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[Overall support for the HIV Prevention Trials Network (HPTN) is provided by the National Institute of Allergy and Infectious Diseases (NIAID), Office of the Director (OD), National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), the National Institute of Mental Health (NIMH), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center].

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[Overall support for the HIV Prevention Trials Network (HPTN) is provided by the National Institute of Allergy and Infectious Diseases (NIAID), Office of the Director (OD), National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), the National Institute of Mental Health (NIMH), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center).]

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[Overall support for the HIV Prevention Trials Network (HPTN) is provided by the National Institute of Allergy and Infectious Diseases (NIAID), Office of the Director (OD), National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), the National Institute of Mental Health (NIMH), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center]

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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: Yes

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: Yes

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4. 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: In this manuscript the Authors describe their findings from a cross-sectional assessment during the pilot phase of the HPTN 096 study. Overall, they found a very high burden of HIV in Black MSM at the study sites. Of those living with HIV, 77% were in HIV care. At two study sites, viral loads were obtained and only 70% were virally suppressed. Of those not living with HIV, only 22% reported being on PrEP, and of those, 12% had no evidence of PrEP on dried blood spots. Overall, the study Authors found a high burden of HIV in Black MSM and low rates of viral suppression and PrEP use in those not living with HIV.

I found this manuscript interesting and well-written and only have some minor suggestions:

1. "southern" should be capitalized throughout the manuscript when referring to "Southern United States".

2. In the Introduction, both present and past tense are used. I would stick with past tense whenever applicable.

3. Line 251-253: This is in track change.

4. Line 276: This is in track change.

5. Line 285-286: What do you mean by "HIV testing was performed for the remaining four participants..." Please consider rephrasing.

6. Lines 411-414: Of those reporting taking PrEP but without detectable TFV-DP on their DBS, were you able to confirm that they were not on injectable PrEP (Cabotegravir was approved by the FDA for PrEP in 2021 before this study)?

Reviewer #2: This is a remarkably well-written and comprehensive description of the cross-sectional study data from HPTN 096. I only have two minor points of clarification.

Were any efforts made to correct for the RDS component of the sampling strategy in the analysis?

Only 29 samples were tested for HIV drug resistance. A little more information about this and if there is any suspected bias in which participants had samples tested for resistance compared to those who did not would be helpful. Was this just due to the differences in lab accessibility across communities? It seems as though there are still missing samples even with this limitation.

Although not pertinent to the review, I found the tribute to Dawn Smith to be quite moving. Having known her and the standards she set for herself and those she worked with, it is fitting for this acknowledgment to be attached to such a thorough, clearly presented, and important paper.

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Reviewer #1: Yes:  Jeffrey D. Jenks

Reviewer #2: No

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Investigating the HIV epidemic among Black gay and bisexual men in the southern United States: Results of the HPTN 096 pilot cross-sectional assessment

PONE-D-25-32729R1

Dear Dr. Beyrer,

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,

Douglas S. Krakower, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: