PONE-D-24-34271Viral suppression among patients in HIV/AIDS care at healthcare facilities in Ethiopia: Same-day antiretroviral initiationPLOS ONE

Dear Dr. Chachu,

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.

Thank you for the submission. After careful review, we find it has merit. Please submit your revised manuscript by Dec 19 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,

Judith Kose, M.D.

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. 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.

3. In the online submission form, you indicated that [Insert text from online submission form here]. 

All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information.

This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 

4. Please remove your figures from within your manuscript file, leaving only the individual TIFF/EPS image files, uploaded separately. These will be automatically included in the reviewers’ PDF.

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:

Thank you for your submission. Please see below the reviewer comments from the reviewers for you to address.

1st Reviewer:

a) The authors describe VL<1000c/ml as VLS, WHO says this level results in practically zero transmission and HIV <200 as undetectable and <50/20/5 copies as viral suppression. This is not possible with this set of data as like SA- VL is defined as suppression if <1000c/ml.

It is thus not current to call HIV loads<1000 as Viral suppression.- Thus the authors need to clarify this.

b)

The result and conclusion sectors needs to be re written to make it more concise.

c) Only 7 patients were followed up to 24months- and thus too small a sample. The massive drop out rate is not discussed either

d) The number of people infected and on therapy is not clear.

e) For a country to know what it needs to achieve to reach the WHO 95-95-95 targets for epidemic control- it needs to have data on numbers infected, numbers initiated, numbers remaining in care as well as suppression rates or numbers on treatment who have rates that will impact on transmission. Critical would be to recognise what is needed to address the challenges of retention- added counselling, intensive adherence support, community based support etc

2nd reviewer

a) The manuscript is technically sound, methodology is clear, and data is presented well. The findings follow logically from the hypothesis to the conclusion. The data collected is in line with the objectives of the study and supports the authors’ claims.

Statistical analysis in the manuscript is proper and thorough. Authors have used suitable statistical methods which are clearly described, and results are reproducible and valid. They have also addressed the confounding variables which makes the findings more reliable.

Authors have made all data fully available following best practices in transparency in research. They have included a data availability statement which describes where and how the data can be accessed so that others can reuse the data and verify their findings.

The manuscript is well organized and written in clear language. It follows standard English and is accessible to a wide audience. Section flow is good and makes complex concepts easy to understand

The following needs revision:

The reference list requires attention, specifically reference number 3, which cites the World Health Organization (WHO). It is important to ensure that the name is formatted correctly and consistently throughout the manuscript. Please revise this entry to accurately reflect the proper citation format for WHO.

[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: Partly

Reviewer #2: Yes

**********

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

Reviewer #1: No

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 challenge facing authors in Africa is the changing goal posts especially in regard to what defines HIV load suppression:

The authors describe VL<1000c/ml as VLS, WHO says this level results in practically zero transmission and HIV <200 as undetectable and <50/20/5 copies as viral suppression. This is not possible with this set of data as like SA- VL is defined as suppression if <1000c/ml.

It is thus not current to call HIV loads<1000 as Viral suppression.- Thus the authors need to clarify this.

The result and conclusion sectors need a major rewrite.

Only 7 patients were followed up to 24months- and thus too small a sample.

The massive drop out rate is not discussed either

the number of people infected and on therapy is not clear.

For a country to know what it needs to achieve to reach the WHO 95-95-95 targets for epidemic control- it needs to have data on numbers infected, numbers initiated, numbers remaining in care as well as suppression rates or numbers on treatment who have rates that will impact on transmission. Critical would be to recognise what is needed to address the challenges of retention- added counselling, intensive adherence support, community based support etc

Reviewer #2: The manuscript is technically sound, methodology is clear, and data is presented well. The findings follow logically from the hypothesis to the conclusion. The data collected is in line with the objectives of the study and supports the authors’ claims.

Statistical analysis in the manuscript is proper and thorough. Authors have used suitable statistical methods which are clearly described, and results are reproducible and valid. They have also addressed the confounding variables which makes the findings more reliable.

Authors have made all data fully available following best practices in transparency in research. They have included a data availability statement which describes where and how the data can be accessed so that others can reuse the data and verify their findings.

The manuscript is well organized and written in clear language. It follows standard English and is accessible to a wide audience. Section flow is good and makes complex concepts easy to understand

The following needs revision:

The reference list requires attention, specifically reference number 3, which cites the World Health Organization (WHO). It is important to ensure that the name is formatted correctly and consistently throughout the manuscript. Please revise this entry to accurately reflect the proper citation format for WHO.

**********

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: Yes:  Dr. Alemayehu Abebe Demissie

**********

[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.

Viral suppression among patients in HIV/AIDS care at healthcare facilities in Ethiopia: Same-day antiretroviral initiation

PONE-D-24-34271R1

Dear Dr. Chachu,

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,

Judith Kose, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: