“It doesn’t require blood!”: Perceptions around non-invasive malaria testing tools in Indonesia, Peru, and Rwanda

Vanessa Fargnoli; Serafina Calarco; Catherine Thomas; Caroline Thomas; Claudius Novchovick Mone Iye; Valerie A. Paz Soldan; Amy Celeste Morrison; Janvier Serumondo; Ladislas Nshimiyimana; Yvonne Delphine Nsaba Uwera; Elena Marbán-Castro; Sonjelle Shilton; Kevin K.A. Tetteh

doi:10.1371/journal.pone.0318393

Peer Review History

Original SubmissionFebruary 3, 2025
24 Jun 2025 Decision Letter - Susan Horton, Editor “It doesn’t require blood!” Dear Dr. Calarco, 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. Reviewer 2 in particular has provided detailed and constructive comments to improve the manuscript. Please respond to these suggestions. Please submit your revised manuscript by Aug 08 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, Susan Horton 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: This study has been funded by UK aid from the UK government (FCDO project number 300341-102), as well as the Swiss Development Cooperation (contract number 81071426). 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. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. Please clarify whether this publication was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript. 5. Please amend the manuscript submission data (via Edit Submission) to include author Claudius Mone, Amy C. Morrison 6. Please amend your authorship list in your manuscript file to include author Claudius Novchovick Mone Iye, Amy Celeste Morrison 7. We notice that your supplementary figures are uploaded with the file type 'Figure'. Please amend the file type to 'Supporting Information'. Please ensure that each Supporting Information file has a legend listed in the manuscript after the references list. 8. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 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: The reviewers thought that this paper provides valuable information. Please respond carefully to their comments; reviewer 2 has provided detailed constructive comments. [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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: The manuscript is well-written, with correct grammar and proper sentence structure. The article provides a comprehensive and accurate overview of the current state of malaria diagnostics and the challenges faced. It effectively discusses the limitations of traditional methods and the potential of new technologies that can be used instead. The references are well structured. The researchers did a good job of explaining complex concepts and providing detailed information about various diagnostic methods. The section on malaria testing tools is informative. It explains the three types of devices, including their current market status and potential applications, which sets up the context for evaluating their acceptability and effectiveness. Method and material section is well-organized into sections (Study design and sites, Study populations, Sampling procedures, and Malaria testing tools), which help guide the reader through the methodology. Various groups were included (community members, pregnant women, teachers, caregivers, HCWs, border professionals, and stakeholders). This variety supports a rich understanding of different perspectives regarding malaria diagnostics, especially in endemic areas. Discussion section does an excellent job of capturing a wide range of perspectives on non-invasive malaria diagnostics and demonstrates the potential value of these tools in improving malaria screening and treatment in diverse settings. The text provides a thorough exploration of both the advantages and disadvantages of non-invasive malaria diagnostics. It discusses perceived benefits such as ease of use, reduced pain, and increased screening capabilities as well as potential challenges and limitations such as the inability to differentiate parasite species and logistical concerns. Reviewer #2: GENERAL REMARKS In this manuscript, the authors present a relevant qualitative study that aimed to generate evidence from end-users around the potential adoption of non-invasive diagnostic technologies, to determine whether these tools are fit for purpose. To this end, they conducted, in three malaria-endemic countries (Indonesia, Peru, and Rwanda), 24 semi-structured interviews with stakeholders and professionals working at borders, and 16 focus group discussions with community members, caregivers of children under 5 years, pregnant women, healthcare workers, and teachers (total n=139). The participants shared their practical needs, concerns, and acceptability regarding the proposed non-invasive tools. Therefore, the study provides valuable insights and guidance for the development of non-invasive malaria diagnostics, ensuring that these tools meet the needs of end-users. Despite the relevance of this study, the authors should address some minor points before the publication of the manuscript. MINOR ISSUES Introduction • Several sentences lack references (e.g., lines 56, 61, 90, 95, 98, 99, 106). Please carefully review the introduction and add appropriate citations where needed. • Lines 76–77: Clarify what UNITAID and FIND are. Materials and Methods • Line 147: Please explicitly define “stakeholders” (e.g., specify roles like policymakers, NGO representatives, or ministry officials). While contextualized later, a clear definition early would aid readability. • Line 150: I recommend clarifying the definition of “community members”. Would they be anyone in the community who is not from the other groups (pregnant women, teachers, caregivers of children under five, and healthcare workers)? • Lines 147–151: Explain the criteria used to establish which method (Semi-Structured Interviews or Focus Group Discussions) was more appropriate for each listed group (e.g., stakeholders, professionals working at borders, community members, pregnant women, teachers). • Lines 156–163: Justify differences in the endemicity levels and standardize their characterization across the selected areas in the three countries. For instance: Indonesia had no sampling from non-endemic areas, unlike Rwanda and Peru. Peru only sampled highly endemic areas, while Indonesia included low-, medium-, and high-endemicity areas. For Rwanda the endemic areas are mentioned without specifying the endemicity level. • Lines 156–163: The selected areas in Indonesia and Rwanda lack description as urban or rural, while those in Peru are clearly characterized. I recommend standardizing this classification across all study sites for better comparability. • Lines 156–163: I suggest to present site characteristics (including FGD/SSI counts and sample sizes) in a table for a better overview of the sampling. • Line 162: Fix spacing in "and Tumbes". • Line 164: What is the reason for discussing Peru-specific findings separately and excluding them from this manuscript? • Line 180: Fix spacing in "aged 18 years". • Line 252: I recommend sharing SSI and FGD guides as supporting information for more transparency of the applied methods. • Lines 259–261: Was the information in Figure S1 the only explanation given to participants about the devices? Was the figure translated into local languages? Were the devices limitations or additional details provided? • I suggest reporting how many people refused to participate or dropped out of the study. Results • Explain why according to Table 1 Indonesia had no community members included. • I recommend the addition of relative values (percentages) and a "Total" column in Table 1 for better interpretation. • Lines 296–267: The authors mention “the interviewer remaining neutral and unbiased throughout”. Please clarify their stance on answering the questions of participants about the devices. If questions were answered, this should be explicitly stated. • Figure 2: Correct the misspelling of "malaria" in "Perceptions that malaria can only be detected in blood". Discussion • While the study focuses on participants’ perceptions, discussing whether these perceptions align with scientific evidence (especially the perceived disadvantages) would strengthen the paper. The authors are not required to do this modification, but it could add valuable context. ADDITIONAL POINT • Regarding data availability: While the authors state that “all data are fully available without restriction”, I was unable to locate the interview transcripts or excerpts of the transcripts relevant to the study in the Supporting Information files. ****** 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: Laura Cordeiro Gomes ******** [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.0318393.r001
Revision 1
30 Sep 2025 Author Response 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 Thank you for the reminder. We reviewed the guidelines and revised the manuscript to ensure it meets the formatting guidelines. Please advise if we missed anything. 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. Thanks, we uploaded the questionnaire as required 3. Thank you for stating the following financial disclosure: This study has been funded by UK aid from the UK government (FCDO project number 300341-102), as well as the Swiss Development Cooperation (contract number 81071426). 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. Thanks for your comment, we added the sentence in the cover letter as required. 4. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. Please clarify whether this publication was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript. Dear Editor, the publication is now formally published (Nussbaum, L., Ortega, E., Ríos López, E.J. et al. Voices from the Amazon: exploring implementor and user perceptions of non-invasive malaria diagnostics in Peru. Malar J 24, 32 (2025). https://doi.org/10.1186/s12936-025-05273-1). As requested, we added a section in the cover letter explaining why this doesn’t constitute dual publication. 5. Please amend the manuscript submission data (via Edit Submission) to include author Claudius Mone, Amy C. Morrison We have checked the manuscript submission data and both authors Claudius Mone and Amy C. Morrison are listed. 6. Please amend your authorship list in your manuscript file to include author Claudius Novchovick Mone Iye, Amy Celeste Morrison Thanks, we addressed this change in the manuscript file 7. We notice that your supplementary figures are uploaded with the file type 'Figure'. Please amend the file type to 'Supporting Information'. Please ensure that each Supporting Information file has a legend listed in the manuscript after the references list. Thank you for bringing this to our attention. The figure has now been correctly uploaded as a Supporting Information file. 8. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Thank you for pointing this out. The Supporting Information captions have been added at the end of the manuscript. We will remove the separate caption file from the submission files, in accordance with the guidelines. 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. Thank you very much for your comment. We have reviewed the references and none of them seem to have been retracted, please let us know if we missed anything. Additional Editor Comments: The reviewers thought that this paper provides valuable information. Please respond carefully to their comments; reviewer 2 has provided detailed constructive comments. [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: N/A Reviewer #2: N/A ________________________________________ 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 ________________________________________ 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 manuscript is well-written, with correct grammar and proper sentence structure. The article provides a comprehensive and accurate overview of the current state of malaria diagnostics and the challenges faced. It effectively discusses the limitations of traditional methods and the potential of new technologies that can be used instead. The references are well structured. The researchers did a good job of explaining complex concepts and providing detailed information about various diagnostic methods. The section on malaria testing tools is informative. It explains the three types of devices, including their current market status and potential applications, which sets up the context for evaluating their acceptability and effectiveness. Method and material section is well-organized into sections (Study design and sites, Study populations, Sampling procedures, and Malaria testing tools), which help guide the reader through the methodology. Various groups were included (community members, pregnant women, teachers, caregivers, HCWs, border professionals, and stakeholders). This variety supports a rich understanding of different perspectives regarding malaria diagnostics, especially in endemic areas. Discussion section does an excellent job of capturing a wide range of perspectives on non-invasive malaria diagnostics and demonstrates the potential value of these tools in improving malaria screening and treatment in diverse settings. The text provides a thorough exploration of both the advantages and disadvantages of non-invasive malaria diagnostics. It discusses perceived benefits such as ease of use, reduced pain, and increased screening capabilities as well as potential challenges and limitations such as the inability to differentiate parasite species and logistical concerns. Reviewer #2: GENERAL REMARKS In this manuscript, the authors present a relevant qualitative study that aimed to generate evidence from end-users around the potential adoption of non-invasive diagnostic technologies, to determine whether these tools are fit for purpose. To this end, they conducted, in three malaria-endemic countries (Indonesia, Peru, and Rwanda), 24 semi-structured interviews with stakeholders and professionals working at borders, and 16 focus group discussions with community members, caregivers of children under 5 years, pregnant women, healthcare workers, and teachers (total n=139). The participants shared their practical needs, concerns, and acceptability regarding the proposed non-invasive tools. Therefore, the study provides valuable insights and guidance for the development of non-invasive malaria diagnostics, ensuring that these tools meet the needs of end-users. Despite the relevance of this study, the authors should address some minor points before the publication of the manuscript. - We would like to thank both reviewers for their encouraging and positive feedback on our study and manuscript. We have tried to address the majority of the minor comments raised by Reviewer 2. MINOR ISSUES Introduction • Several sentences lack references (e.g., lines 56, 61, 90, 95, 98, 99, 106). Please carefully review the introduction and add appropriate citations where needed. Thanks for your suggestion, 5 more references have been added. • Lines 76–77: Clarify what UNITAID and FIND are. Addressed Materials and Methods • Line 147: Please explicitly define “stakeholders” (e.g., specify roles like policymakers, NGO representatives, or ministry officials). While contextualized later, a clear definition early would aid readability. Thank you for this suggestion. We had this address, but it was not clear enough. We have included in brackets the specific stakeholders within that sentence (Line 158 to 160). • Line 150: I recommend clarifying the definition of “community members”. Would they be anyone in the community who is not from the other groups (pregnant women, teachers, caregivers of children under five, and healthcare workers)? Indeed, this needed to be defined better. We added “other” to the term “community members” (Line 163 to 168). This classification included other members of the community who do not fall into the above categories but who are interested in sharing their opinions on the subject. Selection of community members was decided with partners. They could include parents and school staff (recruited at schools), travellers (recruited at travel agencies), established groups at the community (including spiritual/healthcare centres etc.). We have included some wording throughout the manuscript. • Lines 147–151: Explain the criteria used to establish which method (Semi-Structured Interviews or Focus Group Discussions) was more appropriate for each listed group (e.g., stakeholders, professionals working at borders, community members, pregnant women, teachers). Semi-structured interviews were chosen when the objective was to capture in-depth, individual perspectives on context-specific issues, and when engaging with professionals who might not have the time to participate in a group discussion but could accommodate some time for an individual conversation (e.g., stakeholders, professionals working at borders). In contrast, focus group discussions were used when the aim was to explore shared experiences, collective norms, and group dynamics (e.g., community members, teachers, pregnant women), as this method encouraged interaction and exchange among participants from the same community groups. Thanks to the reviewer this has been clarified within the manuscript (lines 154 to 157). • Lines 156–163: Justify differences in the endemicity levels and standardize their characterization across the selected areas in the three countries. For instance: Indonesia had no sampling from non-endemic areas, unlike Rwanda and Peru. Peru only sampled highly endemic areas, while Indonesia included low-, medium-, and high-endemicity areas. For Rwanda the endemic areas are mentioned without specifying the endemicity level. Thanks for this suggestion. We have now included a table to categorize better study locations across countries (Table 1). Not all locations (rural, urban, malaria endemic, and non-endemic) in the three countries had participants available for SSI/FGD in all types of areas. In addition, limited resources restricted the sampling to the ones that were more relevant for country context. We have clarified this in the revised manuscript (Lines 156–163). • Lines 156–163: The selected areas in Indonesia and Rwanda lack description as urban or rural, while those in Peru are clearly characterized. I recommend standardizing this classification across all study sites for better comparability. Thanks for this suggestion. As stated above, we have now included in a table to categorize better study locations across countries (Table 1). (Lines 156–163). • Lines 156–163: I suggest to present site characteristics (including FGD/SSI counts and sample sizes) in a table for a better overview of the sampling. Thanks to this suggestion, we have included a Table within the Methods section to explain the sampling procedures. • Line 162: Fix spacing in "and Tumbes". Addressed • Line 164: What is the reason for discussing Peru-specific findings separately and excluding them from this manuscript? Our partners in Peru were highly motivated to publish a manuscript focused specifically on the findings from the Peruvian context (Nussbaum, L., Ortega, E., Ríos López, E.J. et al. Voices from the Amazon: exploring implementor and user perceptions of non-invasive malaria diagnostics in Peru. Malar J 24, 32 (2025). https://doi.org/10.1186/s12936-025-05273-1). While those data are also included in the current submission, the focus of this manuscript is broader, presenting a comparative analysis across three countries. In contrast, the Peru-focused publication offers an in-depth examination of local findings unique to that setting. Partners in Indonesia are already preparing another separate country-focused manuscript to explore in depth country context perceptions. • Line 180: Fix spacing in "aged 18 years". Addressed • Line 252: I recommend sharing SSI and FGD guides as supporting information for more transparency of the applied methods. Thanks for this suggestion. We have included the guides as supporting information. • Lines 259–261: Was the information in Figure S1 the only explanation given to participants about the devices? Was the figure translated into local languages? Were the devices limitations or additional details provided? The devices were presented following the SSI and FGD guides. We have now included that information Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0318393.r002
1 Oct 2025 Decision Letter - Susan Horton, Editor “It doesn’t require blood!” Dear Dr. Calarco, Please submit your revised manuscript by Nov 15 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, Susan Horton Academic Editor PLOS ONE Additional Editor Comments : The line numbers below correspond to the “track changes” version. Line 80: I don’t believe it is essential to describe UNITAID in detail, can omit the explanatory sentence. Line 82: where is the reference to the technical landscape assessment by FIND? Line 159: suggest small rewrite “and professionals working at borders who, because of human mobility, were familiar with malaria policies” Line 210: Why do border professionals appear both in row 2 and row 3 of Table 2. Should they not appear in only one row? Line 238: Suggest “These are…” not “Are” Line 307: suggest amend sentence to say “there were 7 FGDs in Peru, 5 in Rwanda and 4 in Indonesia”. The total numbers of participants appear in the table and do not need to be repeated in the text. Line 416: How were the interviewees made aware of the characteristics of the new tests, in particular the fact that they could not differentiate different species of malaria parasites? Were they shown Figures 1 and 2, or how was this information transmitted? Line 642-651: I find this paragraph unnecessarily detailed, especially since there is no similar paragraph for Rwanda and Peru. Perhaps rephrase: “In Indonesia, participants highlighted the importance of Puskesmas (primary health centers), community health centers, and community health cadres (volunteers)”. This structure is very common in many low- and middle-income countries. [Note: HTML markup is below. Please do not edit.] [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.0318393.r003
Revision 2
15 Oct 2025 Author Response Additional Editor Comments : The line numbers below correspond to the “track changes” version. Line 80: I don’t believe it is essential to describe UNITAID in detail, can omit the explanatory sentence. Thanks, we addressed this by removing the sentence. Line 82: where is the reference to the technical landscape assessment by FIND? We are currently updating the document and plan to submit it to a peer-reviewed journal. At this stage, however, the document remains internal and unpublished. For this reason, when referring to the UNITAID landscape we use the term “published”, while for the FIND landscape, we use “conducted by FIND”. We hope this clarification is clear. Line 159: suggest small rewrite “and professionals working at borders who, because of human mobility, were familiar with malaria policies”. Thanks for the suggestion, we reviewed accordingly. Line 210: Why do border professionals appear both in row 2 and row 3 of Table 2. Should they not appear in only one row? We apologize to the reviewer, but we don’t see “border professionals” appearing twice; maybe is a formatting issue from the track change version. Line 238: Suggest “These are…” not “Are”. This point has been addressed at row 226 of the revised tracked-changes document. Line 307: suggest amend sentence to say “there were 7 FGDs in Peru, 5 in Rwanda and 4 in Indonesia”. The total numbers of participants appear in the table and do not need to be repeated in the text. This point has been addressed at row 295 of the revised tracked-changes document. Line 416: How were the interviewees made aware of the characteristics of the new tests, in particular the fact that they could not differentiate different species of malaria parasites? Were they shown Figures 1 and 2, or how was this information transmitted? Figure S1, included in the supplementary information, was used to guide the discussion and provide an illustration of how the devices might look. Additional details, such as their capacity to differentiate between malaria species, were conveyed orally during the interviews within participants questions, answers and discussion. In S3 Guide for the FGDs you can see how the question regarding the parasite species was asked “What are the key characteristics that each instrument shall have? (List key characteristics quoted by each participant and check if the ability to differentiate parasite species emerged. If not, ask the question: Do you think it would be relevant if the instrument can differentiate between parasite species (Vivax, Falciparum, Ovale, Malaria, knowlesi)?” for participants' exploration. Line 642-651: I find this paragraph unnecessarily detailed, especially since there is no similar paragraph for Rwanda and Peru. Perhaps rephrase: “In Indonesia, participants highlighted the importance of Puskesmas (primary health centers), community health centers, and community health cadres (volunteers)”. This structure is very common in many low- and middle-income countries. Thanks for this suggestion, we have reviewed the text to be less specific. Now it reads: “In Indonesia, participants highlighted the importance of primary health centers, that offer a wide range of basic healthcare services, community health centers that serve as the first point of contact for most, and health cadres with authorized volunteers to administer malaria medication, especially in remote areas.” Attachments Attachment Submitted filename: Response to reviewer.docx https://doi.org/10.1371/journal.pone.0318393.r004
20 Oct 2025 Decision Letter - Susan Horton, Editor “It doesn’t require blood!” : Perceptions around non-invasive malaria testing tools in Indonesia, Peru, and Rwanda PONE-D-24-60442R2 Dear Dr. Calarco, 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, Susan Horton Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0318393.r005
Formally Accepted
Acceptance Letter - Susan Horton, Editor PONE-D-24-60442R2 PLOS One Dear Dr. Calarco, 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. Susan Horton Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0318393.r006

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 .