Knowledge gaps and structural barriers to prescribing pre-exposure prophylaxis among healthcare providers in North Louisiana: A cross-sectional study

Deborah G. Smith; Camila Castro; Patricia Pichilingue-Reto; Catherine G. Dean; Alexandre Malek; Luis Enrique Espinoza

doi:10.1371/journal.pone.0346890

Peer Review History

Original SubmissionSeptember 30, 2025
18 Jan 2026 Decision Letter - Ayodeji Oginni, Editor -->PONE-D-25-49893-->-->Knowledge Gaps and Structural Barriers to Prescribing Pre-Exposure Prophylaxis Among Healthcare Providers in North Louisiana: A Cross-Sectional Study-->-->PLOS One Dear Dr. Smith, 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. We recommend that you respond to all of the reviewers' comments and make the necessary changes to the manuscript to improve its quality. My specific feedback from my evaluation of the manuscript is on the method section of which I recommend you add more relevant details that can help others who might wish to replicate the study. Secondly, on the lines 114-115, you mentioned the use of Linear regression, and you used it to regress other variables on "Perceived patient HIV risk". The outcome variable seems more like a categorical variable, than a continuous quantitative variable. However, if you consider it a continuous quantitative variable, did it fulfil the assumptions (e.g. linearity) guiding Linear regression before doing the regression analysis? Otherwise, I recommend you recategorize it into a binary variable and use logistic regression for the modelling. -->--> -->-->Please submit your revised manuscript by Mar 04 2026 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 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, Ayodeji Babatunde Oginni Academic Editor PLOS One Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please amend your authorship list in your manuscript file to include author Luis E Espinoza. 3. Please amend the manuscript submission data (via Edit Submission) to include author Luis Enrique Espinoza. 4. We are unable to open your Supporting Information file [HIV data Mar 21.sav.zip]. Please kindly revise as necessary and re-upload. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions -->Comments to the Author 1. 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: Partly ******** -->2. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: Yes Reviewer #2: Yes ****** -->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 ****** -->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 ****** -->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: 1. Title and Abstract • The abstract includes excessive background information but lacks a concise statement of study objectives and key results. Include a clear objective statement in the abstract and emphasize key findings with numerical data (e.g., “27.5% had prescribed PrEP; 84% cited lack of training”). • Statistical results are presented descriptively without emphasizing the main significant findings. Conclude with a brief, action-oriented implication: “Targeted provider training and institutional policy support are essential to improving PrEP implementation in high-burden settings.” 2. Introduction • The background is comprehensive but somewhat repetitive. Transitions between global, national, and regional contexts are abrupt. Consolidate background information to three key paragraphs: 1) Burden and relevance of PrEP, 2) Known provider-level barriers, and 3) Specific knowledge gap in Louisiana. • The research gap and study objectives are not clearly articulated. End the section with a concise objective statement: “This study aims to assess knowledge, attitudes, and structural barriers influencing PrEP prescribing among healthcare providers in North Louisiana.” 3. Materials and Methods • The subheading “Study setting and settings” should be corrected to “Study Design and Setting.” • The survey instrument’s validation process (pilot testing, reliability) is not described. Describe the survey instrument development, including question sources, piloting, and validation (if applicable). • Data management and handling of missing values are unclear. Include details on data handling: “Incomplete responses were excluded using listwise deletion, resulting in a final analytic sample of N=___.” 4. Results • Tables are overcrowded and results are repeated in both text and tables. Present only key findings in the text, referring readers to tables for details. Reorganize Table 1 into two tabless: (1) demographic characteristics and (2) PrEP-related behaviors/barriers. • Figures are limited; visual aids would help communicate key findings. Include one or two visualizations (e.g., a bar chart showing the proportion of providers who prescribed or discussed PrEP). 5. Discussion • Restructure discussion into clear subsections: 1) Key findings summary, 2) Interpretation in context of existing literature, 3) Policy and programmatic implication, and 4) Study limitations and future research. • Remove redundant or overly descriptive paragraphs. • Strengthen interpretation by connecting findings to potential interventions: “Limited provider training and absence of clinic-level protocols suggest that institutional support mechanisms, such as PrEP champions or teleconsultation models, could facilitate broader PrEP uptake.” • Include a dedicated limitations paragraph addressing cross-sectional design, self-report bias, and lack of qualitative exploration. 6. Conclusion • Make the conclusion shorter and more impactful: “This study highlights persistent provider knowledge gaps and structural barriers to PrEP prescribing in North Louisiana. Enhancing provider education, developing institutional protocols, and addressing systemic barriers such as stigma and cost are essential steps toward equitable PrEP implementation.” Reviewer #2: Hello, The title sounds good, but my biggest concern on the discussion part you have discussed based on local context not comparing on the studies around the world. Also on the methodology part especially sampling were not clear as well as sample size no clear how was it obtained. ****** -->6. 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: Faizul Akmal Abdul Rahim Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. --> Attachments Attachment Submitted filename: Reviewer matrix.docx https://doi.org/10.1371/journal.pone.0346890.r001
Revision 1
20 Feb 2026 Author Response Response to the academic editor and reviewers Dear Academic Editor and Reviewers, We sincerely thank you for your thoughtful evaluation of our manuscript and for your constructive feedback. We have carefully revised the manuscript to address all comments and believe these revisions have strengthened the clarity, methodological transparency, and overall quality of the paper. Below, we provide a detailed, point-by-point response to each comment. Academic Editor Comments Comment 1: My specific feedback from my evaluation of the manuscript is on the method section of which I recommend you add more relevant details that can help others who might wish to replicate the study. Response: Thank you for this important suggestion. We expanded the Methods section to provide additional detail regarding recruitment procedures, including the use of QR codes and electronic survey links, participant information and consent procedures, eligibility screening, and automated survey flow. Comment 2: Secondly, on the lines 114-115, you mentioned the use of Linear regression, and you used it to regress other variables on "Perceived patient HIV risk". The outcome variable seems more like a categorical variable, than a continuous quantitative variable. However, if you consider it a continuous quantitative variable, did it fulfil the assumptions (e.g. linearity) guiding Linear regression before doing the regression analysis? Otherwise, I recommend you recategorize it into a binary variable and use logistic regression for the modelling. Response: The variable representing the percentage of patients perceived to be at risk for HIV was originally measured using ordered response categories. Ordinal logistic regression was initially considered; however, testing indicated that the proportional odds assumption was violated. Collapsing the variable into a binary outcome would have resulted in loss of information and reduced variability. Therefore, the variable was modeled as continuous using linear regression, an accepted approach for ordinal variables with multiple ordered categories when assumptions are reasonably met. Model diagnostics were examined to confirm that linear regression assumptions were adequately satisfied. We have clarified this analytic decision in the Methods section. Authorship Amendments Comment: Please amend authorship to include Luis Enrique Espinoza. Response: The authorship list and submission metadata have been updated to reflect the author’s full name, Luis Enrique Espinoza. Supporting Information File Comment: Unable to open supporting file. Response: We have replaced the file and uploaded a revised version. Supporting Information Captions Response: Captions for Supporting Information file and Figure have been added at the end of the manuscript, and in-text citations have been updated accordingly. Reference List Review Response: We reviewed the reference list for completeness and accuracy, removed duplicate citations, and added relevant references where appropriate, based on the reviewers' recommendations. Response to Reviewer #1 Title and Abstract Comment: The abstract includes excessive background information but lacks a concise statement of study objectives and key results. Include a clear objective statement in the abstract and emphasize key findings with numerical data (e.g., “27.5% had prescribed PrEP; 84% cited lack of training”). Response: We revised the abstract to substantially reduce background content, added a clear objective statement, and emphasized key findings with numerical data. Comment: Statistical results are presented descriptively without emphasizing the main significant findings. Conclude with a brief, action-oriented implication: “Targeted provider training and institutional policy support are essential to improving PrEP implementation in high-burden settings.” Response: We revised the abstract conclusion to highlight the primary findings and added a concise, action-oriented implication that emphasizes the importance of targeted provider training and supportive institutional policies to improve PrEP implementation in high-HIV-burden Southern settings. Introduction Comment: The background is comprehensive but somewhat repetitive. Transitions between global, national, and regional contexts are abrupt. Consolidate background information to three key paragraphs: 1) Burden and relevance of PrEP, 2) Known provider-level barriers, and 3) Specific knowledge gap in Louisiana. Response: We reorganized the Introduction into three focused paragraphs addressing (1) the burden and relevance of PrEP, (2) known provider-level barriers, and (3) the research gap and study objective. Transitions were strengthened, and a clear objective statement was added at the end of the section. Comment: The research gap and study objectives are not clearly articulated. End the section with a concise objective statement: “This study aims to assess knowledge, attitudes, and structural barriers influencing PrEP prescribing among healthcare providers in North Louisiana.” Response: We added the objective recommended by Reviewer 1 to the end of the introduction. Materials and Methods Comment: The subheading “Study setting and settings” should be corrected to “Study Design and Setting.” Response: The subheading was revised to “Study Design and Setting.” Comment: The survey instrument’s validation process (pilot testing, reliability) is not described. Describe the survey instrument development, including question sources, piloting, and validation (if applicable). Response: We expanded the Methods section to describe the survey development process. Items were adapted from previously published studies, and the instrument was pilot-tested among physicians to assess clarity, readability, and flow. Minor revisions were made prior to distribution, and pilot participants were excluded from the analytic sample. Comment: Data management and handling of missing values are unclear. Include details on data handling: “Incomplete responses were excluded using listwise deletion, resulting in a final analytic sample of N=___.” Response: We clarified that incomplete responses were excluded using listwise deletion, resulting in a final analytic sample of 102 providers. Results Comment: Tables are overcrowded and results are repeated in both text and tables. Present only key findings in the text, referring readers to tables for details. Reorganize Table 1 into two tabless: (1) demographic characteristics and (2) PrEP-related behaviors/barriers. Response: We revised the Results section to present only key findings in the text while directing readers to tables for detailed data. Table 1 was divided into two tables to improve readability. Comment: Figures are limited; visual aids would help communicate key findings. Include one or two visualizations (e.g., a bar chart showing the proportion of providers who prescribed or discussed PrEP). Response: We added Figure 1 to visually highlight PrEP prescribing, discussion practices, and training barriers. Discussion Comment: Restructure discussion into clear subsections: 1) Key findings summary, 2) Interpretation in context of existing literature, 3) Policy and programmatic implication, and 4) Study limitations and future research. Response: The Discussion was reorganized into clearly labeled subsections addressing key findings, interpretation within the existing literature, policy and programmatic implications, and study limitations, along with directions for future research. Comment: Remove redundant or overly descriptive paragraphs. Response: We removed overly descriptive paragraphs. Comment: Strengthen interpretation by connecting findings to potential interventions: “Limited provider training and absence of clinic-level protocols suggest that institutional support mechanisms, such as PrEP champions or teleconsultation models, could facilitate broader PrEP uptake.” Response: We strengthened the discussion by explicitly linking the findings to potential institutional and provider-level interventions and added a dedicated limitations paragraph that addressed the cross-sectional design, self-report bias, and generalizability. Comment: Include a dedicated limitations paragraph addressing cross-sectional design, self-report bias, and lack of qualitative exploration. Response: We added a dedicated limitations paragraph that addressed the cross-sectional design, self-report bias, and generalizability Conclusion Comment: Make the conclusion shorter and more impactful: “This study highlights persistent provider knowledge gaps and structural barriers to PrEP prescribing in North Louisiana. Enhancing provider education, developing institutional protocols, and addressing systemic barriers such as stigma and cost are essential steps toward equitable PrEP implementation.” Response: The conclusion was revised for clarity and concision, incorporating the reviewer’s suggestion. Response to Reviewer #2 Comment: The title sounds good, but my biggest concern on the discussion part you have discussed based on local context not comparing on the studies around the world. Also on the methodology part especially sampling were not clear as well as sample size no clear how was it obtained. Response: We revised the Discussion to incorporate comparisons with studies conducted in other regions and countries, situating our findings within the broader global literature while maintaining regional relevance. We also clarified the sampling strategy and recruitment procedures. Eligible physician faculty members, residents, and fellows were recruited using convenience sampling with the goal of reaching all providers affiliated with the medical school and teaching hospital during the study period. Additionally, we specified that 104 providers completed the survey and that incomplete responses were excluded using listwise deletion, resulting in a final analytic sample of 102 providers. Response to Reviewer #3 Abstract Comment: Write the section of abstract into structured paragraphs. Response: We revised the abstract by organizing it into clearly labeled sections (Background, Objective, Methods, Results, and Conclusions). Comment: Include p-values of the variables which showed significance Response: We present adjusted effect estimates with 95% confidence intervals, which provide information on both the direction and precision of the associations while maintaining clarity in the abstract. Introduction Comment: State in number rates of new HIV diagnoses in the country Response: We stated the rates of new HIV diagnoses in the country. Comment: State situation globally, regional and locally as far as Pre- exposure prophylaxis is concern Response: We strengthened the Introduction by incorporating global, national, regional, and state-level epidemiologic data and by adding context on disparities in PrEP uptake. Methodology Comment: State the high HIV burden in the region(North Louisiana). Response: We added epidemiologic context to describe Louisiana as a high-HIV-burden state to better justify the study setting. Comment: What is the ideal sampling technique you have used in the selection of study participants. Response: We clarified that participants were recruited using convenience sampling. Comment: Why did you remained with only 102 out 104? Response: We clarified that incomplete responses were excluded using listwise deletion, resulting in a final sample of 102 providers. Measures Comment: Where did you adapt this set of questions? How did you measure knowledge and practice without using scale? Response: We clarified that the questionnaire was informed by previously published studies examining providers’ knowledge, attitudes, and prescribing behaviors related to PrEP and HIV prevention. Provider knowledge was assessed through self-reported familiarity with PrEP, awareness of prescribing guidelines, and prior training, while prescribing practices were evaluated using items assessing PrEP discussion, prescribing history, and confidence in identifying eligible patients. Comment: What were the inclusion criteria? What were the exclusion criteria? Response: We added both inclusion and exclusion criteria. Comment: Show what was the collection tools used in this study?? It is not clear stating electronically Response: We added to the data management and analysis subsection that “Survey data were collected electronically using REDCap (Research Electronic Data Capture), a secure web-based platform designed to support research data collection.” Ethical Approval Comment: Show how the confidentiality and privacy was done as well as how participants were enrolled ethically. Response: We revised the Ethics section to provide additional detail on IRB approval, informed consent waivers, voluntary participation, and data confidentiality procedures. The survey was anonymous, no personally identifiable information was collected, and all data were stored on secure, password-protected servers accessible only to the research team. Results Comment: Include the p-values for the significantly associated variables Response: We included under the tables 3 and 4 that “Statistical significance is shown by asterisks and derived from 95% confidence intervals (p < .05; p < .01; *p < .001).” Comment: Provide N within each percentage composition in the results Response: We included the n within each percentage in the results. Discussion Comment: Please compare findings with other studies around the world Response: We expanded the Discussion to include comparisons with international studies. Comment: Please provide countries and year of study in which specific studies were conducted Response: We provided the countries in the discussion, and the study years are reflected in the cited literature. Comment: Provide long form of OB/GYN Response: We provided the long form of OB/GYN: obstetrics and gynecology (see line 466) Conclusion Comment: Provide recommendations separately. Response: We added a section outlining recommendations for practice. General Comments Comment: Do you think 102 participants are essentially enough for publication and later be generalizable to the country. Response: The primary goal of this study was to provide a detailed, regionally focused assessment within a high HIV-burden Southern setting rather than achieve national generalizability. We clarified in the Discussion that findings should be interpreted within this regional context. Comment: Why was study not a mixed design??? Response: This study was designed as a cross-sectional quantitative survey to systematically assess provider-level knowledge gaps, prescribing practices, and structural barriers. We agree that qualitative methods could provide additional contextual insight and noted in the Discussion that future research should incorporate mixed-methods approaches. Comment: What were the limitations of the study and how to mitigate them Response: We added a dedicated limitations subsection that describes the cross-sectional design, reliance on self-reported data, and the lack of qualitative exploration. Anonymous data collection was used to reduce reporting bias, and future longitudinal and mixed-methods research is recommended. Comment: Provide each authors contribution as well Response: Author contributions have been added. Attachments Attachment Submitted filename: Renpose to reviewers.docx* https://doi.org/10.1371/journal.pone.0346890.r002
22 Mar 2026 Decision Letter - Ayodeji Oginni, Editor <div>PONE-D-25-49893R1-->-->Knowledge Gaps and Structural Barriers to Prescribing Pre-Exposure Prophylaxis Among Healthcare Providers in North Louisiana: A Cross-Sectional Study-->-->PLOS One Dear Dr. Smith, 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.-->--> -->-->I would like you to include under the "Participant and Recruitment" section, the sample size calculated or estimated for the study, including your assumptions. Please submit your revised manuscript by May 06 2026 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 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, Ayodeji Babatunde Oginni Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. --> https://doi.org/10.1371/journal.pone.0346890.r003
Revision 2
23 Mar 2026 Author Response Dear reviewers and editor, Thank you for your question. We agree that reporting how the sample size was estimated would improve the transparency and rigor of our methodology. We have added the following paragraph and a new reference used to estimate the study sample size required for our study, and we have included details in the “Participants and Recruitment” section. “Although convenience sampling was employed within a single academic medical center, an estimated sample size was considered to ensure adequate precision of proportion estimates. Since there were no prior estimates of the proportion of providers reporting the outcomes of interest (e.g., PrEP prescribing), a conservative assumed proportion of 50% was used, as recommended by Lwanga and Lemeshow [7], in standard sample size formulas for estimating proportions in cross-sectional studies, because this produces the largest required sample size. Assuming a 95% confidence level and a margin of error of ±10 percentage points, the minimum estimated sample size required was approximately 96 participants. A total of 104 healthcare providers completed the survey. Incomplete responses were excluded using listwise deletion, resulting in a final analytic sample of 102.” Best regards, Dr. Smith Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0346890.r004
26 Mar 2026 Decision Letter - Ayodeji Oginni, Editor Knowledge Gaps and Structural Barriers to Prescribing Pre-Exposure Prophylaxis Among Healthcare Providers in North Louisiana: A Cross-Sectional Study PONE-D-25-49893R2 Dear Dr. Smith, 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. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ayodeji Babatunde Oginni Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0346890.r005
Formally Accepted
Acceptance Letter - Ayodeji Oginni, Editor PONE-D-25-49893R2 PLOS One Dear Dr. Smith, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Ayodeji Babatunde Oginni Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0346890.r006

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