Peer Review History

Original SubmissionOctober 29, 2019
Decision Letter - Philip C Hill, Editor

PONE-D-19-30098

Active household contact screening for tuberculosis and provision of isoniazid preventive therapy to children in Afghanistan

PLOS ONE

Dear Dr Sayedi,

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 would appreciate receiving your revised manuscript by Jan 31 2020 11:59PM. 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:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
  • A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
  • An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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,

Philip C Hill, MD

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

http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Additional Editor Comments (if provided):

Please address all the comments by the reviewers. Please note, the paper will need to be improved both scientifically and in grammatical aspects.

[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: No

Reviewer #2: Yes

**********

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

Reviewer #1: No

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: No

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: No

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: This is an interesting study of secondary data on contact investigation, a high priority according to the UN high-level meeting held in NYC in 2018. Two previous studies have reported the prevalence of active TB among contacts in Afghanistan. The current manuscript adds a lot to these reports, by discussing LTBI treatment, uptake and completion, and by describing the substantial increase in case finding after the implementation of a new policy in the country. These findings are interesting. The manuscript, however, needs some improvements before it can be suitable for publication.

Abstract:

This abstract should be rewritten. The objectives should clearly state that a new policy was recommended by the NTP in 2011 for contact investigation and this observational study reports the findings since these recommendations.

The Methods section currently describes mainly active TB indicators (NNS and NNT) but the conclusions focus on IPT in children. The authors need to choose what their main message is and write a coherent abstract.

If the number of children starting and completing LTBI treatment is their main focus, they need to define what the national policies for contact investigation and treatment for LTBI were in 2011-2018 in the Methods section, so that the reader can understand why so many children under 5 were prescribed IPT.

In the conclusion, what do the authors call a “high” performance? Do they mean good? The findings should be interpreted in the same was they are reported in the Results section. Incidence rate is not shown in results, so the reader can not follow the conclusion. Please adjust.

The conclusion should also describe briefly how the authors explain the high rates of IPT prescription and completion when compared to other countries.

The sentence ending the abstract is misleading: Afghanistan is not a HBC, and the sentence refers to “other” HBC. Afghanistan is a high TB incidence RATE country, which is different from HBC. Please adjust.

The short title should be adjusted. The study is not about children only.

Main text:

Introduction:

This report is of interest for many other countries. Accordingly, the introduction should highlight why the investigation of contacts is important (anywhere), and just a short paragraph to explain why it is important in Afghanistan. The detailed description of the TB situation in Afghanistan should be reported in a “setting” subheading of the Methods section.

L. 32-33: Incidence and incidence rates are different concepts, please rephrase.

Methods

This is an observational study of a new policy recommended by the NTP. The new policy and the routine investigation of contacts should be explained but not be named “intervention” because this is misleading. All that is currently reported as the “intervention” should be reported as setting. This section should also make clear what were the previous recommendations and what is new in the current recommendation.

Are the reported definitions the ones adopted by the NTP? Are health care workers and community agents instructed to identify contacts as per this definition?

Data analysis: time trend would be a better analysis (quarterly, since these data is available by quarter) than proportions. The increase (or any change) in the population (denominator) should be taken into consideration in analyses/comments of incidence rates.

Ethics: how was data stored? What procedures were made to protect the data?

Results:

“We included” is not a good term for an analysis of secondary data.

The p-values are unnecessary, since the CI are presented (and any difference with such a huge sample would be “statistically significant”.

Discussion

The results should not be repeated in the discussion.

Instead of simply comparing the yield of active TB among screened contacts, it would be interesting to discuss what might explain these differences.

What does this manuscript add to the two previous reports on contact investigation in the country? This should be highlighted in the discussion. How do the current findings compare to findings before the new policy? In other words, what is the impact of the new policy? Were there any other changes in the country or health system in this period that could explain the increase in the proportion of TB cases diagnosed?

Comments on cost-effectiveness of the NNS and NNT would be interesting, even if speculative since this kind of analysis was not the scope of the study.

Above all, the conclusions cannot be withdrawn from the findings of the study.

Minor comments:

1. The text needs some language review.

2. References need to be updated.

Reviewer #2: Summary of Paper:

The manuscript summarizes 8 years of national TB program data in Afghanistan. During this time period 142, 797 active TB cases were reported and 586,292 household contacts of index cases were screened for TB. The number of co-prevalent cases among HHC was found to be high. TPT initiation and completion rates for children under five were high. In many cases data is reported separately for men and women. The number needed to screen (NNS) and number needed to treat (NNT) are also reported.

General comments:

Overall this was an informative and well written paper. Data is presented for many useful TB indicators. The performance of the program is remarkable. Some additional explanation as to how the program has been able to perform so well would be useful so that others can learn from the experience in Afghanistan.

Major comments:

1) On page 4 the authors state that they use “routine contact screen performance” data from the Afghanistan NTP from 2011-2018. It would be useful to know more about how this data is collected and how good the data is felt to be? (has the same registry been in place since 2011 to collect this data? Are they electronic registries? Do they combine data from multiple registries? How reliable are the data collected in screening registries? How complete are they?)

2) Related to the point above, within these registries how is treatment completion measured?

3) How large is the private sector in Afghanistan? If the private sector is involved in TB care, how is this captured in the data reported? Is the private sector involved in routine program reporting? The role of the private sector and the generalizability of the findings reported in the manuscript data should be included in the discussion

4) The authors show that there have been major improvement in the TB outcomes reported during this period. It would be interesting to know what mechanisms may have contributed to the major improvements seen in the country in the last few year. For example has program funding remained stable over these years? How/why has it changed? Have strengthening projects been in place? Readers will be interested to know what investments are required in order to bring a program to this level (both in terms of both $ and program strengthening through Challenge TB etc…)

5) Throughout the manuscript, the authors stratify most findings by sex, and use statistical testing to look at sex differences. It would be helpful to provide a justification in background to support these analyses. Was there an initial hypothesis that there would be gender differences which led to these analysis? I’m not sure what the statistical testing adds without a clear discussion of the rationale and implications. In the discussion there is currently just a comparison to what others have found.

6) In the paper the authors use census data to estimate 6 household members. Do the authors know how many HHC were usually identified when contact investigators were performed? Is there any data available to validate the census assumption?

7) In the discussion the authors state that they attribute the high rate of completion to various things (counseling of parents on the importance of IPT etc..). It would be nice to have more detail about what is involved programmatically in achieving this level of passive case detection, screening, testing and treatment initiation, so that others can learn from the successes of this program. For example, what is involved in good follow up? What lengths do HCW go to in order to help people initiate and complete IPT. If the authors can elaborate on any of these points it would strengthen the paper.

8) The authors final statement that IPT “should probably be extended to all eligible contacts of all ages” seems like a bit of an afterthought. For a program that is seemingly performing so well, one could argue this would be an obvious next step. Can the authors comment on if there are plans for this, or if there are obstacles? It seems that this notion deserves more attention, especially in light on the UNHLM targets to expand TPT to 20 million HHC of all ages by 2022.

.

Minor points:

9) line 110- it should be made clear that by “contact” they are referring to household contacts (based on the definition provided). Throughout would suggest referring to household contact for clarity.

10) line 114 there is a typo?- should be NNS (not NNT)

11) Line 235- typo? It states “interrupted” supply of INH- presumably it should say “uninterrupted”.

12) Page 6 the first line on page 7 (line 132) is redundant as it has already been stated in the first line of the results

13) Page 13, line 251- we recommend following contacts for 2-3 years- to monitor for TB? Pls clarify for what reasons

**********

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

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 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

I have attached a letter with response to comments for reviewers as revised submission document

Attachments
Attachment
Submitted filename: Contact Screening Afghanistan response to reviewers.docx
Decision Letter - Philip C Hill, Editor

PONE-D-19-30098R1

Active household contact screening for tuberculosis and provision of isoniazid preventive therapy to under-five children in Afghanistan

PLOS ONE

Dear Dr. Sayedi,

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 09 2020 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Philip C Hill, MD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

I am afraid the quality of the English, especially in the newly revised sections is not good enough for publication

I am happy to give you an opportunity to fix this issue.

[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.]

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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Revision 2

all the data are in the article.

I have attached two documents for reviewers comments

The English editing done

An excel file with data attached

Attachments
Attachment
Submitted filename: Response to Reviewers 2.docx
Decision Letter - Philip C Hill, Editor

Active household contact screening for tuberculosis and provision of isoniazid preventive therapy to under-five children in Afghanistan

PONE-D-19-30098R2

Dear Dr. Sayedi,

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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 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,

Philip C Hill, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Formally Accepted
Acceptance Letter - Philip C Hill, Editor

PONE-D-19-30098R2

Active household contact screening for tuberculosis and provision of isoniazid preventive therapy to under-five children in Afghanistan  

Dear Dr. Sayedi:

I'm 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 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.

If we can help with anything else, please email us at plosone@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

Prof. Philip C Hill

Academic Editor

PLOS ONE

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .