-->PONE-D-25-05682-->-->Universal Test and Treat strategy effect on Kidney Function in Adults living with HIV in Zambia: A Six-Month Multicenter Retrospective Cohort Study-->-->PLOS ONE

Dear Dr. Siame,

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Chika Kingsley Onwuamah, Ph.D.

Academic Editor

PLOS ONE

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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?

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Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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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: Yes

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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: Yes

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: The authors have reported their research findings in the manuscript titled "Universal Test and Treat strategy effect on Kidney Function in Adults living with HIV in Zambia: A Six-Month Multicenter Retrospective Cohort Study". I have the following comments/observations:

1. I suggest the authors should consider rephrasing the title to read "The effect of the universal test and treat strategy on the kidney function in adults living with HIV in Zambia: A six-month multi center cohort study".

2. The eGFR calculation formulae used as reported were CKD-EPI in the abstract, and MDRD in the body of the manuscript. The authors should clarify the formula that was actually used.

3. In the results section, basic characteristics of study participants (page 5, line 11), the authors mentioned that "a high proportion of participants were taking NNRTI and ABC/3TC regimens. This is similar to what is reported in table 1; however, in table 2, the authors reported 1,173 participants on TDF/XTC, while only 35 participants were on ABC/3TC. The authors need to resolve this discordant results.

4. The explanation by the authors to the fact that in the ATT era, participants commenced ART earlier, and did not have renal complications associated with HIV makes scientific sense. However, TDF-based regimens have been reported extensively in literature to be associated with renal impairment in older patients, patients with co-morbidities etc. So it is critical for the authors to clarify whether these cohorts of patients were predominantly on ABC/3TC or TDF/XTC.

Reviewer #2: Reviewer’s comments on the manuscript titled “ Universal Test and Treat strategy effect on Kidney Function in Adults living with HIV in Zambia: A Six-Month Multicenter Retrospective Cohort Study.”

1. Originality of value:

The study is original and will contribute to scientific knowledge and enrich the repository of knowledge on burden of kidney disease among patient living with HIV, its risk factors and how it can be prevented or detected early, particularly in the sub-Saharan African region. The abstract is concisely written while the introduction was appropriately described, and study objective was clearly defined.

2. Suitability and Soundness:

The methodology is appropriate and suitable for the study design.

3. Clarity of presentation:

The manuscript presentation and lay out is clear and easy to follow.

4. Areas requiring corrections:

None

Reviewer #3: This article about HIV and kidney disease is timely and pertinent because it highlights the potential for preventing kidney disease. The drawback is the use of eGFR as the sole indicator of kidney impairment. An important hallmark of kidney damage is proteinuria whci was not utilised in this patient. One understands the operational issues with regards to HIV treatment funding and implementation especially with laboratory tests. But if serum creatinine could be done, microalbuminuria/proteinuria could be done.

Older patients would have decline in kidney impairment as per eGFR estimation. Could could the authors provide summary on

of eGFR in the two groups in addition to using it as a cut-off point. Could the trend analysis be done since this since a cohort?

The explanation for kidney impairment among urban dwellers is far fetched, especially when this is not based on the data from the study. There is no evidence that these patients had hypertension or diabetes. It may just reflect the disproportionately large number of urban dwellers in the study.

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Reviewer #1: Yes:  Professor Oche O. Agbaji

Reviewer #2: Yes:  Yemi R. Raji

Reviewer #3: No

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The effect of the universal test and treat strategy on the kidney function in adults living with HIV in Zambia: A six-month multi center cohort study

PONE-D-25-05682R1

Dear Dr. Siame,

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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Kind regards,

Chika Kingsley Onwuamah, Ph.D.

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 #1: 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 #1: Yes

Reviewer #3: Yes

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

Reviewer #1: 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 #1: 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 #1: 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 #1: The authors have addressed all issues raised by me in the revised manuscript. The manuscript has been revised accordingly.

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 #1: Yes:  Oche Ochai Agbaji

Reviewer #3: No

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