The burden of HIV/AIDS in Ethiopia: Unveiling 30 years of trends in incidence, mortality, and disability—insights from the Global Burden of Disease study (1990–2021)

Tegene Atamenta Kitaw; Molla Azmeraw; Biruk Beletew Abate; Befkad Derese Tilahun; Alemu Birara Zemariam; Addis Wondmagegn Alamaw; Abebe Merchaw Faris; Addisu Getie; Molalign Aligaz Adisu; Tesfaye Engdaw Habtie; Melesse Abiye Munie; Ribka Nigatu Haile

doi:10.1371/journal.pone.0321024

Peer Review History

Original SubmissionNovember 20, 2024
20 Nov 2024 Author Response https://doi.org/10.1371/journal.pone.0321024.r001
6 Jan 2025 Decision Letter - Deepak Dhamnetiya, Editor PONE-D-24-52871The Burden of HIV/AIDS in Ethiopia: Unveiling 30 Years of Trends in Incidence, Mortality, and Disability—Insights from the Global Burden of Disease Study (1990–2021).PLOS ONE Dear Dr. Kitaw, 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 Feb 20 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. Please include the following items when submitting your revised manuscript: 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 you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. 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, Deepak Dhamnetiya, MD 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 amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical. 3. Your abstract cannot contain citations. Please only include citations in the body text of the manuscript, and ensure that they remain in ascending numerical order on first mention. 4. Please include a caption for figure 2, 3 and 4. 5. 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. [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: Yes Reviewer #2: Yes ****** 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 ****** 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: 1. The Table 1 can be made more concise and data can be grouped in 5ys and shown 2. Recommendations and targeted interventions need to be specified more as to what targeted interventions can be done age wise or gender wise. Reviewer #2: The manuscript appears to be technically sound. The results regarding the trends in HIV/AIDS in Ethiopia are supported by data from the Global Burden of Disease Study, which was analyzed over a significant time span. The methodology seems appropriate, and the findings are strengthened by the use of gender, regional, and age-standardized data. The conclusions are well-supported by the data, and the manuscript offers useful suggestions for addressing persistent HIV/AIDS-related challenges in Ethiopia. The statistical analysis appears to be appropriate and rigorous, with sound methods used for analyzing the trends. The manuscript is generally clear and well-structured, with a logical flow from introduction to methods, results, and conclusion. The language is mostly correct and appropriate for a scientific manuscript. However, it might benefit from further elaboration on terms like "disability-adjusted life years (DALYs)" to ensure clarity, especially for readers who may not be familiar with the concept. Additionally, I suggest standardizing the use of abbreviations throughout the manuscript for consistency and readability, particularly for terms like DALYs, GBD, ART, and others. This will enhance the clarity and uniformity of the manuscript. ****** 6. 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: Rashmi Agarwalla 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 . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0321024.r002
Revision 1
11 Jan 2025 Author Response Point-By-Point Response We are deeply grateful to the editor and all reviewers for their invaluable contributions to enhancing the quality and clarity of our manuscript. The detailed and insightful feedback, particularly on the methodology and statistical analysis sections, has significantly improved the rigor and comprehensiveness of our study. Your thorough review and constructive comments have been instrumental in refining our work. In the following pages, we provide a point-by-point response to all questions and suggestions raised by the editor and reviewers. All changes made in the manuscript are highlighted in blue. Reviewer ≠1 1. The Table 1 can be made more concise and data can be grouped in 5ys and shown Author response: We appreciate the reviewer’s suggestion to make Table 1 more concise by grouping the data into 5-year intervals. To address this, we have revised Table 1 by reorganizing the data accordingly. The updated table provides a more streamlined presentation, while maintaining the clarity and integrity of the data. We believe this modification enhances the readability and utility of the table for the readers. 2. Recommendations and targeted interventions need to be specified more as to what targeted interventions can be done age wise or gender wise. Author response: Thank you for your feedback. We have added a Recommendations and Targeted Interventions section after the conclusion to specify more clearly the age- and gender-targeted strategies. These interventions now include specific approaches for women, adolescent girls and young women, and older adults, as well as region-specific strategies for high-burden areas like Gambela. The revised section also highlights targeted prevention efforts for high-risk groups and expands on the need for equitable access to HIV treatment for all populations, including maternal health services for women and pediatric ART for children and adolescents. Reviewer #2 1. The manuscript appears to be technically sound. The results regarding the trends in HIV/AIDS in Ethiopia are supported by data from the Global Burden of Disease Study, which was analyzed over a significant time span. The methodology seems appropriate, and the findings are strengthened by the use of gender, regional, and age-standardized data. The conclusions are well-supported by the data, and the manuscript offers useful suggestions for addressing persistent HIV/AIDS-related challenges in Ethiopia. Author response: Thank you for your positive feedback. We are glad to hear that you find the manuscript technically sound and that the use of data from the Global Burden of Disease Study, along with the gender, regional, and age-standardized analysis, has strengthened the finding. 2. The statistical analysis appears to be appropriate and rigorous, with sound methods used for analyzing the trends. Author response: Thank you for your feedback. We appreciate your recognition of the statistical analysis as appropriate and rigorous. We are confident that the methods used to analyze the trends are robust and have helped ensure the reliability and validity of the findings. We will continue to ensure that the statistical approach remains transparent and well-documented throughout the manuscript. 3. The manuscript is generally clear and well-structured, with a logical flow from introduction to methods, results, and conclusion. The language is mostly correct and appropriate for a scientific manuscript. However, it might benefit from further elaboration on terms like "disability-adjusted life years (DALYs)" to ensure clarity, especially for readers who may not be familiar with the concept. Additionally, I suggest standardizing the use of abbreviations throughout the manuscript for consistency and readability, particularly for terms like DALYs, GBD, ART, and others. This will enhance the clarity and uniformity of the manuscript. Author response: Thank you for your valuable feedback. In response to your suggestion, we have added further elaboration on terms like "disability-adjusted life years (DALYs)" in the methodology section to ensure clarity, particularly for readers who may not be familiar with the concept. Additionally, we have standardized the use of abbreviations such as DALYs, GBD, ART, and others throughout the manuscript to improve consistency and readability. We believe these revisions enhance the overall clarity and uniformity of the manuscript. Attachments Attachment Submitted filename: PBP-HIV-plos.docx https://doi.org/10.1371/journal.pone.0321024.r003
28 Feb 2025 Decision Letter - Deepak Dhamnetiya, Editor The Burden of HIV/AIDS in Ethiopia: Unveiling 30 Years of Trends in Incidence, Mortality, and Disability—Insights from the Global Burden of Disease Study (1990–2021). PONE-D-24-52871R1 Dear Dr. Tegene Atamenta Kitaw, 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. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. 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, Deepak Dhamnetiya, MD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0321024.r004
Formally Accepted
Acceptance Letter - Deepak Dhamnetiya, Editor PONE-D-24-52871R1 PLOS ONE Dear Dr. Kitaw, 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 If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks 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. 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. Deepak Dhamnetiya Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0321024.r005

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 .