive cancer incidences by 42-51% [53]. Similarly, a simulation for New Zealand women showed that transitioning to HPV testing would reduce cervical cancer incidence by 32% and mortality rates by 25% [51]. Reviewer #2: This study analyzed the impact of HPV vaccine coverage, transition of screening modalities, and screening coverage on the goal of eliminating cervical cancer. It quantitatively calculated the years to achieve the goal of cervical cancer elimination under different resource allocation scenarios, along with cost estimation. The study confirmed the importance of transitioning screening modalities comprehensively to HPV testing, providing a solid scientific basis for prioritizing policy support for HPV testing. We deeply respect your comments and acknowledge that several areas require further attention and improvement. 1. What would happen if the vaccine coverage rate increased to 95% or 100%? What would be the impact if the screening coverage reached 80% or above? The modelling and simulation study can provide a scientific basis for the government to set and adjust goals. Response: Thank you for your constructive feedback on our manuscript. We sincerely appreciate your encouragement and have diligently addressed the valuable comments the editor and reviewers provided. In relation to the next comment, we expanded the simulation to include sensitivity analyses. In the sensitivity analyses, we have incorporated varying vaccination rates as one of the parameters being tested. The scenario whereby the HPV vaccination rate reached 100% coverage was simulated as part of the sensitivity testing. Given the extensive methods and results sections in the manuscript, we have included the results of the sensitivity analyses in the appendix and referenced them in the results section. We have also tested a higher screening coverage; however, in the situation where the vaccination rate is sustained at a high level (90%), the impact of higher screening coverage is minimal. We decided to retain the screening rate at 70%, as targeted by the Ministry of Health’s policymakers. Change: Method: Page 16, Line 435 - 439, clean version In addition to these scenarios, sensitivity analyses were conducted on several crucial parameters, including a range of non-adherence rates to follow-up after a positive screening test, varying HPV infection rates across different age groups, and varying unvaccinated rates. The sensitivity analyses were performed based on the baseline model whereby screening was done via LBC sustained at 25% coverage. Results: Appendix E in File S5 2. Since the selection of parameters is crucial for the model results, especially for parameters like vaccine efficacy obtained from references in other countries and unpublished parameters from expert consultations, could sensitivity analysis be conducted to enhance the study? Response: Thank you for your suggestion. We recognise the importance of conducting sensitivity analyses in simulation models. As mentioned in response to the previous comment, we have expanded the simulation to include sensitivity analyses. We also acknowledge the reviewer’s suggestion to include vaccine efficacy in the sensitivity analysis. However, vaccine efficacy varies based on the recipient group (e.g., it decreases when given to non-sexually naïve women) and different HPV types. Currently, the simulation model adheres to the Malaysian vaccination practice whereby the vaccine is administered to 13-year-old girls, presumed to be sexually naïve, and therefore 100% effective against high-risk HPV types. This assumption, which limits the simulation, is documented in the manuscript. With this information and assumption, vaccination efficacy is not tested in the sensitivity analysis. Instead, the vaccination rate is tested in the sensitivity analysis. We appreciate your understanding and hope this decision maintains the clarity and precision of the manuscript. Reviewer #3: The title should be changed since the vaccination is in the model. My suggestion is: Finding the best strategy for cervical cancer elimination-because Response: Thank you for your constructive feedback on our manuscript. We sincerely appreciate your encouragement and have diligently addressed the valuable comments the editor and reviewers provided. We have revised the title accordingly to incorporate HPV vaccination. Change: Title: Achieving cervical cancer elimination: The simulated impacts of HPV vaccination and transitioning from liquid-based cytology to HPV-based screening test In abstract: increasing screening coverage from which % Response: Thank you for your suggestion. The sentence has now incorporated a baseline screening coverage. Change: Page 2, Line 35 - 37, clean version The Ministry of Health Malaysia aims to fully replace liquid-based cytology (LBC) with Human Papillomavirus (HPV) tests and increase the screening coverage from a baseline of 25% to 40% by 2023, followed by a 10% yearly increment until 70% coverage. MYR should be converted in US dollars because of international comparison Response: Thank you for your suggestion. The MYR values in the abstract are now accompanied by the equivalent amount in USD. Change: Improved abstract In abstract (46th raw): I don't understand how much in MYR is difference between two models- related to results. Response: Thank you for your comment. The difference in the cost between LBC and HPV tests is mentioned in the methodology section, under the subheading 2.2.2: Model assumptions, as follows (Page 9, Line 244 - 250): 6. Screening costs: MYR 58.66 (USD13.33) per LBC test and MYR 102.86 (USD23.38) per HPV test done through in-house laboratory processing. MYR 84.55 (USD19.22) per HPV test done through outsourcing the laboratory processing was done as an alternative scenario. The details in the cost calculation are reported elsewhere [39]. The monetary figures in this study were denominated in the local currency unit (MYR) and converted to USD, utilising the World Bank's official exchange rate for 2022 (1 USD equivalent to 4.4 MYR) [40]. Constant screening costs without discounted rates were applied in the simulation. The screening cost via HPV test is higher than the traditional LBC test. That is why the total cost for HPV tests is higher than LBC, despite its superiority in detecting cervical cancer. These findings are interpreted and discussed in the discussion section as follows (Page 26, Line 618 - 626): Owing to the increased expense associated with conducting HPV tests, the total screening costs for all scenarios were higher than the baseline, except in cases where HPV testing was performed twice over a lifetime. The higher cost of performing HPV is due to higher laboratory processing requirements to run the polymerase chain reaction (PCR) test [56], and efforts to reduce the price gap are necessary. One of the ongoing efforts involves outsourcing the laboratory processes, which have been rolled out in phases across multiple regions in Malaysia since 2019 [6]. A cost-effectiveness study is recommended to analyse the relative cost implications based on the health outcomes, which is beyond the purview of the current study. We hope this clarifies the difference between the two approaches. unclear English should be clearer (exp. 110-111 raw) Response: Thank you for your comment. We have improved the sentence structure as advised. Change: Page 4, Line 111 - 113, clean version Although many dynamic models of cervical cancer screening programs have been developed and tested [14, 16-18], each model was created to address specific objectives and was applied to different health system contexts. Journal 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 Response: The formatting has been checked, complying with PLOS ONE’s style requirement. 2. Please note that PLOS ONE has specific guidelines on code sharing for submissions in which author-generated code underpins the findings in the manuscript. In these cases, all author-generated code must be made available without restrictions upon publication of the work. Please review our guidelines at https://journals.plos.org/plosone/s/materials-and-software-sharing#loc-sharing-code and ensure that your code is shared in a way that follows best practice and facilitates reproducibility and reuse. Not applicable. 3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their datasets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-dataaccess-restrictions. Response: The data availability section has been updated. Change: Page 27 – 28, Line 665 – 672, clean version Availability of data and materials The dataset supporting this article’s findings belongs to the Family Health Development Division, MOH Malaysia and the National Cancer Registry, Malaysia. However, restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data sharing is subjected to a formal request and approval by data holders and the Director-General of Health, Malaysia. Data are, however, available upon reasonable request from the Principal Investigator (anissyakira.j@moh.gov.my) or through the National Institutes of Health Malaysia-Data Repository System (NIH-DaRS), accessible from https://nihdars.nih.gov.my/. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. Response: The data availability section has been updated. Change: Page 27 – 28, Line 665 – 672, clean version Availability of data and materials The dataset supporting this article’s findings belongs to the Family Health Development Division, MOH Malaysia and the National Cancer Registry, Malaysia. However, restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data sharing is subjected to a formal request and approval by data holders and the Director-General of Health, Malaysia. Data are, however, available upon reasonable request from the Principal Investigator (anissyakira.j@moh.gov.my) or through the National Institutes of Health Malaysia-Data Repository System (NIH-DaRS), accessible from https://nihdars.nih.gov.my/. 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Response: We have moved the ethics statement into the method section of the manuscript. Attachments Attachment Submitted filename: Response to editor and reviewers_110624.docx https://doi.org/10.1371/journal.pone.0307880.r002
7 Jul 2024 Decision Letter - Yitagesu Habtu Aweke, Editor PONE-D-24-07127R1Achieving cervical cancer elimination: The simulated impacts of HPV vaccination and transitioning from liquid-based cytology to HPV-based screening testPLOS ONE Dear Dr. Anis-Syakira, 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 Aug 21 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. 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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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: I Don't Know ****** 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 #3: 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 #3: 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 #3: With what strategy The Ministry of Health Malaysia aims to fully replace liquid-based cytology (LBC) with Human, Papillomavirus (HPV) tests and increase the screening coverage from a baseline of 25% to 40% by 2023, followed by a 10% yearly increment until 70% coverage? ****** 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 #3: 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.0307880.r003
Revision 2
11 Jul 2024 Author Response Response to editor and reviewers 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. Response: Thank you for your constructive feedback. We have reviewed and updated the reference list. We would like to confirm there is no citation of retracted or unpublished materials in the reference list. Reviewer #3: With what strategy The Ministry of Health Malaysia aims to fully replace liquid-based cytology (LBC) with Human, Papillomavirus (HPV) tests and increase the screening coverage from a baseline of 25% to 40% by 2023, followed by a 10% yearly increment until 70% coverage? Response: Thank you for your comment. The strategy being proposed by the Ministry of Health Malaysia to replace LBC with HPV tests and increase screening coverage has been added to the introduction session, along with the relevant sources. Change: Page 4, Line 95-98, clean version To achieve this, the MOH plans to increase the yearly procurement of HPV test kits to replace LBC and expand screening through collaborative platforms such as private facilities, workplace screening programs, and nonprofit organizational activities [6, 13]. Attachments Attachment Submitted filename: Response to editor and reviewers_100724.docx https://doi.org/10.1371/journal.pone.0307880.r004
15 Jul 2024 Decision Letter - Yitagesu Habtu Aweke, Editor Achieving cervical cancer elimination: The simulated impacts of HPV vaccination and transitioning from liquid-based cytology to HPV-based screening test PONE-D-24-07127R2 Dear Dr. Jailani Anis-Syakira, 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, Yitagesu Habtu Aweke, Ph.D Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0307880.r005
Formally Accepted
17 Jul 2024 Acceptance Letter - Yitagesu Habtu Aweke, Editor PONE-D-24-07127R2 PLOS ONE Dear Dr. Anis-Syakira, 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 PhD Candidate Yitagesu Habtu Aweke Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0307880.r006

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