-->PONE-D-24-41127-->-->Healthcare providers' experiences and recommendations for antiretroviral therapy adherence in Ghana: a facility-based phenomenological study-->-->PLOS ONE

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Reviewers' comments:

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

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: No

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: 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: Summary

This qualitative study explores health care provider’s experiences with managing people living with HIV, their perspectives on the barriers to adherence, and their recommendations. The objectives are clear and methodology is sound. The paper is easy to understand and follow. There are a few things that may need to be addressed to improve the paper as described below

General comments

The authors frequently use the terms defaulter and defaulted in the manuscript. These terms are not aligned with patient-centered language. Please consider revising these terms in the main text (excluding direct quotes from healthcare workers) to more patient-centered alternatives. For example, defaulter could be rephrased as person who has interrupted treatment, and defaulted as interrupted treatment.

Introduction

Line 64- Can the authors use the more updated UNAIDS 2024 HIV fact sheet for the global HIV statistics.

Figure 1- For consistency and clarity, can the authors consider changing caregiver’s perspectives to “healthcare provider” perspectives in the conceptual framework.

The aims of the study lack clarity regarding the study population. Was the focus on healthcare workers' perceptions of ART adherence limited to adult patients only, or did it include all populations (children, adolescents, and adults)?"

Although the literature on health care worker perspectives on ART adherence is scarce, it will be useful to review some existing literature to strengthen the study justification. You can consider adding these two articles:

Lahai M, Theobald S, Wurie HR, Lakoh S, Erah PO, Samai M, Raven J. Factors influencing adherence to antiretroviral therapy from the experience of people living with HIV and their healthcare providers in Sierra Leone: a qualitative study. BMC Health Serv Res. 2022 Nov 8;22(1):1327. doi: 10.1186/s12913-022-08606-x

Moucheraud C, Stern AF, Ahearn C, Ismail A, Nsubuga-Nyombi T, Ngonyani MM, Mvungi J, Ssensamba J. Barriers to HIV Treatment Adherence: A Qualitative Study of Discrepancies Between Perceptions of Patients and Health Providers in Tanzania and Uganda. AIDS Patient Care STDS. 2019 Sep;33(9):406-413. doi: 10.1089/apc.2019.0053. PMID: 31517526; PMCID: PMC6745526.

Methods

Typo in line 122- change “ast” to East.

Can the authors please specify whether the analysis was deductive or inductive.

Ethics- A more detailed discussion on how participant confidentiality and anonymity was maintained needs to be included in the ethics section.

Recruitment process- The recruitment process is unclear in terms of the number and type of healthcare workers that were targeted for the study. Furthermore, it is unclear why only 18 interviews were conducted. Was data collection stopped once saturation was reached?

Line 163- Please change the number 3 in bracket to 2.

Results

The authors have provided comprehensive data. To add depth to their narrative and strengthen the findings, it would be useful if they could also present any negative or outlier cases related to the identified challenges.

It would also be useful to provide a summary table that helps to better align the study recommendations to the reasons for interrupting ART. This could be done in a tabular format, where you have a column for the challenge, a second column describing the challenge, with a corresponding quote, and a third column with recommendations.

Discussion

The discussion is comprehensive and well-supported by evidence, but it includes some repetition as challenges and recommendations are addressed separately. Consolidating the findings by discussing challenges alongside healthcare provider recommendations in a single paragraph may better highlight the link between them.

Line 548, the sentence is incomplete.

Line 560- There is a repeated word “experiences”. Please delete the extra word.

Line 593- Please add the word “interruption” after ART.

The authors have listed some study limitations. Are there some strengths of the study that was conducted.

Conclusion

The conclusion is somewhat unclear. It would be beneficial if the authors could emphasize two or three main challenges and provide corresponding recommendations as a take-home message.

Reviewer #2: The manuscript provides a valuable contribution to the literature on antiretroviral therapy (ART) adherence by offering a unique perspective from healthcare providers, an often underrepresented yet critical stakeholder group. While much of the existing research focuses on patient-reported barriers and facilitators, this study highlights the systemic, logistical, and interpersonal challenges that healthcare providers observe in their interactions with patients. Focusing on the Volta Region of Ghana, it provides context-specific insights into the socio-cultural and operational barriers impacting adherence in resource-constrained settings. Additionally, the actionable recommendations offered such as decentralizing ART services, improving counselling, and addressing stigma are grounded in the practical realities of healthcare delivery, making the findings both academically significant and directly applicable to policy and practice. This approach bridges an important gap in the global effort to enhance ART adherence and achieve UNAIDS 95-95-95 targets.

The authors need to address the following:

Methods Section: Provide more detail on the sampling strategy, data saturation, and justification for the sample size.

• The manuscript mentions recruiting healthcare providers with ≥2 years of experience, which aligns with the study objectives. However, it lacks details about data saturation in interviews.

Limitations: Acknowledge methodological constraints like potential interviewer bias or regional contextual factors.

• The authors mention sample size and geographic scope as limitations. but a more comprehensive limitations section (e.g., interviewer bias, and generalizability of qualitative findings) would strengthen the manuscript.

Supplement with Appendices: Provide the interview guide and coding framework in appendices for transparency

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Reviewer #1: No

Reviewer #2: No

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-->PONE-D-24-41127R1-->-->Healthcare providers' experiences and recommendations for antiretroviral therapy adherence in Ghana: a facility-based phenomenological study-->-->PLOS ONE

Dear Dr.Elvis Enowbeyang Tarkang:,

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 Oct 29 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,

Zewdu Gashu Dememew, M.D, PhD

Academic Editor

PLOS ONE

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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 #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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: N/A

Reviewer #2: Yes

**********

-->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: No

Reviewer #2: Yes

**********

-->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 #2: 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: (No Response)

Reviewer #2: (No Response)

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Ghana_HIV_review.docx

Healthcare providers' experiences and recommendations for antiretroviral therapy adherence in Ghana: a facility-based phenomenological study

PONE-D-24-41127R2

Dear Dr. Elvis Enowbeyang Tarkang  and the team,

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.

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Kind regards,

Zewdu Gashu Dememew, M.D, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: