Sociodemographic characteristics, community engagement and stigma among Men who have Sex with Men (MSM) who attend MSM-led versus public sexual health clinics: A cross-sectional survey in China

Christina Huon; Gifty Marley; Rayner Kay Jin Tan; Dan Wu; Qilei Sheng; Ye Liu; Margaret Elizabeth Byrne; Qiwen Tang; Rong Mu; Cheng Wang; Ligang Yang; Tong Wang; Weiming Tang; Joseph D. Tucker

doi:10.1371/journal.pone.0310957

Peer Review History

Original SubmissionJuly 2, 2024
24 Jul 2024 Decision Letter - Geng-Feng Fu, Editor PONE-D-24-26827Sociodemographic characteristics, community engagement and stigma among Men who have Sex with Men (MSM) who attend MSM-led versus public sexual health clinics: A cross-sectional survey in ChinaPLOS ONE Dear Dr. Marley, 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 Sep 06 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, Geng-Feng Fu, Ph.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. 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. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. 3. Thank you for stating the following financial disclosure: "National Institutes of Health (Grant number NIH NIAID R01AI158826)" 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. 4. In the online submission form you indicate that your data is not available for proprietary reasons and have provided a contact point for accessing this data. Please note that your current contact point is a co-author on this manuscript. According to our Data Policy, the contact point must not be an author on the manuscript and must be an institutional contact, ideally not an individual. Please revise your data statement to a non-author institutional point of contact, such as a data access or ethics committee, and send this to us via return email. Please also include contact information for the third party organization, and please include the full citation of where the data can be found. 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: Reviewer 1: his research article provides significant insights for the public health field by comparing the sociodemographic and psychosocial characteristics of Chinese men who have sex with men (MSM) seeking sexual health services at different types of clinics. The study targets the MSM population, a crucial group for the prevention and control of sexually transmitted diseases (STDs), which holds global significance in public health. Overall, this paper holds substantial research value in promoting the optimization of sexual health services for MSM in China. Some minor problems should be revised for the current version manuscript. Introduction: It is recommended to provide more background information on the existing literature and knowledge gaps regarding health-seeking behaviors and psychosocial factors among MSM in China. Methods: It is suggested to provide more details on the statistical analysis, including the variable selection process for the multivariate models and the handling of potential confounding factors. Statistical analysis: Further details should be provided on the statistical analysis, including the variable selection process for the multivariate models and the handling of potential confounding factors. Results: The current Table 1 on the comparison of sociodemographic and psychosocial characteristics of MSM is somewhat disorganized; partitioning it into two tables would be more appropriate. Discussion: It is recommended to discuss the potential limitations of the self-reported data and their impact on the validity of the study results. Reviewer 2: This study was found that MSM in Guangzhou who use public STD clinics were found to have different sociodemographic characteristics, lower community engagement, and increased social cohesion, compared to MSM who use MSM-led clinics. Some comments and suggestions are as follows: 1. In the “Intrdution”, P.3”MSM-led clinics. Although same-sex behaviours were decriminalized in China in 1997, thereremains a lack of legal protection for MSM against discrimination, and same-sex marriage is illegal”, please provide references. 2. There was a big difference in sample size between the two groups, Public STD is only 63 participants and MSM-led is 175 participants. Was the sample size enough for this study? 3. In Table 1, it is suggested that the analysis of the two groups of sociodemographic characteristics, and psychological factors related to attend clinics, should not be placed in the same table. 4. Why did both types of clinic operate in the same facility in three cities (Guangzhou, Foshan, and Jiangmen)? 5. Was there any information collected on why the subjects chose to visit these institutions? 6. In Table 1, it is recommended to supplement subjects' condom use during sexual behaviors. 