Rethinking HIV care for youth: Insights from qualitative research with youth in Chad

Esias Bedingar; Ferdinan Paningar; Ngarossorang Bedingar; Eric Mbaidoum; Naortangar Ngaradoum; Rifat Atun; Aisha K. Yousafzai

doi:10.1371/journal.pone.0309497

Peer Review History

Original SubmissionAugust 15, 2024
15 Aug 2024 Author Response https://doi.org/10.1371/journal.pone.0309497.r001
Decision Letter - Sara Jewett Nieuwoudt, Editor Dear Dr. Bedingar, 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. -->Upon review, I am in general agreement with the first reviewer that there is additional work required. Given the time it has taken to secure reviewers and the need for a second round of review, I encourage you to take time to reflect on reviewer 1's feedback, which is detailed, and submit an updated version. Should you disagree with any points in the review, ensure that you include a clear response.-->--> -->-->In addition to the reviewer comments, I suggest the following revisions:-->--> -->-->1. Review and update the labelling of your supplementary files within the text, particularly S1.-->-->2. While your section on reflexivity is great, please provide additional clarify on who was involved in the secondary analysis. Was this the entire co-author team or a subset?-->-->3. Remove periods after the headings for tables and figures-->-->4. According to the journal requirements, your Tables should placed within the body of the manuscript directly after the paragraph in which it is first cited (read order) instead of Supplemental Files. Tables require a label (e.g., “Table 1”) and brief descriptive title to be placed above the table in the manuscript.-->-->==============================?> Please submit your revised manuscript by Jan 24 2025 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. 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. We look forward to receiving your revised manuscript. Kind regards, Sara Jewett Nieuwoudt, Ph.D, MPH Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional 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 2. Thank you for stating the following financial disclosure: The study received funding from the Tessa Jowell Fellowship for Doctoral Research and Chad’s Prime Minister’s Office. 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. 3. Thank you for stating the following in the Acknowledgments Section of your manuscript: We are grateful for the collaboration and support received from the Blue Cross Chad, Rose Service Learning Fellowship, Fostering Diversity in HIV Research Program, Tessa Jowell Fellowship for Doctoral Research, Gamble Scholarship, and Chad’s Prime Minister’s Office. We thank the study participations for their willingness to share their experiences and perspectives, which has provided an essential foundation for our research. The study received funding from the Tessa Jowell Fellowship for Doctoral Research and Chad’s Prime Minister’s Office. We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: The study received funding from the Tessa Jowell Fellowship for Doctoral Research and Chad’s Prime Minister’s Office. Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. 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 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. 5. 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. 6. See earlier Editor Comments on how to align with the journal requirements. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Partly ******** 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 Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No ****** Reviewer #1: Overall, the manuscript has a potential, and with adjustments, it could make a valuable contribution to the field. I recommend that the authors should consider the following suggestions The primary issue is the predominant use of quantitative language to describe what is fundamentally qualitative research. I recommend that the authors revise how they present their findings using qualitative descriptors and narratives that better capture the depth and richness of their data. One gets the impression that the primary study generated good qualitative data. The proposed secondary analysis should be clearly described in terms of the research question that informed their analysis and the details of the research methods. The authors should align their language and presentation style with the qualitative nature of their research to maintain coherence throughout the manuscript. ****** 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 ******** [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: DC_Reviewer_comments.docx https://doi.org/10.1371/journal.pone.0309497.r002
Revision 1
30 Dec 2024 Author Response Dr. Sara Jewett Nieuwoudt Academic Editor PLOS ONE December 24th, 2024 Dear Dr. Sara Jewett Nieuwoudt, Thank you for your insightful and constructive comments regarding our manuscript. We have taken a great consideration for each of the comments provided. We provide a detailed response to each of the points raised: 1. Editor’s comments a. Reviewed and updated the labelling of my supplementary files within the text. b. Provided additional clarification on who was involved in the secondary data analysis. c. Removed periods after the headings for tables and figures. d. Placed Tables within the body of the manuscript directly after the paragraph in which it is first cited. 2. Journal requirements a. Ensured that the manuscript meets PLOS ONE’s style requirements, including those for file naming. b. Created a new section called “Funding” to state the financial disclosure, and the role the funders took in the study. c. Amended the Role of Funder statement within my cover letter. d. Updated the Data Availability statement. e. Included captions for my Supporting Information files at the end of my manuscript and updated in-text citations to match accordingly. 3. Reviewer’s comments a. Abstract i. Clarified the study design to specify that the study is a secondary data analysis based on a parent study that employed a Grounded Theory design to develop theory inductively. ii. Removed the term “significant” to avoid exaggeration as it cannot be supported by qualitative data. iii. Added findings from healthcare workers (service providers), emphasizing their perspectives on barriers, facilitators, and their roles in the HIV care continuum. iv. Rephrased the statement to make it a clear recommendation rather than a prescriptive assertion. b. Introduction i. Rephrased the study aim to reflect the qualitative nature of the research. c. Sampling i. Defined “diverse” and “relevant” in the context of this study. ii. Addressed the random selection question for the selection of participants. iii. Revised the paragraph to mention three categories instead of focus group discussions. iv. Re-wrote all numbers from one to ten from numbers to letters. d. Data collection i. Moved all details about the recruitment criteria, planned participant numbers, and random selection process to Sampling. ii. Clarified definitions of diversity and relevance in Sampling. iii. Organized details about service provider categories and facility eligibility under Sampling. iv. Focused on the process and logistics of conducting FGDs. v. Highlighted participatory activities and their role in data enrichment. vi. Kept descriptions of audio recording, transcription, and quality assurance in this section. e. Data analysis i. Clarified how deductive codes were used as a framework in the initial stages of coding and complemented by inductive coding to capture emergent themes. ii. Explicitly stated the research aims for the secondary data analysis. iii. Added a description of how participant feedback was sought and used to validate findings. iv. Replaced the word “guaranteed” with a more accurate description of efforts to ensure reliability and cultural accuracy. v. Retained the explanation of working with original languages while empathizing the rationale behind this approach. f. Results i. Added an introductory paragraph to contextualize the findings. ii. Described demographics and referenced clearly. iii. Expanded on participant demographics and their relevance to study findings. iv. Created descriptive headings reflecting the qualitative nature of the findings, removing numerical labeling for subthemes. v. Ensured findings were described before referencing tables and figures, per reviewer feedback. g. Discussion i. Rephrased statements to reflect that findings are based on participants’ experiences and perceptions, avoiding generalizations not supported by qualitative data. ii. Rephrased statements that implied comparison, measurement, or quantitative assessments. h. Conclusion i. Rephrased conclusion to link findings to the aim. ii. Avoided opinion-like statements, grounding conclusions in the data. iii. Maintained a focus on actionable recommendations while emphasizing the study’s contribution to knowledge. We are confident that these revisions have strengthened our manuscript and addressed the concerns raised. We hope that the revised manuscript will now be considered favorably for publication at PLOS ONE. Thank you once again for your constructive feedback. We are available to address any queries or provide additional information as needed. Please address all correspondence to: esias_bedingar@g.harvard.edu or esias.bedingar@gmail.com. Sincerely, Esias Bedingar, SM, PhD on behalf of the author team. Attachments Attachment Submitted filename: Response_Review.docx https://doi.org/10.1371/journal.pone.0309497.r003
Decision Letter - Sara Jewett Nieuwoudt, Editor Dear Dr. Bedingar, 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: Please submit your revised manuscript by Jun 13 2025 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. 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 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, Sara Jewett Nieuwoudt, Ph.D, MPH 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. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: In this paper, the authors analyze secondary qualitative data to understand the barriers and facilitators to HIV care for adolescents. The paper is well-written and addresses an important public health issue. Below I highlight a few concerns about the framing of the paper that I hope the authors find helpful 1) To help the reader understand the context in Chad, it would be helpful to speak about policies around young people’s access to services, including any age of consent restrictions when it comes to getting HIV testing and other HIV care services 2) While a qualitative study is suitable given the study aim, one aspect that is not sufficiently discussed under the ethical implications section is the suitability of FGDs for the interactions with adolescents particularly as the groups were divided by HIV status. Given the potential for stigma, it would be important for the authors to what measures were taken to ensure that young people were comfortable being put in groups based on HIV status. Were they aware of this grouping? 3) Given that care for HIV negative adolescents is centered around HIV testing, it feels like the paper would be more focused if it was on pathways to care for youth with HIV. 4) The discussion is sparse on references with several statements needing relevant citations (e.g., line 495 - Similar challenges have been reported by studies, highlighting these health-system and structural barriers, further complicating youth’s engagement in HIV care.) Minor suggestion Since the paper mostly uses the terms “youth” and “young people” rather than “adolescents”, when speaking to responsive care, they should use the term “youth-friendly” rather than “adolescent-friendly.” Similarly, they should use one term consistently (e.g., lines 225-227, 511-515 the authors switch to using the term “adolescent”) There are acronyms listed that are not used in the text e.g., LGBTQ+ ****** 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 #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 https://doi.org/10.1371/journal.pone.0309497.r004
Revision 2
5 May 2025 Author Response Dear Dr. Sara Jewett Nieuwoudt, Thank you again for your constructive and thoughtful comments regarding our manuscript. We have carefully reviewed and addressed all feedback from both the editorial team and the reviewer. Below, we provide a point-by-point summary of the changes made to the manuscript, including a response to the most recent request regarding references accuracy and completeness. 1. Editor’s comments a. Made a final round of revisions based on the feedback of the second reviewer. 2. Journal requirements a. Added additional references and edited the reference list. The references are #34 (lines 824-826), #40 (lines 843-845), #51 (lines 882-884), #52 (lines 885-887), #53 (lines 888-890), and #54 (lines 891-893). 3. Reviewer #2 comments a. Introduction i. Added a section on the legal and policy-related obstacles to accessing HIV services. b. Methods i. Addressed comment #2 by adding more information on the stratification of FGDs by HIV status in the Ethical approval section. c. Discussion i. Addressed comment #4 by reviewing and updating our reference list to ensure it is complete and accurate. d. Minor suggestion i. Changed the term “adolescents” to “youth” and “young people” when speaking to responsive care. ii. Removed the acronym “LGBTQ+” from the acronym list. We are confident that these revisions have substantially strengthened our manuscript and fully addressed the reviewer and editorial feedback. We respectfully resubmit our revised manuscript and hope it will be considered favorably for publication in PLOS ONE. Please do not hesitate to contact us with any further questions. Warm regards, Esias Bedingar, SM, PhD on behalf of the author team. Attachments Attachment Submitted filename: Response_Review_auresp_2.docx https://doi.org/10.1371/journal.pone.0309497.r005
Decision Letter - Sara Jewett Nieuwoudt, Editor Dear Dr. Bedingar, 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 Jul 12 2025 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. 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 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, Sara Jewett Nieuwoudt, Ph.D, MPH Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: Thank you to the authors for their thoughtful revisions to the manuscript. The paper is well-written and offers valuable insights for HIV programs focused on young people. I have two minor suggestions: I appreciate the enhanced discussion of the implications of the legal age of consent in both the introduction and discussion sections. While the discussion notes that parental presence during testing was identified as a challenge (page 28), this finding is not explicitly presented in the results. Please add a sentence or two detailing these findings in the results section. Regarding the acronym list: as previously mentioned, it should only include acronyms used within the text. Acronyms such as FCAS, CDC, and CGT are not used and should be removed. Additionally, "NGO" appears only once (page 15) and is not defined. I recommend spelling out "non-governmental organization" on page 15 and removing "NGO" from both the text and the acronym list. ****** 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 #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 https://doi.org/10.1371/journal.pone.0309497.r006
Revision 3
1 Jun 2025 Author Response Dear Dr. Sara Jewett Nieuwoudt, Thank you again for your constructive and thoughtful comments regarding our manuscript. We have carefully reviewed and addressed all feedback from both the editorial team and the reviewer. Below, we provide a point-by-point summary of the changes made to the manuscript, including a response to the most recent request regarding references accuracy and completeness. 1. Editor’s comments a. Made a final round of revisions based on the feedback of the second reviewer. b. There is no explicit use of the word “adolescent” in the abstract, and the abstract already aligns with the youth-friendly framing, consistently using the term “youth”. 2. Reviewer #2 comments a. Minor suggestion i. Although it was already explicit through the quotes used on page 18, I edited the paragraph to make it more explicit. We are confident that these revisions have substantially strengthened our manuscript and fully addressed the reviewer and editorial feedback. We respectfully resubmit our revised manuscript and hope it will be considered favorably for publication in PLOS ONE. Please do not hesitate to contact us with any further questions. Warm regards, Esias Bedingar, SM, PhD on behalf of the author team. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0309497.r007
Decision Letter - Sara Jewett Nieuwoudt, Editor Rethinking HIV care for youth: Insights from qualitative research with youth in Chad. PONE-D-24-34018R3 Dear Dr. Bedingar, 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, Sara Jewett Nieuwoudt, Ph.D, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Congratulations! This is an important contribution to the literature, particularly Chad. Thank you for your patience and commitment to publishing with us. While I've noted that Figure 1 appears twice at the end, but this will be handled through the publishing process. I look forward to seeing this in print. https://doi.org/10.1371/journal.pone.0309497.r008
Formally Accepted
Acceptance Letter - Sara Jewett Nieuwoudt, Editor PONE-D-24-34018R3 PLOS ONE Dear Dr. Bedingar, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. Sara Jewett Nieuwoudt Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0309497.r009

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