Prevalence of pulmonary tuberculosis among key and vulnerable populations in hotspot settings of Ethiopia. A systematic review and meta-analysis

Melese Abate Reta; Zelalem Asmare; Assefa Sisay; Yalewayker Gashaw; Ermias Getachew; Muluken Gashaw; Zelalem Dejazmach; Abdu Jemal; Solomon Gedfie; Getinet Kumie; Marye Nigatie; Wagaw Abebe; Agenagnew Ashagre; Tadesse Misganaw; Woldeteklehaymanot Kassahun; Selamyhun Tadesse; Alene Geteneh; Atitegeb Abera Kidie; Biruk Beletew Abate; Nontuthuko Excellent Maningi; P. Bernard Fourie

doi:10.1371/journal.pone.0309445

Peer Review History

Original SubmissionMay 18, 2024
16 Jul 2024 Decision Letter - Zewdu Gashu Dememew, Editor PONE-D-24-19020Prevalence of pulmonary tuberculosis among key populations in hotspot settings in Ethiopia: A systematic review and Meta-AnalysisPLOS ONE Dear Dr. Reta, 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. Congratulations again for coming up with this quite relevant evidence of PTB among KVP. This is very important for Ethiopian TB program where the focus is on tailored active TB case finding is among KVPs at hotspot settings for TB. However, the is one critical comment to deal with. It is very instrumental to revise that all the literatures/references underwent for review were PTB. That is, it is advisable to check your topic/objective of assessing the prevalence PTB versus the cited references—looks some publications are not categorized into form/types of TB ,i.e not limited to PTB by excluding EPTB. If you are interested in only PTB that may be reflected clearly in the literature search and inclusion/exclusion criteria. Also, here are other minor comments for your consideration. The document will benefit out of professional English language editorial (grammar, structure and spacing) E.g university student vs University student; spacing in “..8.8% (95%CI: 5.00-12.55), University students 23.1% (95%CI: 15.81-30.37), Refugee camps 28.4%(95%CI: -1.27-58.15), Homeless individuals 5.8% (95%CI: -0.67- 12.35),..” Check the recently revised terminology ( under STOP TB KVP) as ‘key and vulnerable population’(KVPs) is the updated and standard terminology in use. You may use and refer the latest TB incidence estimate of TB in Ethiopia, 126/100k--Global tuberculosis report 2023 (who.int) in the statement “ Ethiopia’s TB incidence was 157 per 100,000 population, in 2020 [5].” Consider changing the referenced in text and list as well. Check the explanation and justification of the declining in the prevalence of KVP. This might show the increasing effort of active TB screening after 2015 where the denominator, # screened KVPs, might be increasing. Review the manuscript write up per the PLOS ONE writing standard, e.g. TB cannot be defined twice- at introduction and discussion. Please submit your revised manuscript by Aug 30 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. 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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 captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 3. 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 (if provided): [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: 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 manuscript is scientifically sound. The aim of the study corresponds to the methods used. The protocol is registered in International Prospective Register of Systematic Reviews (PROSPERO) (ID: 543925). For the literature review the PRIZM system was used. The statistical analysis is transparent and clear. The article is well structured with respect of all parts of the research. Reviewer #2: The manuscript provided important information of TB prevalence in risk groups in Ethiopia. It is very interesting that university students were considered a risk group along side refugees and prison inmates and what is even more surprising that TB prevalence was the highest in that group compared to all others. It would be very interesting to hear authors ideas on that issue in discussion - why students are considered a risk group and why there is so much TB. Additionaly authors could show some firgures on risk groups' contribution to overall burden of TB in Ethiopia percentage wise, if this data is available, e.g. total number of cases per year in risk groups and outside of risk groups. Also minor errors occur thoughout the text, e.g. s ".....observed from 2000 to 20233. Thus.....' etc ****** 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 ******** [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. Attachments Attachment Submitted filename: Academic editor comment.docx https://doi.org/10.1371/journal.pone.0309445.r001
Revision 1
7 Aug 2024 Author Response Author's Response to Reviewers’ comments Title: Prevalence of pulmonary tuberculosis among key populations in hotspot settings of Ethiopia. A Systematic Review and Meta-Analysis Manuscript ID: PONE-D-24-19020 PLOS ONE Dear reviewers First and foremost, we would like to extend our deepest gratitude to the reviewer(s)/editors for their time, effort, and commitment to reviewing our submitted paper and for their constructive comments. We greatly appreciate the detailed and thoughtful comments provided to our manuscript. These insightful comments were instrumental in guiding us to refine and improve our manuscript. They provided valuable perspectives that helped us address key issues and strengthen the overall presentation of our research. The detailed feedback highlighted areas that needed further clarification and allowed us to make necessary revisions, ultimately resulting in a more robust and impactful manuscript. We have made a rigorous effort to amend our manuscript in accordance with the reviewers'/editor’s comments and have employed additional revisions to further enhance the quality of our work. As highlighted in the main document, we made significant revisions in the manuscript. Hence, we made sure that each one of the comments has been addressed carefully and the manuscript is revised accordingly. Below are detailed responses (point-by-point responses) to all the comments/suggestions. All revisions that have been made to our manuscript are highlighted (track changing) in the revised versions of the manuscript. Please let us know if you have further inquiries regarding the revised manuscript or if any queries or comments still need clarity. We will be happy to address them, now on time. Thank you very much for your time and efforts to evaluate our manuscript. With sincere regards, Melese Abate Reta (PI) Date: 03 August 2024 Reviewer’s Comments and Author/s’ Responses Major comment 1. Reviewer’s/editor’s Comment_1: However, there is one critical comment to deal with. It is very instrumental to revise that all the literatures/references underwent for review were PTB. That is, it is advisable to check your topic/objective of assessing the prevalence PTB vs the cited references—looks some publication are not categorized in to form/types of TB, i.e not limited to PTB by excluding EPTB. If you are interested in only PTB that may be reflected clearly in the literature search and inclusion/exclusion criteria. Author’s response_1: We greatly appreciate your valuable comments on this point. As we have clearly highlighted in the “title” of our paper, “inclusion criteria”, “search strategies”, and the “study outcomes” section, our main focus/objective is to assess the combined/pooled prevalence of PTB while excluding extrapulmonary TB (EPTB). We carefully constructed our search terms for PTB to ensure we captured all relevant papers from the electronic databases. However, if the eligible and included studies report both the incidence or prevalence of PTB and EPTB among presumptive TB patients, we carefully extract the data pertaining to PTB cases only and calculate it’s prevalence by excluding EPTB cases. We emphasize this statement in the “Study Outcomes” section of the manuscript. Additionally, in our exclusion criteria: (c) "Studies reporting only extrapulmonary TB cases or latent TB" were excluded. Minor Comments 2. Reviewer’s Comment_2: The document will benefit out of professional English language editorial (grammar, structure and spacing) E.g university student vs University student; spacing in “..8.8% (95%CI: 5.00-12.55), University students 23.1% (95%CI: 15.81-30.37), Refugee camps 28.4%(95%CI: -1.27-58.15), Homeless individuals 5.8% (95%CI: -0.67- 12.35),..” Author’s response_2: Thank you very much for your constructive comments. We have revised the paper to improve its writing, including grammar, structure, and spacing, throughout the manuscript. Additionally, we invited native English speakers to review our paper, resulting in many corrections. 3. Reviewer’s Comment_3: Check the recently revised terminology (under STOP TB KVP) as ‘key and vulnerable population’(KVPs) is the updated and standard terminology in use. Author’s response_3: Thank you very much. We have reviewed the recently revised terminology for KVP and updated it to "key and vulnerable populations" (KVPs). These corrections have been made throughout the document. 4. Reviewer’s Comment_4: You may use and refer the latest TB incidence estimate of TB in Ethiopia, 126/100k--Global tuberculosis report 2023 (who.int) in the statement “ Ethiopia’s TB incidence was 157 per 100,000 population, in 2020 [5].” Consider changing the referenced in text and list as well. Author’s response_4: Thank you for your valuable comment. We have referred to the latest TB incidence estimates for Ethiopia from the Global Tuberculosis Report 2023 (126/100,000) and updated/changed the reference accordingly. 5. Reviewer’s Comment_5: Check the explanation and justification of the declining in the prevalence of KVP. This might show the increasing effort of active TB screening after 2015 where the denominator, # screened KVPs, might be increasing. Author’s response_5: We have reviewed the explanation and justification for the declining trends in the prevalence of KVP and included the following statement in the discussion section: “Another possible reason for the decline in PTB prevalence post-2015 could be the country’s increased efforts in active TB screening after 2015. This might reflect a rise in the total number of screened populations, especially among key and vulnerable groups.” 6. Reviewer’s Comment_6: Review the manuscript write up per the PLOS ONE writing standard, e.g. TB cannot be defined twice- at introduction and discussion. Author’s response_6: Thank you for this important comment. We have tried to adhere to the PLOS ONE manuscript writing standards and revised the introduction and discussion sections to remove the repeated use of the abbreviation "TB". Attachments Attachment Submitted filename: 2 Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0309445.r002
13 Aug 2024 Decision Letter - Zewdu Gashu Dememew, Editor Prevalence of pulmonary tuberculosis among key and vulnerable populations in hotspot settings of Ethiopia. A Systematic Review and Meta-Analysis PONE-D-24-19020R1 Dear Dr. Melese, 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, Zewdu Gashu Dememew, M.D Academic Editor PLOS ONE Dear Dr Melse, Congratulations again for this important evidence, and for revising your article per the given comment. I am happy that you also consider a few and very minor suggestion before publication. • ‘’compulsory TB testing’’ (for whom? Presumptive TB cases among KVPs or all KVPs irrespective of TB signs and symptoms?): check if this is a feasible and practical recommendation in Ethiopia. • Figure 1: the Asterix ( *) refers to what? • Once defined during the first appearance, ‘Key and Vulnerable Population (KVP)’ could be written as KVP throughout. Best regards https://doi.org/10.1371/journal.pone.0309445.r003
Formally Accepted
20 Aug 2024 Acceptance Letter - Zewdu Gashu Dememew, Editor PONE-D-24-19020R1 PLOS ONE Dear Dr. Reta, 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. Zewdu Gashu Dememew Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0309445.r004

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