7. It is suggested that more detailed information on the two different types of institutions be added to the method. [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: No Reviewer #2: No ****** 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: This research article provides significant insights for the public health field by comparing the sociodemographic and psychosocial characteristics of Chinese men who have sex with men (MSM) seeking sexual health services at different types of clinics. The study targets the MSM population, a crucial group for the prevention and control of sexually transmitted diseases (STDs), which holds global significance in public health. Overall, this paper holds substantial research value in promoting the optimization of sexual health services for MSM in China. Some minor problems should be revised for the current version manuscript. Introduction: It is recommended to provide more background information on the existing literature and knowledge gaps regarding health-seeking behaviors and psychosocial factors among MSM in China. Methods: It is suggested to provide more details on the statistical analysis, including the variable selection process for the multivariate models and the handling of potential confounding factors. Statistical analysis: Further details should be provided on the statistical analysis, including the variable selection process for the multivariate models and the handling of potential confounding factors. Results: The current Table 1 on the comparison of sociodemographic and psychosocial characteristics of MSM is somewhat disorganized; partitioning it into two tables would be more appropriate. Discussion: It is recommended to discuss the potential limitations of the self-reported data and their impact on the validity of the study results. Reviewer #2: This study was found that MSM in Guangzhou who use public STD clinics were found to have different sociodemographic characteristics, lower community engagement, and increased social cohesion, compared to MSM who use MSM-led clinics. Some comments and suggestions are as follows: 1.In the “Intrdution”, P.3”MSM-led clinics. Although same-sex behaviours were decriminalized in China in 1997, thereremains a lack of legal protection for MSM against discrimination, and same-sex marriage is illegal”, please provide references. 2.There was a big difference in sample size between the two groups, Public STD is only 63 participants and MSM-led is 175 participants. Was the sample size enough for this study? 3.In Table 1, it is suggested that the analysis of the two groups of sociodemographic characteristics, and psychological factors related to attend clinics, should not be placed in the same table. 4.Why did both types of clinic operate in the same facility in three cities (Guangzhou, Foshan, and Jiangmen)? 5.Was there any information collected on why the subjects chose to visit these institutions? 6.In Table 1, it is recommended to supplement subjects' condom use during sexual behaviors. 7.It is suggested that more detailed information on the two different types of institutions be added to the method. ****** 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. https://doi.org/10.1371/journal.pone.0310957.r001
Revision 1
4 Sep 2024 Author Response Sociodemographic characteristics, community engagement and stigma among Men who have Sex with Men (MSM) who attend MSM-led versus public sexual health clinics: A cross-sectional survey in China (PONE-D-24-26827) Dear Editor, Thank you for the helpful editorial and reviewer comments and interest in accepting our manuscript for publication. We have revised the manuscript according to the requests suggested. Please find below our point-by-point response to the reviewer's comments. Thank you. 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 Response: We have ensured the revised manuscript meets PLOS ONE's style requirements. 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. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. Response: We have uploaded the questionnaire version used in the pilot study as supporting information. Please see the S1 File. 3. Thank you for stating the following financial disclosure: "National Institutes of Health (Grant number NIH NIAID R01AI158826)" 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. Response: This statement is correct. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation. 4. In the online submission form you indicate that your data is not available for proprietary reasons and have provided a contact point for accessing this data. Please note that your current contact point is a co-author on this manuscript. According to our Data Policy, the contact point must not be an author on the manuscript and must be an institutional contact, ideally not an individual. Please revise your data statement to a non-author institutional point of contact, such as a data access or ethics committee, and send this to us via return email. Please also include contact information for the third party organization, and please include the full citation of where the data can be found. Response: We have updated the data statement to the University of North Carolina-Project China. The institutional email address ‘sesh@seshglobal.org’ has been 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. Response: We have double-checked all cited references to ensure they are complete and correct. Reviewer 1: This research article