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Additional Editor Comments:

Thank you for submitting your manuscript to PLOS ONE. The paper addresses an important topic in adolescent HIV prevention and contributes to understanding how youth perceive HIV self-testing in Uganda. Three expert reviewers and the editorial team have carefully evaluated the submission.

After weighing the reviewers’ comments and conducting an independent editorial assessment, I am inviting you to revise and resubmit the manuscript for further consideration. The study demonstrates methodological soundness and relevance, but substantial revisions are required to meet PLOS ONE’s standards for conceptual framing, analytic transparency, and clarity of presentation.

Decision: Major Revision

The study has merit but requires deeper theoretical articulation, clearer reporting of methods and analysis, and stronger synthesis of findings. In addition the responding to the assessment below, please also respond to reviewer comments

Editorial Assessment

While your qualitative design and socio-ecological framing are appropriate, several key issues must be addressed:

1. Conceptual clarity and theoretical depth

• Expand engagement with the Social-Ecological Model (SEM) by mapping each theme to a specific SEM level.

• Briefly justify why SEM is well suited to HIV self-testing concerns, and consider integrating complementary frameworks such as the Health Belief Model or Theory of Planned Behavior to capture perceptions of risk, stigma, and control.

• Avoid implying causality (e.g., that HIVST “causes” risky behavior); retain interpretive focus on perceived or anticipated effects.

2. Methods transparency

• Clearly state the study design (qualitative exploratory).

• Provide the full participant profile (age, gender, schooling, occupation, prior testing, urban/rural site).

• Explain recruitment through VHTs/CHEWs, describing how confidentiality and voluntariness were maintained.

• Describe how data saturation was determined and whether any pilot testing occurred.

3. Analytic procedures

• Re-state the analytic process following Braun & Clarke’s six phases of thematic analysis.

• Clarify how SEM informed coding and theme review without constraining emergent insights.

• Move beyond descriptive quotation to include latent-level interpretation (norms, shame, social pressures).

• Indicate steps taken to ensure credibility (multiple coders, debriefs, audit trail).

4. Reflexivity and positionality

• Retain a brief paragraph summarizing team composition and insider/outsider balance, but focus on how this influenced access, questioning, and interpretation.

5. Contextualization and limitations

• Explain the choice of fishing-community settings and how mobility, economic vulnerability, or social norms shape HIVST use.

• Add a concise Limitations section noting sampling channels that may favor engaged youth, possible social desirability bias, and limited transferability beyond the study sites.

6. Presentation and structure

• Consider merging “Results” and “Discussion” or add a bridging “Findings and Interpretation” section that reconnects themes to the SEM and to existing literature.

• Reduce repetition of quotations; synthesize patterns instead.

• Ensure consistent acronym use (HIVST, VHTs, CHEWs).

• Correct typographical issues (e.g., “goal,” not “gaol”) and apply professional English editing.

7. Ethics and data availability

• Confirm that all anonymized excerpts are included in supplementary materials or a repository, per PLOS ONE data policy.

• Re-affirm IRB approval details and informed-consent procedures.

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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?

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: N/A

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Title

Precise and concise, reflects content, target group, and location. Missing study design and study period, consider adding.

Abstract

Includes introduction, objectives, methods, results, and conclusions. Problem and justification not clearly reflected, consider adding. Study design not stated.

Results: include brief participant description (demographics, number of themes, etc.).

Conclusion: highlight major findings first, then recommendations; current text is mostly recommendations.

Background

Explains scientific rationale and context (global and Ugandan HIV/AYP). Knowledge gap clearly stated. Specific aims included.

Line 60: Specify region in Uganda.

Line 61: Check tense, use past tense unless statistics are current.

Line 66: Define HIVST at first mention.

Line 88: Add comma between “testers” and “Despite.”

Aim: clarify focus on experiences, perceptions, and contextual factors influencing HIVST uptake among AYP in Uganda.

Methods

Study design should be explicitly stated (qualitative exploratory study).

Line 130: Define HISTAZU study.

Explain how sample size was determined; comment on saturation.

Clarify participant selection: purposeful or voluntary?

Line 145: Correct spelling of “goal.”

Consistently use “AYP” across the document and not AYPs (plural already).

Data Collection

State language in which interviews were conducted. Specify location and duration of sessions. Was piloting conducted? Were IDIs planned from the start? Explain criteria for selecting 14 IDI participants. Describe coding process: number of coders, cross-checking, consensus, theme development. Clarify whether analysis was inductive or deductive.

Results

Key results summarized along SEC framework, with quotes. Consider adding a visual of key barriers along SEC format.

Line 232: Avoid identifying information in IDI quotes; maintain consistency with GD quotes.

Discussion

Line 461: Change “were” to “where.”

Limitations

Include additional limitations such as bias, small sample size, and self-reporting.

Conclusion

Be precise: focus on main findings, implications, and recommendations. Move extra details to discussion.

Reviewer #2: Article Title: Navigating HIV Self-Testing: concerns among adolescents and young people aged 15-24 years in Uganda

Authors: Richard Muhumuza et al.(2025)

Summary and overall assessment

This qualitative manuscript addresses a high-priority question: how adolescents and young people (15–24) in Uganda navigate HIV self-testing (HIVST). Using a social-ecological framing is appropriate because testing behavior is shaped by factors at individual, interpersonal, community, and system levels. To meet journal standards, the theoretical framing, methods transparency, and analysis need strengthening. Results should connect themes more clearly to theory and to established evidence on youth testing contexts in Uganda. I recommend major revision.

Major strengths

1. Timely topic and population. Youth remain central to epidemic control, and qualitative work can surface barriers and emotions missed by surveys. Recent global statistics underscore the continuing need for youth-friendly testing pathways (UNAIDS, 2025).

2. Level-based structuring. Organizing patterns by social-ecological levels improves clarity and aligns with common practice in HIV prevention research.

3. Attention to underserved groups. A focus on first-time testers and young men is justified; the definition of “marginalized” can be broadened to include LGBTIQ youth and young sex workers who face layered stigma and access barriers in East African settings.

Major issues (required for publication)

1) Theory use and conceptual depth

• Shallow engagement with the social-ecological model (SEM). The SEM is mentioned but not fully used. Map each theme to a specific SEM level and state how the evidence supports, refines, or challenges level-specific propositions. Consider complementary theories to capture latent forces: the Health Belief Model for perceived susceptibility, severity, benefits, barriers, and cues to action (Glanz, Rimer, & Viswanath, 2015); the Theory of Planned Behavior for norms and perceived control (Ajzen, 1991); and stigma/identity perspectives for shame and anticipated discrimination.

• Abductive stance. An abductive approach would allow emergent insights to reshape the conceptual lens rather than forcing data into a fixed frame.

• Chrono-level dynamics. Adolescence and young adulthood involve transitions (school-to-work, marriage, parenthood). Discuss how these transitions alter HIVST meaning over time within a chronosystem view of development.

2) Methods transparency and sample description

• Participant profile. Provide richer demographics to support transferability: age distribution, sex/gender, education, socioeconomic indicators, urban/rural site, prior testing, and (if volunteered) HIV status.

• Recruitment via CHEWs/VHTs. Explain why village meetings and peer mobilization were chosen and how confidentiality and voluntariness were protected when community health cadres supported recruitment. Literature notes role tensions and ethical sensitivities when local health workers engage neighbors on sexual health; show how your procedures mitigated these risks (Lehmann & Sanders, 2007; McCollum et al., 2016).

• Method credibility. Cite precedents using FGDs and peer-led approaches in HIV/STI research with Ugandan youth to anchor these choices.

3) Analysis clarity and alignment

• “Thematic analysis guided by SEM” needs precision. Thematic Analysis (TA) is a flexible method with established steps (familiarization; coding; generating, reviewing, defining/naming themes; write-up). Describe these steps and clarify how SEM functioned as a sensitizing framework rather than a coding template that constrained emergence (Braun & Clarke, 2006).

• From quotations to interpretation. Several sections read as narration of quotes. Strengthen latent-level analysis (norms, shame, social pressure). Define and exemplify each theme and provide concise analytical claims after each excerpt.

• Reflexivity and positionality. The statement about a Zambian–British–Ugandan team is a start, but explain how insider/outsider status, power, culture, and resources shaped access, questioning, and interpretation, and what you did to manage these dynamics (e.g., iterative debriefs, local co-coding, audit trails) (Finlay, 2002).

4) Contextualization of setting and populations

• Fishing communities. Briefly justify relevance: youth in Lake Victoria fishing communities face mobility, economic and social-norm pressures, and higher HIV incidence that can shape HIVST uptake (Kiwanuka et al., 2014).

• Epidemic dynamics. When citing global burden, add one orienting sentence on trends to motivate youth-friendly testing (UNAIDS, 2025).

5) Structure and reporting

• Results vs discussion. In qualitative studies, integrating findings with interpretation often improves coherence. Consider “Findings and Interpretation” or ensure a subsequent Discussion explicitly re-engages theory at each SEM level.

• Limitations. Add a clear limitations section (sampling channels may favour more engaged youth; social desirability in FGDs; transferability beyond sampled districts).

• Editing. Correct typos (e.g., “goal,” not “gaol”) and tighten long sentences.

Minor issues (actionable edits)

• Define “marginalized” to include LGBTIQ youth and young sex workers (where lawful and safe), with ethical safeguards noted.

• Spell out acronyms at first use (HIVST, CHEWs, VHTs).

• Tag participant quotes (FGD number, participant code) for transparency.

Specific, testable revision checklist

1. Revise Conceptual Framework to specify SEM assumptions by level; add 1–2 complementary theories (HBM, TPB); justify an abductive stance.

2. Expand Methods with full participant profile, recruitment rationale, ethical safeguards with CHEWs/VHTs, and citations to similar Ugandan youth HIVST/peer-led designs.

3. Re-state Analysis following Braun and Clarke’s six phases; explain how SEM informed memos/theme review without constraining emergence; note audit-trail elements.

4. Re-structure Results/Discussion so each theme is defined, evidenced with quotes, interpreted at manifest and latent levels, linked back to SEM and complementary theories, and situated against prior Ugandan youth evidence.

5. Add a Context paragraph on fishing communities to justify salience.

6. Insert a Limitations section on sampling, desirability bias, and transferability.

7. Update Background with current burden and trajectory to motivate youth-friendly testing.

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

Finlay, L. (2002). Negotiating the swamp: The opportunity and challenge of reflexivity in research practice. Qualitative Research, 2(2), 209–230.

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice (5th ed.). San Francisco, CA: Jossey-Bass.

Kiwanuka, N., Ssetaala, A., Nalutaaya, A., Mpendo, J., Wambuzi, M., Nanvubya, A., ... & Kaleebu, P. (2014). High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV prevention trials in fishing communities on Lake Victoria, Uganda. PLoS ONE, 9(5), e94932.

Lehmann, U., & Sanders, D. (2007). Community health workers: What do we know about them? Geneva: World Health Organization.

McCollum, R., Gomez, W., Theobald, S., & Taegtmeyer, M. (2016). How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review. BMC Public Health, 16, 419.

UNAIDS. (2025). Global AIDS Update 2025. Geneva: Joint United Nations Programme on HIV/AIDS.

Reviewer #3: As a researcher I would give a 60% to the author ,more sustainable measures need to be arisen especially on the area of children and also more realistic regressions and Correlations need to be assessed.

Deploy more econometric measures but other wise all is well

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes: Musisi John Kaduwanema

Reviewer #3: Yes: Uwayesu Happy E

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Navigating HIV Self-Testing: concerns among adolescents and young people aged 15-24 years in Uganda. An exploratory qualitative study.

PONE-D-25-40176R1

Dear Author,

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,

Gamji Rabiu Abu-Ba'are, Ph.D, MA

Academic Editor

PLOS One

Additional Editor Comments (optional):

Congratulations, all reviews have been addressed and I recommend your manuscript for publication with PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Title and abstract: Title and the abstract modified as guided.

Background: It has been re-writted, the aim of the study is clearer and the typos were removed.

Methods: All identified gaps were addressed.

Results and discussion: All comments addressed.

Reviewer #2: Dear authors. I am absolutely delighted with the changes you have so thoughtfully made to your work. This is very important research as we all participate in creating a society without HIV. Thank you and wishing you all the best in your publication journeys. Warmest regards. Musisi John.

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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: Kayinda Francis

Reviewer #2: Yes: Musisi John Kaduwanema

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