Peer Review History
Original SubmissionJanuary 29, 2020 |
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PONE-D-20-02701 High Prevalence Of Injection Drug Use And Blood-Borne Viral Infections Among Patients In An Urban Emergency Department PLOS ONE Dear Dr. Anderson, 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. The authors should address all of the critiques raised by the review, and which I concur with. I also urge the authors to be more transparent in the abstract regarding prevalence of self-reported injection drug use the the infections HIV and HCV. Information about those not surveyed should be provided for comparison purposes if possible. Identifying strengths that can support the potential impact of the study would add to the manuscript. We would appreciate receiving your revised manuscript by April 25, 2020. When you are 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. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript:
Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Kimberly Page, PhD, MPH Academic Editor PLOS ONE Additional Editor Comments (if provided): I concur I concur with the review regarding the weaknesses of the study: including the lack of information about people who did not take the survey, the survey instrument validity, the weaknesses of self-reported infection status and editing the figures. However, I think that the authors can address these critiques with a major revision, noting the more carefully the strengths and weaknesses of the study. For example what are HIV and HCV testing rates in this area? If they are high, do they inspire confidence in the self-reported prevalence. Addressing the potential biases of the study are important and not over-interpreting the results. 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 http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure. 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide.
4. Thank you for stating the following in the Competing Interests section: "I have read the journal's policy and the authors of this manuscript have the following competing interests: ESA, CR, KB, HL, AC, and DAEW received funding from Gilead Sciences FOCUS Grant. The grant provided partial salary support and program support for HIV and HCV screening in the emergency department. " Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. Please know it is PLOS ONE policy for corresponding authors to declare, on behalf of all authors, all potential competing interests for the purposes of transparency. PLOS defines a competing interest as anything that interferes with, or could reasonably be perceived as interfering with, the full and objective presentation, peer review, editorial decision-making, or publication of research or non-research articles submitted to one of the journals. Competing interests can be financial or non-financial, professional, or personal. Competing interests can arise in relationship to an organization or another person. Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests [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: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No ********** 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: No ********** 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 ********** 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: The manuscript details results from a convenience sample survey of approximately 2,200 emergency department (ED) patients at a single urban ED (Highland) in Oakland, CA. The survey focuses on assessing injection drug use (IDU) history and self-reported HIV and hepatitis C (HCV) infections. The authors report high rates of IDU (and HIV and HCV) among their sample. The findings are relatively limited, including only a few demographic and visit characteristics. Within their findings, the note high reported IDU (e.g., 26% in respondents 25-34 years) and generally high rates of HIV (6%) and HCV (53%) infection. The authors report a very high response rate--about 95%. The challenge is interpreting this number is that the authors do not describe the characteristics of 2,015 patients that they did not approach--and critically why not? Where these patients too ill? Intoxicated? Spoke a language other than English or Spanish? Discharged before the RA could approach them for participation? This information is critical to judge the validity of the remaining responses. The convenience sample design is practical, but it may have important implications on the findings. For example, if patients who inject drugs (or have HIV or HCV infection) have longer ED visits lengths of stay compared to their null counterparts, then the findings are subject to length biased sampling--and the results may be biased. The convenience sample design, single site selection, and lack of methodologic details limit the general applicability of their findings. Specific comments: 1. Abstract: The authors state that they used a 'validated questionnaire' in the abstract. This is a bit of an overstatement. The authors used 2 validated question items from the NIDA Clinical Trials Network (CTN) Common Data Elements (CDE). This is a strength in their methods, but a general overstatement to imply that the questionnaire was validated (it would be fair to say that 2 items were validated). The authors do not provide their questionnaire for review. They do not describe the other survey data elements. 2. The authors should clarify their use of 'Hispanic,' 'white,' and 'black'. In many contexts, Hispanic refers to ethnicity and white and black refer to race. I would presume that 'white' means 'non-Hispanic white' and 'black' means 'non-Hispanic black'. Again, if the questionnaire were provided as supplemental material, it would help gauge how the questions were asked. 3. Were subjects compensated in any way? Were there any duplicate respondents (more than 1 ED visit during the study period)? If so, how were they managed? 4. The statistical analysis is relatively simple, reporting percentages and absolute percentage differences between categories. The manuscript would be strengthened by a more robust analysis that included both absolute and relative differences (whether reporting as prevalence ratios or odds ratios). There are limited attempts to detect confounding or interaction (via limited stratification provided by text and not shown in tables). Sample size restrictions (of reported IDU, HIV, and HCV) limit the ability to adjust for confounding. 5. The figure is difficult to read. Colored bar graphs have poor data to ink ratios. Try point and line figures with meaning groupings. Two figures, one for current IDU and one for former IDU would be better--and would have a better data to ink ratio. IDU is also better than PWID, as the figures describe an action (IDU) rather than a general group characteristic (PWID). 6. The authors rely upon self-reported HIV and HCV infection. The authors do not describe how this information was collected (e.g., were respondents asked about HIV and HCV infections directly or was a staged approach used--have you ever had a test for HIV? When was the last time you were tested for HIV? Has a health care provider ever told you that your test was positive?). There are a number of validated screening tools to ask this information. Were they used? Furthermore, the authors allude to results (presumably from the same project) indicating that "many of the current PWID had not undergone recent HIV or HCV screening." This further calls into question the accuracy of their results (while estimates of self-reported HIV and HCV infection are important, the actual seroprevalence rates are really what we want to know). The authors should also report HIV/HCV co-infection rates. 7. The limitations included are appropriate, notably that these results come from a single urban center that serves a marginalized community. The authors should address the additional limitations noted above (e.g., reliance on self-reported HIV and HCV infection, unclear impact of selection biases). 8. In the discussion, the authors state that "we believe the prevalence of PWID among urban ED patients is between 7% and 11%". The authors should temper their conclusion. Estimates vary based upon methods and study samples. Certainly the prevalence of injection drug use is significant and deserves attention, but accurate unbiased estimates of IDU among ED patients remain unknown. 9. On page 10, "We performed a cross-sectional survey study..." Suggest rewording to either "We performed a cross-sectional study..." or "We surveyed..." The terms cross-sectional and survey essentially mean the same thing. 10. On page 11, please define how you operationalized 'medically stable'. Non-medically (presumably) trained research assistants collected the data. How did they determine 'medical stability'? ********** 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: 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 be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. |
Revision 1 |
High Prevalence Of Injection Drug Use And Blood-Borne Viral Infections Among Patients In An Urban Emergency Department PONE-D-20-02701R1 Dear Dr. Anderson, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and 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. With kind regards, Kimberly Page, PhD, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: |
Formally Accepted |
PONE-D-20-02701R1 High Prevalence Of Injection Drug Use And Blood-Borne Viral Infections Among Patients In An Urban Emergency Department Dear Dr. Anderson: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, 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. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Kimberly Page Academic Editor PLOS ONE |
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