PONE-D-24-25429Seroprevalence of HIV, HBV, and Syphilis co-infections and its associated factors among pregnant women attending antenatal Care in Amhara regional state, Northern EthiopiaPLOS ONE

Dear Dr. Anteneh,

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: Thank you for submitting the manuscript titled "Seroprevalence of HIV, HBV, and Syphilis Co-infections and Its Associated Factors Among Pregnant Women Attending Antenatal Care in Amhara Regional State, Northern Ethiopia." The review is complete, and the authors are advised to revise the following sections: the background needs rewriting, the methodology requires revision, and the conclusion should be rewritten based on the study's findings. The authors must also submit a letter of approval from the institutional ethics committee along with the revised manuscript. A supportive letter from the department will not be accepted. Failure to submit the ethically approved letter from the committee will result in the manuscript not being considered for further processing.​

Please submit your revised manuscript by Aug 25 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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We look forward to receiving your revised manuscript.

Kind regards,

Alqeer Aliyo Ali, MSc

Academic Editor

PLOS ONE

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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: No

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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: Yes

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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: Yes

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: Thank you for the opportunity to review the manuscript titled 'Seroprevalence of HIV, HBV, and Syphilis Co-infections and Its Associated Factors Among Pregnant Women Attending Antenatal Care in Amhara Regional State, Northern Ethiopia'. While I find the study compelling, I have identified several areas that require clarification prior to further consideration. Below are my comments and inquiries:

1. Abstract: Is the P-value ≤ 0.05 accurate?

2. Background: The background section is overly extensive; the author needs to eliminate redundancies and revise it.

3. Methodology:

The sampling technique is not clear, and the authors should illustrate the number of participants recruited from each hospital with a diagram.

Data Collection Method:

The suitability of the study design is questionable. The design is cross-sectional, yet the data collectors obtained HIV, Syphilis, and HBV results from chart reviews, which constitutes secondary data. This implies the use of both primary and secondary data. The author must address the following points:

i. Was a data extraction checklist utilized?

ii. If the hospital conducted HIV, HBV, and Syphilis tests only during the initial visit and not in subsequent visits, how were the test results for the second, third, and fourth visits obtained? A brief explanation is requested.

iii. The author should detail the HIV, HBV, and Syphilis testing procedures employed in the hospitals. Reviewing charts alone in a cross-sectional study is not acceptable.

iv. The name of the screening kits and confirmation tools, along with their countries of manufacture, should be specified; otherwise, the manuscript may face rejection.

Data Quality Control

Implement quality control measures for laboratory tests conducted in the hospital and ensure quality assurance for the checklist utilized in chart reviews.

4. Results

The author needs to clarify why sociodemographic were not analyzed and if there were any associated factors with co-infections.

5. Discussion

The discussion section is overly extensive; it would be beneficial for the author to highlight significant implications.

Acknowledge the limitations associated with the cross-sectional study design.

7. Conclusion

The author states that current infection prevention and control programs are insufficient to curb these infections' transmission. Was there an assessment of STI prevention and elimination programs?

The author mentions "regular screening of pregnant women." Is there a reported deficiency in regular screening?

References

DOIs should be included in the references.

Reviewer #2: I would like to thank the editor for the opportunity to review this interesting paper. I have reviewed the study and believe it has merit, provided the author takes into account my following comments in the revised manuscript.

1. The conclusion suggesting the strengthening of HIV, HBV, and syphilis testing and treatment does not align with the study's findings and requires revision.

2. The background section should be restructured to flow from a global perspective to Africa, and then specifically to Ethiopia.

3. Were all ANC attendees (e.g., 1st, 2nd, 3rd, and 4th visits) included in the study?

4. What were the reasons for the study's inability to directly test for HIV, HBV, and Syphilis?

5. The ethical clearance letter issued at the departmental level is inadequate for this study, which was conducted at the regional level and involved sensitive data such as HIV, HBV, and Syphilis results. I strongly urge the author to provide an approval letter endorsed by the university/college-level review committee. Additionally, the ethical considerations during the review of test results have been overlooked and should be addressed by the author.

6. The results section is well-articulated.

7. Please remove the first paragraph of the discussion as it is not relevant.

8. Also, highlight the strengths of your study.

9. Regarding the high prevalence observed, what baseline was used for comparison

10. What recommendations do you have for future research?

11. Overall, the conclusion does not reflect the study's findings, and the author should undertake a thorough revision.

12. Please note the presence of a duplicated Figure 1.

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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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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-24-25429R1Seroprevalence of HIV, HBV, and Syphilis co-infections and its associated factors among pregnant women attending antenatal Care in Amhara regional state, Northern EthiopiaPLOS ONE

Dear Dr. Anteneh,

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: While the reviewers recognize the manuscript's merit, the following issues require revision:

1. The manuscript requires further language editing due to numerous instances of poor language.

2. Please add the study design to the end of your study's title. Note: Refer to previously published papers by this journal for guidance on how to do this.Please ensure that your decision is justified on PLOS ONE’s publication criteria and not, for example, on novelty or perceived impact.

Please submit your revised manuscript by Sep 05 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,

Alqeer Aliyo Ali, MSc

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.

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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: The authors have responded to my concerns and revised the manuscript to a standard suitable for publication.

Reviewer #2: The authors have sufficiently addressed the comments from the previous round of review, and now the manuscript suitable for publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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[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.

Seroprevalence of HIV, HBV, and Syphilis co-infections and  associated factors among pregnant women attending antenatal Care in Amhara regional state, Northern Ethiopia: A hospital-based cross-sectional study

PONE-D-24-25429R2

Dear Dr. Anteneh,

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,

Alqeer Aliyo Ali, MSc

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: