PONE-D-24-26120PrEP knowledge and perceptions among women living in North Carolina public housing communitiesPLOS ONE

Dear Dr. Hill,

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PLOS ONE

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Research focused on Black women and PrEP is of priority for reaching the End the HIV epidemic 2030 goals. This paper provides insights from Black women in the US south and can serve as a basis for how best to engage women in HIV prevention and improve PrEP uptake. A few items for authors to consider:

1. Line 34 discusses social and economic structures contributing to barriers to PrEP, but there is no mention of structural racism called out. Given the long standing literature that supports the impact of racism on health and health outcomes, calling it out is warranted.

2. There are a few items in the discussion section that can be added such as implications for the new forms of PrEP delivery for this population, the influence of policy being that majority of participants had Medicaid, and the report of one partner by majority of the women- what influence do men have in PrEP education and uptake for this population.

3. Consider the use of language around "risk" See Risk to Reasons publication by Viv: https://viivhealthcare.com/content/dam/cf-viiv/viivhealthcare/en_US/pdf/from-risk-to-reasons-reframing-hiv-prevention-and-care-for-black-women-spreads.pdf

4. Finally, there is a link to social determinants of health (SDOH) and health outcomes, PrEP use and acquisition of HIV- many of which were discussed in the background, however, limited data collected about SDOH to examine how these intersect with the findings reported. There is an opportunity to mention in the discussion as a future need and/or a limitation so that the science can shift to addressing and examining SDOH in a way that interventions and programs will reflect strategies that respond to these SDOH.

Thank you for the opportunity to review this manuscript and thank you for your work in prioritizing the needs of Black women in HIV prevention.

Reviewer #2: REVIEWER RESPONSE

PONE-D-24-26120

An Integrated Intervention to reduce HIV risk behaviors among heterosexual HIV- negative, PrEP knowledge and perceptions among women living in North Carolina public housing communities

Reviewer Comments:

The study offers insights into the lack of awareness and favorable opinions regarding PrEP, among women from disadvantaged areas. Specifically African American women, in the Southeastern United States region. Although the research impressively combines methodologies and sheds light on discoveries related to obstacles facing PrEP adoption there are certain aspects that could benefit from enhancements in terms of clarification, thoroughness and overall impact. There are opportunities, for improvement listed below that will help enhance its clarity, coherence and academic value.

Abstract:

Strengths:

• The abstract clearly outlines the problem (lack of awareness of PrEP among women in low-income communities).

• The objective of the study is well-defined, focusing on women’s knowledge and perceptions of PrEP.

• The results provide valuable insights into both quantitative and qualitative data.

Suggestions for Improvement:

• Clarity on Specifics: The abstract could benefit from a more specific presentation of key statistics. For instance, the mention that “35% had heard of PrEP” and “61% would take it” can be highlighted further with brief explanations of their significance.

• Problem Context: Add a sentence that frames the problem more globally or within the wider literature on PrEP uptake in underserved populations to emphasize the importance of the findings.

• Conclusion: The final sentence could offer a stronger closing message about the implications of these results for future PrEP outreach and intervention strategies.

Introduction:

• It would be helpful to more clearly highlight gaps in the existing literature, especially in PrEP campaigns targeted at women in low-income communities.

• The introduction could flow better with more transition sentences linking various sections (e.g., from HIV prevalence to why PrEP remains underutilized).

• A section briefly reviewing perceived barriers such as stigma, cost, and misinformation in the introduction would provide context for the later findings.

Methodology:

• The sampling is described as convenience-based. A more detailed explanation of why this method was chosen, along with its potential limitations (e.g., selection bias), should be provided.

• Address any potential limitations with respect to non-responses or how different sociodemographic factors were controlled for in the analysis.

Results:

• Tables are somewhat dense and could be simplified or split into more digestible sections. Key findings from the tables could also be highlighted or summarized in the text for easier reading.

• The qualitative insights from focus groups could benefit from more examples or direct quotes to bring participant perspectives to life.

• The manuscript mentions differences between women with HIV risk factors and those without but could delve deeper into explaining these differences (e.g., using subgroup analyses).

Discussion:

Suggestions for Improvement:

• The discussion would benefit from more direct references to other studies on PrEP uptake in similar populations. This could reinforce the validity of the study’s findings.

• Since side effects and costs are recurring concerns, more emphasis should be placed on how future campaigns can specifically address these barriers.

• The limitations are not deeply discussed. While convenience sampling is mentioned, issues such as the generalizability of the findings to women outside public housing should be acknowledged.

Citations:

• Ensure the inclusion of the most recent studies in the field of PrEP uptake and women’s health to keep the research current.

• Consistency: Double-check for citation consistency, especially in terms of formatting. All references should be thoroughly proofed to follow journal guidelines.

Conclusion:

• Add more actionable takeaways or specific next steps that could guide future researchers, practitioners, or policymakers in PrEP intervention design.

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Reviewer #1: No

Reviewer #2: Yes:  Dawn Goddard-Eckrich

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PrEP knowledge and perceptions among women living in North Carolina public housing communities

PONE-D-24-26120R1

Dear Dr. Hill,

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.

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Kind regards,

Douglas S. Krakower, MD

Academic Editor

PLOS ONE

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