provides significant insights for the public health field by comparing the sociodemographic and psychosocial characteristics of Chinese men who have sex with men (MSM) seeking sexual health services at different types of clinics. The study targets the MSM population, a crucial group for the prevention and control of sexually transmitted diseases (STDs), which holds global significance in public health. Overall, this paper holds substantial research value in promoting the optimization of sexual health services for MSM in China. Some minor problems should be revised for the current version manuscript. Response: Thank you Introduction: 1.It is recommended to provide more background information on the existing literature and knowledge gaps regarding health-seeking behaviors and psychosocial factors among MSM in China. 2.Response: We have provided more background on the existing gap in the literature on lines 77-82 in the statement, "Some studies have investigated the psychological characteristics of MSM in China, and one found that MSM with and without high-risk homosexual behaviours in China have different social and psychological characteristics [14-16]. However, none of these studies have assessed the relationship between these psychological characteristics and healthcare seeking behaviors and testing sites among MSM in China to our knowledge. Additionally, most studies of healthcare seeking behaviour have focused on high income countries [17]. 3.Methods: It is suggested to provide more details on the statistical analysis, including the variable selection process for the multivariate models and the handling of potential confounding factors. Response: We have provided more details on the variable selection process for the multivariate models and the handling of potential confounders in the new Statistical analysis section on lines 128-140 in the statement: “Statistical Analysis A descriptive analysis was conducted to summarize the sociodemographic characteristics, sexual behaviors, and STD testing experience of participants. Sociodemographic data were analyzed for inter-group differences using Pearson's chi-squared test or Fisher's exact test. The association between psychosocial factors and clinic presentation was examined using univariate and multivariable logistic regression. Socio-demographics, psychosocial characteristics, and clinic type (public STD vs. MSM-led). Variables found to be marginally associated (a priori determined as p<0.20) with clinic type in crude bivariate analysis were included in a multivariable logistic regression model. No variable had >15% missing data, and variables with missing data were exempted from the regression models using a listwise deletion approach. Age, level of education, and marital status were controlled in the regression model as confounders of the psychosocial factors. The results were reported as adjusted odds ratio(aOR) with 95% confidence intervals (C.I) and p-values [17]." Statistical analysis: Further details should be provided on the statistical analysis, including the variable selection process for the multivariate models and the handling of potential confounding factors. Response: We have provided more details on the variable selection process for the multivariate models and the handling of potential confounders in the new Statistical analysis section on lines 133-145 in the statement: “Statistical Analysis A descriptive analysis was conducted to summarize the sociodemographic characteristics, sexual behaviors, and STD testing experience of participants. Sociodemographic data were analyzed for inter-group differences using Pearson's chi-squared test or Fisher's exact test. The association between psychosocial factors and clinic presentation was examined using univariate and multivariable logistic regression. Socio-demographics, psychosocial characteristics, and clinic type (public STD vs. MSM-led). Variables found to be marginally associated (a priori determined as p<0.20) with clinic type in crude bivariate analysis were included in a multivariable logistic regression model. No variable had >15% missing data, and variables with missing data were exempted from the regression models using a listwise deletion approach. Age, level of education, and marital status were controlled in the regression model as confounders of the psychosocial factors. The results were reported as adjusted odds ratio(aOR) with 95% confidence intervals (C.I) and p-values." 4. Results: 5.Table 1, which compares the sociodemographic and psychosocial characteristics of MSM, is somewhat disorganized; partitioning it into two tables would be more appropriate. Response: We agree with you and have partitioned the table into Tables 1 and 2. Thank you 6.Discussion: 7.It is recommended to discuss the potential limitations of the self-reported data and their impact on the validity of the study results. Response: We have discussed the potential limitations of the self-reported data on lines 195-199 in the statement, "Furthermore, the data on sexual behaviours and psychosocial characteristics are self-reported and may be subject to recall and social desirability bias. Our investigation addressed sensitive questions that may have led to the misreporting of personal sexual risk and STD testing behavior data owing to social desirability bias. Therefore, our findings and conclusions should be interpreted cautiously." Reviewer 2 This study was found that MSM in Guangzhou who use public STD clinics were found to have different sociodemographic characteristics, lower community engagement, and increased social cohesion, compared to MSM who use MSM-led clinics. Some comments and suggestions are as follows: 1. In the “Intrdution”, P.3”MSM-led clinics. Although same-sex behaviours were decriminalized in China in 1997, there remains a lack of legal protection for MSM against discrimination, and same-sex marriage is illegal”, please provide references. Response: We have revised this phrase on lines 68-71 in the statement, " Although same-sex behaviours were decriminalized in China in 1997 and declassified as part of the Chinese Classification of Mental Disorders in 2001 [9, 10], there remains a lack of legal protection for MSM against discrimination, and same-sex marriage is illegal". We have also provided two references to support this statement. Reference: 1.Tanner HM. The Offense of Hooliganism and The Moral Dimension of China's Pursuit of Modernity, 1979–1996. Twentieth-Century China. 2000;26(1):1-40. doi: 10.1179/tcc.2000.26.1.1. 2.Chen YF. Chinese classification of mental disorders (CCMD-3): towards integration in international classification. Psychopathology. 2002;35(2-3):171-5. Epub 2002/07/30. doi: 10.1159/000065140. PubMed PMID: 12145505. 2. There was a big difference in sample size between the two groups, Public STD is only 63 participants and MSM-led is 175 participants. Was the sample size enough for this study? Response: We believe the sample size was enough for the study, as the generally recommended sample size for pilot trials ranges from 24 to 100 participants. Reference: 1.Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res 2016; 25(3): 1057-73. 2.Thorlund K, Thabane L, Mills EJ. Modelling heterogeneity variances in multiple treatment comparison meta-analysis--are informative priors the better solution? BMC Med Res Methodol. 2013; 13: 2. 3. In Table 1, it is suggested that the analysis of the two groups of sociodemographic characteristics, and psychological factors related to attending clinics, should not be placed in the same table. Response: We agree with you and have partitioned the table into Tables 1 and 2. The revised Table 1 summarizes the sociodemographic characteristics of the participants, and Table 2 reports the findings of the logistic regression model, which shows the relationship between psychological factors and attended clinics. Thank you 4. Why did both types of clinic operate in the same facility in three cities (Guangzhou, Foshan, and Jiangmen)? Response: In these sites, the MSM-led CBOs we partnered with had existing partnerships with the public STD clinics that enabled them to provide routine HIV testing, counselling, and other healthcare services to their local MSM communities at the facility. The clinics were also run by clinical staff identifying with the LGBTQ community as members or allies, creating an inclusive environment that respected and valued all patients, regardless of their potential distrust of other clinicians at the facility. Notably, most of the MSM-led clinics in other cities had partnerships with the local CDC and/or other local health facilities for laboratory testing and treatment referral purposes although they did not operate in the same facility buildings as these three. 5. Was there any information collected on why the subjects chose to visit these institutions? Response: Unfortunately, this information was not collected. 6. In Table 1, it is recommended to supplement subjects' condom use during sexual behaviors. Response: We have included the data on participants' condom use rates for the past 6 months in Table 1. 7. It is suggested that more detailed information on the two different types of institutions be added to the method. Response: We have stated on lines 103-104 that 'S1 Fig provides more details on the similarities and differences between the two clinic types'. Thank you Attachments Attachment Submitted filename: Plos One Reviewer Response_04Aug2024.edited.docx https://doi.org/10.1371/journal.pone.0310957.r002
10 Sep 2024 Decision Letter - Geng-Feng Fu, Editor Sociodemographic characteristics, community engagement and stigma among Men who have Sex with Men (MSM) who attend MSM-led versus public sexual health clinics: A cross-sectional survey in China PONE-D-24-26827R1 Dear Dr. Tucker, 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, Geng-Feng Fu, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0310957.r003
Formally Accepted
7 Oct 2024 Acceptance Letter - Geng-Feng Fu, Editor PONE-D-24-26827R1 PLOS ONE Dear Dr. Tucker, 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. Geng-Feng Fu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0310957.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .