“I was given PrEP, but had no privacy”: Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya

Melissa Vera; Helen Aketch; Caroline Omom; Felix Otieno; George Owiti; Joseph Sila; John Kinuthia; Kristin Beima-Sofie; Jillian Pintye; Valarie Kemunto; Eunita Akim; Grace John-Stewart; Pamela Kohler

doi:10.1371/journal.pone.0309075

Peer Review History

Original SubmissionFebruary 19, 2024
5 Apr 2024 Decision Letter - Matt A Price, Editor PONE-D-24-01290“I was given PrEP, but had no privacy”: Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, KenyaPLOS ONE Dear Dr. Vera, 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 May 20 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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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. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. 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In the online submission form, you indicated that your data is available only on request from a third party. Please note that your Data Availability Statement is currently missing [the contact details for the third party, such as an email address or a link to where data requests can be made]. Please update your statement with the missing information. 5. 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: I have reviewed and have only minor comments. In general, the paper is well written and easy to follow. Two minor suggestions: Results, first sentence: what is “case 1”, “case 2” etc. I thought there were 8 actors/USPs not 6, is this the number of interviews from each USP? I see from the table this refers to scenarios or scripts. Perhaps this could be better described in the methods? Did each USP participate in each scenario/case, or did some “specialize” in certain cases, so to speak? [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 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 ****** 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 ****** 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: Authors present a large qualitative study of mystery clients who presented as AGYW who were interested to discuss PrEP continuation/prescription. The study was embedded in a large trial involving 24 health facilities. Data were thematically analysed and revealed three themes reflecting on the interactions experienced. Privacy, attitudes to clients, and 'patient-centered communication' - emerge as main perceived determinants of improved HIV preventive care (i.e. PrEP continuation and initiation). The paper is well-written reinforces that clinician attitudes impact uptake of prevention products. The discussion is fairly brief and reiterates the three major findings. I was missing a broader discussion on what it will take to get AGYW to take up daily oral PrEP. It is clear that improved privacy and client-centred communication is one aspect. There are several other aspects of PrEP programming (e.g. stigma reduction, societal attitudes to sexual activity and PrEP, mental health support, alternative PrEP dispensing approach, role of peer support) that go beyond the mystery clients approach but could be mentioned to contextualise study findings. The final sentence of the discussion is weak: "Future research is needed that includes a broader sample of non-actor AGYW participants to evaluate of whether provider and health systems interventions to improve these interactions will result in improved uptake and persistence in this priority population." Especially since authors speak about health systems interventions that have hardly been discussed or put in context. Small point: how did the sex (gender) of the provider impact interactions? ****** 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: Eduard Sanders ******** [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.0309075.r001
Revision 1
3 Jul 2024 Author Response Response to Reviewers Dear Matt Price and Eduard Sanders, Thank you for your feedback and time. Below are my responses to your edits for Manuscript: PONE-D-24-01290, “I was given PrEP, but had no privacy”: Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya. Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Addressed. I reviewed the PDF links and reformatted the title page and main manuscript per PLOS One requirements. 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Completed and uploaded to submission. 3. Thank you for stating the following financial disclosure: This study was funded through P.K. by the National Institutes of Health (NIH, R01 HD094630) and M.V. received additional funding by the National Institute of Nursing Research (NINR, T32NR019761). Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Completed and changed in the Cover Letter. Added: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." 4. In the online submission form, you indicated that your data is available only on request from a third party. Please note that your Data Availability Statement is currently missing [the contact details for the third party, such as an email address or a link to where data requests can be made]. Please update your statement with the missing information. Amended the online statement with an email and phone number to contact the third party (UW Human Subjects Research Dept.). 5. 