PONE-D-24-18373Prevalence and factors associated with detectable viral load among adult patients receiving ART in Choma District, ZambiaPLOS ONE

Dear Dr. Mutukwa,

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.This is an important study that aims to describe factors associated with VL suppression among clients receiving ART in Choma District, Zambia. Viral suppression is critical requirement that will facilitate AIDS-free generation efforts by 2030, hence the study is timely. Unfortunately, the study is not presented in a concise manner that will aid comprehension by readers. Additionally, the methodology lacks details to aid reproducibility. Therefore, the authors are requested to please review carefully the following comments in addition to comments provided by the 3 reviewers below. Failure to respond to tall comments will delay or result in rejection of this paper in the next round of revision. Therefore, kindly restructure the paper accordingly and ensure conciseness and clarity.

• Data availability – stated “some restrictions will apply” please explain the level of restrictions and how the data can be accessed.
• Title: Prevalence and factors associated with detectable viral load among adult patients receiving ART in Choma District, Zambia. “Prevalence” is confusing in the title, is it referring to prevalence of factors or prevalence of detectable VL? Please make it clear, for example “Prevalence of Detectable VL and Associated Factors among Adult Patients Receiving ART in Choma District, Zambia”.
• Introduction: Good epidemiologic context provided. However, no reference made to factors influencing VL suppression. Consider restructuring the section using 95:95:95 cascade and about 50% of the section should focus on factors influencing VL suppression, including gaps in Zambia and study region.
• Methods:
  
  • Study design: is it primary data collection or secondary data analysis?
  • Selection and sampling: 448 clients were selected. Please describe sampling criteria, method and sample size estimation. Also describe accurately “selection based on proportional to size”.
  • Data collection and storage: was the data collected using paper-based questionnaire or electronically? What are the variables of interest and their definition?
• Results: not structured and presented without keeping the study objectives in mind. Of course, the study objectives were not well defined in the methods, and this may be the reason for the long and unstructured results section. The section is very lengthy and difficult to follow. No need to mention all findings. Focus on major findings that are elated to the objectives. Try to make the text for this section like maximum of 1 page. The tables should be self-explanatory. The tables are also too long and confusing. Focus on key findings and avoid repetition.
  
  1. Table 1: should be “Sociodemographic characteristics and VL suppression of participants from selected health facilities in Choma, Zambia”. The table should end at “perinatal HIV” because the variables that follow are not sociodemographic and should be moved to another table.
  2. Table 2: Please avoid repetition. Harmonize table 1 and 2 based on the comment above. Make Table 2 to focus on “VL suppression by site and clinical characteristics”
  3. Tables 3 and 4: please harmonize these tables into 1 table and be concise by focusing on the primary intention of the table.  
• Discussion: too long. Please be concise and focus on key findings relating to the study objectives. 1.5 pages should be good for well-structured discussions.
• Acknowledgement: though the authors mentioned that no financial assistance received for this study, however it will be appropriate to acknowledge the program that resulted in the data used in the study. Additionally, the 7 hospitals and the clients should be acknowledged.
• References: please review all the references and ensure they align with Plosone citation guidelines.

Please submit your revised manuscript by Nov 15 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

PLOS ONE

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2. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. 

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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

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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: Yes

Reviewer #3: 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: No

Reviewer #3: 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: 1. Among the participants who received enhanced adherence counselling, a significant

140 proportion of them had detectable VL compared with the ones who did not have detectable VL,

141 32.6% vs. 0.5%, p <0.001 (row 140 and 141, this sentence is standalone and not explanatory)

2, Row 142. A higher prevalence of the clients aged between 16 and 24 years had

detectable VL compared with those without detectable VL, 15.2% vs. 6.2% ( i suggest it can be a higher percentage or proportion rather than prevalence)

Reviewer #2: This paper addressed a very important topic. I have provided some detained comments in the attached documents to help improve the flow and readability. The authors can consider shortening the paper, restructuring the background and results section and discussing the key findings.

Reviewer #3: Short title has a minor grammatical error, remove 'of'. The inclusion and exclusion criteria is missing. There is need to show the age of consent and who needs assent. The Consent form was only in English, looking the population ,there was need to have a translated version to native language. Researcher may need to explain how the questionnaire was administered.

The data was not available in the manuscript

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes:  Sandra Shawarira-Bote

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Attachments

Attachment

Submitted filename: PONE-D-24-18373_Review Comments.pdf

Prevalence and factors associated with detectable viral load among adult patients receiving ART in Choma District, Zambia

PONE-D-24-18373R1

Dear Dr. Mutukwa,

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,

Ibrahim Jahun, MD, MSC, PhD

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 #2: All comments have been addressed

Reviewer #3: 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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #2: (No Response)

Reviewer #3: (No Response)

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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 #2: Yes:  Moses Bateganya

Reviewer #3: Yes:  Sandra Shawarira-Bote

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