Knowledge, attitudes and practices relating to HIV self-testing following its introduction in the Bas-Sassandra region of Côte d’Ivoire: the case of the ATLAS project

Arlette Simo Fotso; Christian Koukobo; Romain Silhol; Arsène Kouassi Kra; Marie-Claude Boily; Anthony Vautier; Joseph Larmarange; on behalf of the ATLAS team

doi:10.1371/journal.pone.0314947

Peer Review History

Original SubmissionNovember 19, 2024
21 Feb 2025 Decision Letter - Leila Molaeipour, Editor Dear Dr. Larmarange, 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. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. 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: “This analysis was supported by Unitaid (grant number 2018–23 ATLAS) through a collaborative agreement with Solthis.” 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. Please note that 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. 5. 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. 6. In the online submission form, you indicated that: “Data cannot be shared publicly at this time, as it was collected through a joint survey conducted by the ATLAS program and the MTV Shuga initiative. As members of the ATLAS program team, we can only share the data once MTV Shuga has published results on the primary outcomes of their project. In the meantime, the data will be available upon request, and we have included it as a supplementary document during the submission process for reviewers’ reference. Ultimately, the data will be made publicly available on Zenodo.” 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. 7. One of the noted authors is a group or consortium: ATLAS team In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address. 8. We are unable to open your Supporting Information file data.zip. Please kindly revise as necessary and re-upload. 9. 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: Investigating knowledge about HIV self-testing is crucial for strengthening public health strategies to increase testing rates and reduce HIV-related stigma. While our study provides significant evidence in this area, there are several key issues that still need to be addressed. 1- Include keywords derived from MeSH terms. 2- The introduction does not transition smoothly from general concepts to specific details. Please revise the introduction to ensure clarity and maintain coherence. 3- Please include the sample size formula as well as the criteria for inclusion and exclusion in the study. 4- Please provide the content of the knowledge, attitude, and practice survey form, including the number of questions and the scoring method used. 5- In the methods section on page 6, it is unclear whether HIV-related knowledge and stigma or attitude have been investigated. Please clarify, as attitude and stigma are distinct concepts and should be addressed separately. 6- Please include the Ethics Committee Code in the manuscript. [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? Reviewer #1: Yes Reviewer #2: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: This manusccrips describes apect knowlledge attitude and practices towrads HIV self testing the Bas-Sassandra region of Côte d’Ivoire. The reserach questions were carefully enunciateds, the design and sampling methods were sound and the analystical techniques employed were appropriate considering the design and research questions. Overall the manuscript was well written and it was joy to read. The authors report on some signoificant findings which although not novell does provide the foundation to faciliatate evaluation of programme effficay should scaling be pursued Reviewer #2: 1. Keyword based on mesh is not 2. The introduction does not proceed clearly from generalities to details. 3. Sample size formula? 4. Study inclusion and exclusion criteria? 5. Content of the knowledge, attitude, and practice survey form (number of questions) and its scoring method. 6. Is it attitude or stigma that has been investigated? 7. Attitude and stigma are two separate concepts. 8. Ethics Committee Code? ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: MARVIN REID 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 Attachments Attachment Submitted filename: PLOSE ONE.docx https://doi.org/10.1371/journal.pone.0314947.r001
Revision 1
7 Apr 2025 Author Response We thank the Editor and reviewers for their helpful comments, which have improved the manuscript. Below, you will find our responses in purple to each point raised by the academic editor and reviewers. Editor Comments 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 The manuscript style has been updated accordingly 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. The questionnaire has been uploaded. 3. Thank you for stating the following financial disclosure: “This analysis was supported by Unitaid (grant number 2018–23 ATLAS) through a collaborative agreement with Solthis.” 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. The cover letter has been amended with the following statement “This analysis was supported by Unitaid (grant number 2018–23 ATLAS) through a collaborative agreement with Solthis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” 4. Please note that 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. The funding-related information has been removed from the acknowledgements as suggested 5. 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. The minimal anonymized dataset and R script used to replicate the presented analyses have been made publicly available on Zenodo with the DOI: 10.5281/zenodo.15064708 . The full survey data are considered only pseudonymized according to the European General Data Protection Regulation (GDPR) and therefore cannot be made publicly available. They can only be shared under specific restrictions by contacting the corresponding authors. Data Availability statement has been updated accordingly. 6. In the online submission form, you indicated that: “Data cannot be shared publicly at this time, as it was collected through a joint survey conducted by the ATLAS program and the MTV Shuga initiative. As members of the ATLAS program team, we can only share the data once MTV Shuga has published results on the primary outcomes of their project. In the meantime, the data will be available upon request, and we have included it as a supplementary document during the submission process for reviewers’ reference. Ultimately, the data will be made publicly available on Zenodo.” 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. The minimal anonymized dataset and R script used to replicate the presented analyses have been made publicly available on Zenodo with the DOI: 10.5281/zenodo.15064708 . See response to comment 6 7. One of the noted authors is a group or consortium: ATLAS team In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address. Individuals from the ATLAS group have been named in the acknowledgments. Note that they do not meet the criteria for authorship of this paper; that is why we used “on behalf of the…” instead of “and the…” in the author list. 8. We are unable to open your Supporting Information file data.zip. Please kindly revise as necessary and re-upload. The minimal anonymized dataset and R script used to replicate the presented analyses have been made publicly available on Zenodo with the DOI: 10.5281/zenodo.15064708 . See response to comments 6 and 7 9. 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. Our reference list is complete and correct. Additional Editor Comments: Investigating knowledge about HIV self-testing is crucial for strengthening public health strategies to increase testing rates and reduce HIV-related stigma. While our study provides significant evidence in this area, there are several key issues that still need to be addressed. 1- Include keywords derived from MeSH terms. The following keywords derived from MeSH were included: Health Knowledge, Attitudes, Practice; Self-Testing; HIV Infections; Humans, Cote d’Ivoire; Cross-Sectional Studies 2- The introduction does not transition smoothly from general concepts to specific details. Please revise the introduction to ensure clarity and maintain coherence. The introduction was revised accordingly 3- Please include the sample size formula as well as the criteria for inclusion and exclusion in the study. The following paragraph was added to the method section: “The sample size was calculated to ensure that the study's power was estimated at 92% and 99% to detect a minimum difference of 10% and 15%, respectively, in the ATLAS primary outcome compared to the 2018 PHIA (Population-Based HIV Impact Assessment) survey. The inclusion criteria were individuals aged 15 to 49 years, de facto household members (i.e., those present in the household at the time of the survey), individuals aged 18 or older with written informed consent, and those aged 15–17 with written informed assent and parent/guardian's written informed consent. The exclusion criteria included individuals younger than 15 or older than 49 years, those not present in the household at the time of the survey, refusal by the participant and/or parent/guardian, refusal by individuals aged 18 or older, refusal by a parent/guardian or lack of assent from individuals aged 15–17, and cognitive issues preventing the individual from providing informed consent.” 4- Please provide the content of the knowledge, attitude, and practice survey form, including the number of questions and the scoring method used. The questions about HIV self-testing (HIVST) knowledge, attitude, and practice are now provided in Supporting Information S1 Table. No special scoring method was used, as these were binary variables. To clarify how these variables were coded, the manuscript has been amended as follows: “We defined four dichotomous dependent variables related to knowledge, attitudes, and practices relating to HIV self-testing derived from the questions presented in the supporting information S1 Table. The first dependent variable measured individuals’ knowledge of HIVST, assessing whether the respondent had already heard of HIV self-testing, coded as “yes” or “no”. The second and third dependent variables concerned the respondents’ interest in using HIVST for themselves or for their partners if it was freely available. Each of these were binary variables indicating whether the individuals responded that they interested /very interested or not. These variables reflected the respondents’ attitudes towards HIVST. The fourth variable reflecting practices asked individuals whether they had ever used HIVST. This was also a binary variable, coded as “yes” or “no”.” 5- In the methods section on page 6, it is unclear whether HIV-related knowledge and stigma or attitude have been investigated. Please clarify, as attitude and stigma are distinct concepts and should be addressed separately. In the literature, HIV-related stigma is often seen as an umbrella concept and "refers to beliefs and/or attitudes about HIV" (see the articles doi: 10.1002/jia2.25915 or doi: 10.1007/s10461-009-9593-3). However, to address the reviewer's suggestion and given that our specific questions are mainly related to attitudes towards PLHIV, we have changed the wording to "negative attitudes toward PLHIV. 6- Please include the Ethics Committee Code in the manuscript. Ethics committee codes have been included in the manuscript page 6 as follow “Ethics approvals were obtained from the Côte d’Ivoire Ministry of Health (N/ref: 051-21/MSHP/CNESVS-km), the London School of Hygiene and Tropical Medicine (LSHTM) (LSHTM Ethics Ref: 26258), and the World Health Organization (WHO) (ERC.0003596) ethics committees in June, July and September 2021 respectively.” It was also added to acknowledgement as per editor’s suggestion Reviewer #1: This manusccrips describes apect knowlledge attitude and practices towrads HIV self testing the Bas-Sassandra region of Côte d’Ivoire. The reserach questions were carefully enunciateds, the design and sampling methods were sound and the analystical techniques employed were appropriate considering the design and research questions. Overall the manuscript was well written and it was joy to read. The authors report on some signoificant findings which although not novell does provide the foundation to faciliatate evaluation of programme effficay should scaling be pursued We thank the reviewer for their very positive comments regarding the paper. Reviewer #2: 1. Keyword based on mesh is not Comment addressed. Please see our response to editor’s additional comment number 1. 2. The introduction does not proceed clearly from generalities to details. Comment addressed. Please see our response to editor’s comment number 2. 3. Sample size formula? Comment addressed. Please see our response to editor’s additional comment number 3. 4. Study inclusion and exclusion criteria? Comment addressed. Please see our response to editor’s additional comment number 3. 5. Content of the knowledge, attitude, and practice survey form (number of questions) and its scoring method. Comment addressed. Please see our response to editor’s additional comment number 4. 6. Is it attitude or stigma that has been investigated? Comment addressed. Please see our response to editor’s additional comment number 5. 7. Attitude and stigma are two separate concepts. Comment addressed. Please see our response to editor’s additional comment number 6. 8. Ethics Committee Code? Comment addressed. Please see our response to editor’s additional comment number 7. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0314947.r002
13 Oct 2025 Decision Letter - Lara Vojnov, Editor Dear Dr. Larmarange, 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 Nov 27 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, Lara Vojnov Academic Editor PLOS ONE Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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 #1: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #3: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #3: Yes ****** Reviewer #1: (No Response) Reviewer #3: The authors have addressed prior reviewer comments. However one area that needs addressing, is the abstract - there is no indication of the number of people interviewed, where they came from, or how they were selected - a sentence or two on this would make all the difference. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: Marvin Reid Reviewer #3: 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.0314947.r003
Revision 2
27 Oct 2025 Author Response We thank the reviewers and the editor for their very positive comments. Only point 6 required a response from us: However one area that needs addressing, is the abstract - there is no indication of the number of people interviewed, where they came from, or how they were selected - a sentence or two on this would make all the difference. We have addressed this comment by adding the following sentences to the abstract: “A total of 6,271 people (3,203 men and 3,068 women) were interviewed. They were selected using a three-stage stratified sampling approach in the Bas-Sassandra region.” Attachments Attachment Submitted filename: Response to reviewers comment.docx https://doi.org/10.1371/journal.pone.0314947.r004
5 Jan 2026 Decision Letter - Matthew Mimiaga, Editor Knowledge, attitudes and practices relating to HIV self-testing following its introduction in the Bas-Sassandra region of Côte d’Ivoire: the case of the ATLAS project PONE-D-24-50776R2 Dear Dr. Larmarange, 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. For questions related to billing, please contact billing support . 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, Matthew J. Mimiaga, ScD, MPH, MA Academic Editor, PLOS One Additional Editor Comments (optional): The study assesses knowledge, attitudes, and practices (KAP) regarding HIV self-testing (HIVST) in the Bas-Sassandra region of Côte d’Ivoire after the ATLAS program distributed a large number of HIVST kits. Using a 2021 cross-sectional survey of 6,271 individuals aged 15–49 with a three-stage stratified sampling design, the authors employed bivariate analyses and multivariable logistic regressions to examine correlates of KAP. They found that actual awareness of HIVST was low (11%) and recent use was even lower (3%), yet an overwhelming majority expressed strong interest in using HIVST if it were freely available (about 76% for personal use and 75% for their sexual partners). Education and wealth were consistently positively associated with better knowledge and more favorable attitudes for both men and women, while age showed a positive association with knowledge and use among men only. A higher number of sexual partners in the past year correlated with greater knowledge and willingness to use HIVST for oneself or one’s partners in both sexes. Media exposure was linked to greater knowledge, and higher HIV-related knowledge coupled with lower negative attitudes predicted more positive attitudes toward HIVST. The findings imply a large unmet demand for HIVST that could be leveraged if the service were freely available, with uptake shaped by socioeconomic status, sexual behavior, and media exposure. Overall, the paper is strong: it uses a large, regionally representative sample and robust analyses to illuminate KAP gaps and drivers, contributing valuable, actionable insights to the literature on HIVST uptake in West Africa. It is also responsive to prior reviews. As such, I think the paper should be accepted for publication. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: (No Response) ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: Marvin Reid ******** https://doi.org/10.1371/journal.pone.0314947.r005
Formally Accepted
Acceptance Letter - Matthew Mimiaga, Editor PONE-D-24-50776R2 PLOS One Dear Dr. Larmarange, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Matthew J. Mimiaga Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0314947.r006

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