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. Reviewed References and did not need to retract any citations. Additional Editor Comments: I have reviewed and have only minor comments. In general, the paper is well written and easy to follow. Two minor suggestions: Results, first sentence: what is “case 1”, “case 2” etc. I thought there were 8 actors/USPs not 6, is this the number of interviews from each USP? I see from the table this refers to scenarios or scripts. Perhaps this could be better described in the methods? Did each USP participate in each scenario/case, or did some “specialize” in certain cases, so to speak? Added: "Two USPs were assigned to each case (some overlapping cases) using scripted commonly occurring PrEP scenarios (Table 1) to seek PrEP services at all 24 facilities." to the Data Collection sub-section. [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 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A 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 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 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: Authors present a large qualitative study of mystery clients who presented as AGYW who were interested to discuss PrEP continuation/prescription. The study was embedded in a large trial involving 24 health facilities. Data were thematically analysed and revealed three themes reflecting on the interactions experienced. Privacy, attitudes to clients, and 'patient-centered communication' - emerge as main perceived determinants of improved HIV preventive care (i.e. PrEP continuation and initiation). The paper is well-written reinforces that clinician attitudes impact uptake of prevention products. The discussion is fairly brief and reiterates the three major findings. I was missing a broader discussion on what it will take to get AGYW to take up daily oral PrEP. It is clear that improved privacy and client-centred communication is one aspect. There are several other aspects of PrEP programming (e.g. stigma reduction, societal attitudes to sexual activity and PrEP, mental health support, alternative PrEP dispensing approach, role of peer support) that go beyond the mystery clients approach but could be mentioned to contextualise study findings. The final sentence of the discussion is weak: "Future research is needed that includes a broader sample of non-actor AGYW participants to evaluate of whether provider and health systems interventions to improve these interactions will result in improved uptake and persistence in this priority population." Especially since authors speak about health systems interventions that have hardly been discussed or put in context. Small point: how did the sex (gender) of the provider impact interactions? Thank you for your review and extremely helpful comments. I have added more context to the Discussion and Conclusion sections as stated below. First paragraph in Discussion; added: "This adds to the broader context in which AGYWs are seeking HIV prevention services where stigma reduction is paramount and changing discriminating attitudes towards HIV prevention and sex are crucial to decreasing HIV transmission. If AGYW can receive better care in the setting they receive care most often (i.e. within the healthcare system among health care providers), it could help with HIV prevention efforts among this population." Discussion; added ending paragraph: "In the broader context of HIV prevention among AGYW, more is needed: more access points to PrEP, better systems for retention of AGYW to PrEP services, an overall cultural shift toward more understanding and acceptance of AGYW sexual practices and what they do to protect themselves. Retail pharmacies are a promising new addition to PrEP acquisition.33 Purchasing PrEP over-the-counter has shown in recent studies to provide the privacy, good communication, and convenience many AGYWs prefer when accessing PrEP. Peer-support groups are another way to potentially increase PrEP intiation among AGYWs.34 This model utilizes experienced AGYWs to help PrEP-naïve AGYWs take HIV self-tests and then refers them to PrEP services at clinic. Peer-supported PrEP initiation may be another way to bolster PrEP initiation among AGYWs, but they still need a good experience at the clinic once they get there. Our study reinforces the potential impact that health care providers have among AGYWs accessing HIV prevention." Conclusion; added: "Further, more research is needed to better contextualize and understand the benefits of retail pharmacy-based PrEP services and peer-supported PrEP programs, both aimed at increasing PrEP access points and retaining more clients on PrEP for younger populations." 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: Eduard Sanders Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0309075.r002
6 Aug 2024 Decision Letter - Matt A Price, Editor “I was given PrEP, but had no privacy”: Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya PONE-D-24-01290R1 Dear Dr. Vera, 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, Matt A Price Academic Editor PLOS ONE Additional Editor Comments (optional): The authors have adequately addressed the reviewer comments Reviewers' comments: https://doi.org/10.1371/journal.pone.0309075.r003
Formally Accepted
9 Aug 2024 Acceptance Letter - Matt A Price, Editor PONE-D-24-01290R1 PLOS ONE Dear Dr. Vera, 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. Matt A Price Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0309075.r004

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