Dear Dr. Abu-Ba'are,

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Kind regards,

Serge Tonen-Wolyec, M.D., Ph.D.

Academic Editor

PLOS One

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2. Please provide additional information regarding the considerations  made for the Refugee included in this study. For instance, please discuss whether participants were able to opt out of the study and whether individuals who did not participate receive the same treatment offered to participants.

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“The project described was supported by award number P30MH062294 from the National Institute of Mental Health (NIMH) through the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Public Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Interdisciplinary Research on AIDS, the National Institute of Mental Health, or the National Institutes of Health “

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Additional Editor Comments:

The manuscript is very well written, with details that are important for understanding the methodology and the main findings.

The major weakness of this article is the use of non-probability sampling for the quantitative survey phase. I would have liked to see the use of sampling methods that have already been validated for hard-to-reach populations, such as respondent-driven sampling (RDS).

Statistically, the authors should specify that the validity of the chi-square tests was systematically verified and how they controlled for confounding factors.

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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: Dear authors

Thank you for the opportunity to review your manuscript: Factors Associated with Oral HIV Self-Testing Awareness Among African Refugee Male Sex Workers in Italy. A Mixed-Methods Study. I have carefully completed the revision and provided detailed feedback below, this manuscript examines HIVST awareness and associated factors among ARMSWs to inform targeted interventions.

Congratulations, this is a well written manuscript.

1. Please revise your title to make it punchier and impactful.

2. Please revise your introduction, to make it shorter and I would suggest you focus on research gaps regarding ARMSWs in Europe.

3. Please repeat table header on subsequent pages.

4. Please do you have information on how much participants charge per client? I would suggest you to include it to highlight their vulnerability as they earn 250euros/month mean (use range best) and 58% see less than 20 clients per month.

5. Please include a new "Sample and Sampling" subsection to better describe the peer-referral (snowball) recruitment process.

6. Please avoid ending your introduction with questions, I would suggest rephrasing the objective in the last paragraph as text.

7. Please further condense some of the information in your discussion and focus on interpreting your key findings (while making sure they tie back to what was presented in the introduction section), to make the paper more cohesive, and please include more information on what would be the implications for future research and clinical practice as ARMSWs are a very particular population in Italy : very vulnerable, small size, often without a regulated immigration status, language barriers, etc.

8. Please make sure to revise the references and typos in general .

9. Please make sure to revise and maybe cite other publications for HIVST in Italy/Europe, for example: https://pubmed.ncbi.nlm.nih.gov/39863901/, https://pubmed.ncbi.nlm.nih.gov/35784245/, https://pubmed.ncbi.nlm.nih.gov/25394102/

Reviewer #2: The paper has been extensively and correctly revised according to all issues raised by the referees, in particular the methodological issues and the addition of a full "Study Strengths and Limitations" paragraph. The paper is relevant on a topic rarely addressed in medical literature.

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Reviewer #1: Yes: CARMEN FIGUEROA

Reviewer #2: No

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HIV Self-Testing Awareness Among African Refugee Male Sex Workers in Italy. A Mixed-Methods Study

PONE-D-25-61075R1

Dear Dr. Abu-Ba’are,

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,

Serge Tonen-Wolyec, M.D., Ph.D.

Academic Editor

PLOS One