-->PONE-D-24-33586-->-->Treatment outcomes among young persons living with HIV who transitioned to adult care in Southern Nigeria: A retrospective cohort study-->-->PLOS ONE

Dear Dr. Nwanja,

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.

ACADEMIC EDITOR: -->-->The manuscript reports on the effectiveness of peer-led interventions in improving long term treatment outcomes for YLHIV who are transitioning to adult care in 2 states in Nigeria. The study is critical and timely due to challenges associated with adherence, retention, VL suppression among the sub-population. Therefore, it is important to be very explicit and to eliminate confusions in order to aid reproducibility and understanding. Hence, the authors should please respond to the following comments in addition to the comments from the 2 reviewers below:-->-->

Financial disclosure:

As a secondary data analysis, the data is likely to have been collected from a program funded by an agency (refer to methods – study setting – line 133). Please indicate this as part of your financial disclosure. You should include the agreement/contract number and indicate that the findings are exclusively the opinions of the authors and do not represent the position of the funder.

Data availability:

Not all data is presented within the manuscript. Therefore, indicate that data is available within the manuscript and other supporting documents, also provide rough data to support this as additional supporting document.

Ethics statement:

You indicated N/A. However, from line 233 you reported “ethical approvals/exemptions”. Please clearly indicate your ethics statement and not N/A.

Some technical observations:

Methods:

• Please clearly and outline inclusion and exclusion criteria. though some of them have been mentioned under data collection, but there is need to explicitly outline them to avoid confusions. For example, the duration of the intervention; is it a client must be 1 year before data collection, or 8 months e.t.c.
• Line 203 – “transition was said to have happened after attaining 25 years”. Earlier it was stated that “transition assessment is conducted”. So, which of the two is more important? Attaining 25 years or passing transition assessment?
• Is there transition assessment checklist? Please provide key questions in the checklist or provide it's picture as a figure.
• Line 210 “retention in care disaggregated by….”. Retention in care is when someone satisfy the definition of “retention in care”. Consider using “continuity in care is disaggregated into….”.

Results:

• Subsection “retention” – consider “continuity in care” instead. See earlier comment provided for line 210. Using “retention” the understanding is “client is retained”, and providing other categorization will cause confusion. However, retention can be a category under continuity in care, similarly retention with interruption, not retained, e.t.c can be other categories of continuity in care but not categories of retention.

Acknowledgement:

• Consider acknowledging the funder.

-->-->==============================

Please submit your revised manuscript by Jan 04 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.

We look forward to receiving your revised manuscript.

Kind regards,

Ibrahim Jahun, MD, MSC, PhD

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 your authorship list in your manuscript file to include author Bala Gana.-->

3. 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.

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: 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: No

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: This manuscript highlights the effectiveness of peer-led interventions to improve long term treatment outcomes for youth living with HIV (YLHIV) who are transitioning to adult care. The YLHIV transitioning to adult care in the period following implementation of the peer-based transition preparedness model showed improved viral load suppression and retention to care, more significant at 12 months post transition, with a slight decrease at 24 months post-transition. Retention to care in this study, following implementation of the peer-based intervention, was concluded to be in line with the UNAIDS target for sustained ART, as well as other studies with similar peer-led interventions. Retention was further described under categories, which also highlights the challenges in HIV care in adolescence and youth. Additionally, the ART regimen is also described and discussed as a factor that may have contributed to the viral load suppression; this is particularly important in the context of the introduction of dolutegravir-based regimens at around the same time as implementation of the peer-based intervention.

A strength in this manuscript lies in the study population of youth and adolescents living with HIV, who have unique challenges within the scope of HIV care. Additionally, the setting of mostly in primary and secondary care facilities is also a strength, as most other studies reviewed focus on transition to care in predominantly secondary or tertiary facilities. The study presents a clear timeframe around the implementation of the peer-based intervention. A shortfall lies in the data set itself, as limited socioeconomic, geographic, and clinical factors were used in describing the potential factors influencing retention to care/ transition to care. Attrition of patients and exclusion of some patients also resulted in a much smaller sample size prior to the peer-based intervention compared to after. The adherence support platform is also an interesting component which was not fully discussed. The population was mostly female, but the reasons for this skew were not described in the text.

The areas of improvement are highlighted below:

Data presentation:

1) Line 270: 12 months percentages do not correlate with the data presented in Table 4. This is present in the abstract as well.

2) Line 276: retention at 12 months for females in 2018 percentage does not correlate with Table 5 data.

3) Table 7: Total number for column 12 months post transition, 2018 transition year, number with undetectable VL noted as 197/323 – correct denominator is 328. Percentage calculated is correct for a denominator of 328.

4) Adherence support platform data, parameters and results not discussed in main body of manuscript. I suggest potentially renaming this table as the adherence support platform data does not necessarily fall under “demographic characteristics”, but this is in reference to the VL suppression through the post-transition period/ year of transition.

5) Line 136: suggest adding that the bracketed numbers are “n=” as this can be misinterpreted as a reference.

6) Line 261 references Table 1 instead of Table 3 – requires a correction.

7) Line 267 references Table 4 after a period – suggest that is is referenced more clearly.

Technical clarifications:

1) I recommend changing the term “undetectable viraemia” to “undetectable viral load” which has been used in the body of the manuscript and better describes what the authors are referencing.

2) The Description of the Intervention (line 156) would be better linked to Table 2, and I would recommend removing Table 1 and incorporating this as descriptive text into the sub-headings of Pre-Intervention Period and Description of the Intervention.

3) Table 2 has a bracketed number at the end of “Transfer to adult care/service provider”: (25). Suggest clarifying if this is the age at transfer of “25 years”. I recommend deleting if this is reference.

References:

1) Vancouver referencing style is used throughout the relevant section, except for reference 3, 7, and 34; reference 50 appears to be incomplete.

2) Line 133 references the “2023 Spectrum Estimates”, but this is not included in the main references list.

3) Spacing text from reference brackets would help in readability within the main body of the manuscript. This also includes adhering to one convention when referencing an author in text, such as for lines 372 – 373.

Typos, spelling, grammar and phrasing issues

1) I recommend maintaining formatting as per the PLOS guidelines – these have been followed, but not consistently, as seen with the indentation (lines 39 and 40, but not 56 – this should be the paragraph, not the heading), table formatting and referencing within the text (including location of table, table headings, and table footnotes), and heading formatting (font size for main vs. sub-heading).

2) This manuscript will benefit from thorough copyediting, as typographical errors are present throughout the text, including spelling (example: line 24), inconsistent capitalization of words (some examples: line 97 – in, Table 3 + line 388 for “dolutegravir, Table 1 – “trained”, etc.), maintaining standardized hyphenation throughout the manuscript body (12-month vs. 12 month), and switching of verb tense (present vs. past tense).

3) Careful adherence to writing conventions needs to be maintained, such as numbering conventions at the start of sentences (line 146), and acronyms being expanded on first use in the text (see: ART, DSD).

4) Rewording confusing phrases such as lines 143 – 145 and lines 203 – 204.

5) Line 239: recommend the use of “Informed” consent instead of “Ethical” consent.

Overall, this study has strengths in its design, population and setting, but will benefit from a revision.

Reviewer #2: Treatment outcomes among young persons living with HIV who transitioned to adult care in Southern Nigeria: A retrospective cohort study.

1. Summary of the Research

The study examined the impact of a peer-based transition preparedness model on the treatment outcomes of young persons living with HIV (YLHIV) who transitioned to adult care. It compared the 12- and 24-month treatment outcomes of YLHIV who transitioned before and after the introduction of the model across primary, secondary, and tertiary health facilities in Southern Nigeria. The authors claim that the introduction of the peer-based transition preparedness model significantly improved the treatment outcomes of YLHIV transitioning to adult care with higher retention rates at 12 and 24 months post-transition for those who transitioned after the model was introduced, higher rates of undetectable viraemia at 12 and 24 months post-transition for the 2021 cohort compared to the 2018 cohort, and a greater proportion of YLHIV in the 2021 cohort had sustained undetectable viraemia compared to the 2018 cohort.

The study strengths include that: the sample relatively large, which enhances reliability and generalizability of findings; it used real-world data from medical records across multiple health facilities provides a realistic picture of the treatment outcomes; and it was conducted in a resource-limited setting where the majority of the global HIV burden live, making the findings highly relevant for similar contexts.

The weaknesses of the study include the following: it uses a retrospective methodology which may introduce biases related to data collection and recording; the analysis does not appear to adjust for potential confounders; the findings may not be generalizable to other regions or countries with different healthcare systems and support structures; and there is inadequate details on the peer-based transition preparedness model to better understand what specific components contributed to the improved outcomes.

My recommendation is that the manuscript needs minor revisions. The authors should consider providing more details on the peer-based transition preparedness model, including its components and how it was implemented. They should also discuss potential confounders and how they were addressed in the analysis or acknowledge this as a limitation if not adjusted for. Furthermore, they could consider performing a sensitivity analysis to assess the robustness of the findings. Finally, they could expand on the discussion to include potential mechanisms by which the intervention improved outcomes and how these findings can be applied to other settings.

Overall, the manuscript makes a valuable contribution to the literature on HIV care transitions and provides evidence for the effectiveness of peer-based interventions in improving treatment outcomes for YLHIV.

2. Examples and Evidence

2.1. Major Issues

2.1.1. The Abstract

The abstract provides a clear and concise summary of the study, including the background, methods, results and conclusion. It could be improved by addressing the following:

• As the peer-based transition preparedness model is central to the study, the authors could consider adding a sentence in the introduction to provide more context about the model.

• In the conclusion, the authors could highlight the potential implications of the findings for policy and practice to strengthen the impact of the conclusion.

2.1.2. Introduction

The introduction is well-written and provides a comprehensive overview of the context and significance of the study. It could however be enhanced by addressing the following:

• Provide more details on the peer-based transition preparedness model introduced in 2019, especially how it differs from previous models and why it was expected to improve outcomes considering the importance of transitioning YLHIV to adult care.

• More recent studies or reviews could be added to support the need for the current research to better position the study within the existing body of knowledge.

• The study rationale is not mentioned explicitly. It would help to clearly state the gaps in the literature that this study aims to fill.

• The introduction does not explicitly state the objectives of the study. I would suggest that a clear statement of the study's objectives be explicitly added to provide a better roadmap for the reader.

2.1.3. Materials and Methods

The methods section is detailed and describes the study design, setting, population, and data collection procedures. The use of logistic regression analysis is appropriate for comparing retention in care and undetectable viraemia between the two groups. However, the section would benefit by the authors addressing the following:

• In addition to the authors stating the study design as a retrospective cohort study, they could consider adding that it is a before and after study. Furthermore, they could provide the rationale for choosing the study design to strengthen the justification.

• Include a brief explanation of why the particular states were chosen. The authors also do not explicitly describe the sampling method for facilities and participants, and it could improve clarity if the manuscript explicitly states the sampling method used for both facilities and participants.

• The data collection process is described, but the researchers could clarify how missing data were handled and whether any imputation methods were used.

• The statistical methods used are appropriate, but the authors could provide more details on the logistic regression models, including how potential confounders were handled.

2.1.4. Results

The results are presented clearly, with a focus on the key outcomes of retention in care and undetectable viraemia. The use of tables to summarize the characteristics of the study population and the outcomes is effective. The results section could benefit from the following revisions:

• More detailed descriptions of the statistical analyses performed, which could include specifying the statistical tests used to calculate the p-values, the logistic regression models used, together with explicitly stating the covariates included in the models.

• Generally, the results narrative uses p-values to indicate significance, but it would be helpful to also report the effect sizes and confidence intervals for the estimates, as they provide more information about the magnitude and precision of the effects.

• The retention rates at 12 and 24 months are reported using p-values. However, the odds ratios for retention at 24 months seem to suggest a lower retention rate for the 2021 cohort compared to the 2018 cohort, which contradicts the statement that a higher proportion of those who transitioned in 2021 were continuously retained. This discrepancy should be addressed.

2.1.5. Discussion

The discussion interprets the findings in the context of the existing literature and the study's limitations. It provides a thoughtful analysis of the potential reasons for the observed improvements in treatment outcomes. It could however be strengthened by addressing the following:

• The authors could provide more details on the similarities and differences in study design, population and settings between their study and the cited studies to complement the comparison they have provided between their findings with those of the other studies.

• The discussion would be strengthened by a more detailed exploration of the potential mechanisms through which the peer-based transition preparedness model improves outcomes.

• Line 341 uses the word “disintermediation”. Since this word is not a common term in healthcare literature, it may be helpful to provide a brief explanation or definition of its use in the manuscript to ensure clarity for all readers, especially those who may not be familiar with its use in this context.

• The discussion on the higher retention rates at 12 months post-transition for the 2021 cohort is clear, but the lower retention rates at 24 months post-transition for the same cohort is not explained. The authors need to explore potential reasons for this decline in more detail.

• The authors have contextualized their findings within the broader literature on HIV care transitions but have not included a specific discussion on the unique challenges faced by YLHIV in Nigeria. This would provide more insight into the study's results.

• Though the limitations of the study are acknowledged, the authors could also discuss the potential impact of these limitations on the study's findings, e.g. how the use of secondary data might have influenced the results.

2.1.6. Conclusion

The conclusion succinctly summarizes the main findings, and it appropriately emphasizes the positive impact of the peer-based transition preparedness model on treatment outcomes. It can however be strengthened by addressing a number of issues.

• More discussion can be provided on the implications of the findings for policy and practice, particularly in low- and middle-income countries.

• The authors stated that "peer-led interventions to support YLHIV transitioning to adult care results in good treatment outcomes," but it does not specify what these outcomes are. It would be more informative to mention the key outcomes, such as retention rates and viral suppression rates, directly in the conclusion.

• The statement "irrespective of the facility type" is quite broad. While the study may have included various facility types, it's important to note any differences in outcomes between these types, if they exist. The authors could conduct analyses to explain the differences e.g. stratifying the data by facility type, calculating outcomes by facility type, doing statistical analysis to compare the outcomes between the different facility types, adjusting for confounders, etc.

• The conclusion does not suggest any future research directions. It would be beneficial for the authors to highlight areas where further investigation is needed, especially given the limitations mentioned in the discussion.

2.2. Minor Issues

2.2.1. Materials and Methods

• Though the peer-based transition preparedness model is provided in table 2, it could be helpful if the authors included a brief summary in the text.

• The authors mention ethical approval was obtained. It would help if they could discuss the ethical considerations in the methods section.

2.2.2. Results

• The viral load suppression data is well-presented in Table 6. I would suggest that the authors consider adding a note to explain the categories of viral load changes over the 24 months post-transitioning.

2.2.8. Language and Grammar

The language and grammar of the manuscript are generally clear and understandable. However, there are several areas where the language can be improved for clarity, conciseness, and readability. For example:

• "Thesa" instead of "These" in line 23.

• The sentence starting in line 62, “Undetectable viraemia was higher among the 2021 cohort ….” could be rephrased.

• Some long sentences could be broken down for better readability. E.g. the sentence starting "YLHIV is a heterogeneous group that includes adolescents (10-19 years) and youth (15-24 years) with both ….”

• It would help to use simpler language and words, and avoid uncommon words like “disintermediation”.

A thorough proofread of the manuscript could help identify and correct grammatical errors and typos, and improve some of the language for better readability and flow.

**********

-->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: No

Reviewer #2: Yes:  Brain C Chirombo, MBChB, MPH, MCPHP (Zim), FCPHP (ECSA), FAPH

**********

[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.-->

-->PONE-D-24-33586R1-->-->Treatment outcomes among young persons living with HIV who transitioned to adult care in Southern Nigeria: A retrospective cohort study-->-->PLOS ONE

Dear Dr. Nwanja,

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.

ACADEMIC EDITOR: -->-->Thank you for submitting your revised manuscript to PLOS ONE. You have adequately responded to comments from the Editor and the 2 Reviewers. However, your funding statement is still not acceptable. If fund have been allocated for the program that resulted in the data used for this study, then the study is considered funded. The funder does not necessarily need to participate or directly fund this study (manuscript). Therefore, we invite you to submit revised funding statement indicating the funder, the contract/agreement number. Also adjust your acknowledgement by removing any information about the funder.

Please submit your revised manuscript by Apr 06 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,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

PLOS ONE

Journal Requirements:

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. 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

**********

-->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: (No Response)

**********

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

Reviewer #2: (No Response)

**********

-->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: (No Response)

**********

-->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: (No Response)

**********

-->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)

**********

-->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: 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.-->

Treatment outcomes among young persons living with HIV who transitioned to adult care in Southern Nigeria: A retrospective cohort study

PONE-D-24-33586R2

Dear Dr. Nwanja,

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,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: