PONE-D-24-27141Enhancing Programmatic Scale-Up: Applying the Consolidated Framework for Implementation Research to Evaluate Decentralized Drug-Resistant Tuberculosis Services in Southern NigeriaPLOS ONE

Dear Dr. Agu,

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Pengpeng Ye

Academic Editor

PLOS ONE

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The research leading to these results was funded by the Stop TB Partnership under TB REACH Wave 9 grant number: STBP/TBREACH/GSA/W9-9833. However, the views expressed do not necessarily reflect the views of Stop TB Partnership, but belong solely to the authors.

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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: No

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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

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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 project piloted the decentralization of DR-TB treatment registration services in Nigeria, and systematically assessed its implementation in national TB programming. The study use CFIR as framework to evaluate the facillitators and barriers of the intervention and contributes to implementation science research. The study decription was quite clear and facillitators and barriers of the intervention have been identified. There are some questions regarding the research.

Methods：

1. (line 185) Please describe criteria for deciding when no further sampling was necessary in the data collection part (e.g., sampling saturation).

2. Please describe data management and security, anonymization/deidentification of excerpts.

Results：

1. (line 251-252) Majority of the emergent themes were grouped under the Innovation Characteristics (17 of 38 themes) and Inner Setting (11 of 38 themes) domains respectively. Can you explain the possible reasons why the remaining three parts have less content identified?

2. In the CFIR analysis results section, some excerpts can be added to help understand the content and increase credibility.

Reviewer #2:  Summary: This is a retrospective analysis of a pilot study testing the decentralized approach to drug-resistant TB services in two states in Nigeria. The authors conducted and qualitatively analyzed interviews with key informants using the Consolidated Framework for Implementation Research (CFIR). The authors do a nice job of applying the CFIR in a way that is methodologically sound and well explained. The findings show a good number of enablers to implementing this approach and describe barriers to implementation; the work is useful for informing further adoption and scale-up of such an approach.

Overall comments

• Implementation science application: There is a lot of really rich detail that is well-laid out and clear to follow because of the application of the CFIR. It would help clarify a great deal if the language in the intervention description aligned directly with what is presented in the results so that it can be referred back to.

o It is difficult to follow what is the intervention and what are the implementation strategies to deliver the intervention.

o For example, in the discussion, the authors describe implementation strategies that were previously mentioned as part of the innovation (e.g. WhatsApp) – please clarify what is the intervention and what are implementation strategies

o Line 269 – first mention of the WhatsApp group – is this part of the innovation? Please add to the intervention description or clarify particularly as it a large part of the discussion

o Some inconsistent use of the CFIR and the CFIR domain/construct terms use consistent CFIR terms (e.g. external should be outer setting?)

o Line 118, 363, 529 - Don’t need to say “CFIR framework” as “framework” is already in the name

o COM-B is introduced in the discussion – was this model used to guide analysis and interpretation of the findings? It needs to be presented in the methods and the results rather than only the discussion if it helped to guide the work. Furthermore, COM-B itself is not well-explained on what it is, what the components are, and why it is applied. This explanation of the model belongs in methods.

• The authors may need clarification on what availability of data means. This would include access to all fully transcribed interviews, which I don’t believe are included in full within the manuscript. Currently, the statement reads, “All relevant data are within the manuscript and its Supporting information files”

Minor comments

• Line 164 – additional explanation of what maximum variation purposive sampling is (with citation) and why it was used would be helpful

• Line 175, is there a word or phrase missing? One-on-one interviews with diverse stakeholders who were directly involved in implementing the project interventions in both states.

• Line 186 – capitalization of “CFIR Interview Guide” tool suggests it came from a specific place (CFIRguide.org?) - please cite where the guide comes from

• Line 199 – does this mean you undertook a deductive coding approach rather than inductive? Please clarify this sentence, “We adopted the CFIR constructs as our coding template rather than generating a coding template with our subset of data.”

• Line 271 – unclear how “sharing lived experience” fits in relative advantage? Can you clarify/explain more clearly what about the intervention design compared to the centralized approach makes it possible to share lived experience?

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Reviewer #1: Yes:  YE JIN

Reviewer #2: Yes:  Natalie A Blackburn

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Enhancing Programmatic Scale-Up: Applying the Consolidated Framework for Implementation Research to Evaluate Decentralized Drug-Resistant Tuberculosis Services in Southern Nigeria

PONE-D-24-27141R1

Dear Dr. Agu,

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.

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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,

Pengpeng Ye

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. 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

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

Reviewer #1: N/A

Reviewer #2: Yes

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4. 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

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5. 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

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6. 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: (No Response)

Reviewer #2: The authors have adequately addressed comments and this work makes a strong contribution to the field.

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7. 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: Yes:  Ye Jin

Reviewer #2: Yes:  Natalie A Blackburn

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