Review Reports - HIV Prevention Practices Among South African University Students

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Many thanks for the opportunity to review your work. I enjoyed reading your timely and relevant work. My comprehensive reviewer comments and suggestions for further refining the manuscript are attached hereto. More strength to your arm.

Comments for author File: Comments.pdf

Author Response

Comment: Thank you, the title is well formulated. However, reading through the manuscript, I think you need to adjust the title; currently, it gives the impression that it was only a scoping review, whereas it was an actual research study.

Response: Thank you for pointing this out. We agree with the comment. We have revised the title and removed the caption “scoping review” to read HIV prevention practices among South African University Students. Page 1 lines 1-2

Comment: Your abstract is well written. Reading through the abstract, I am getting a feeling that this is a research article and not a scoping review (although the scoping review formed part of the first phase of the study), considering that you actually conducted interviews with 15 students, collected data, and analysed it. To add more value, consider adding brief points on the conclusion and recommendations of the study. Kindly remove the numbering in your keywords and consider reducing the number of keywords from 9 to 6. I am suggesting that you delete HIV prevention, condom use, and biomedical HIV prevention since they are already covered/implied by other keywords.

Response: Thank you for pointing this out. We agree with the comment and have included a statement for the conclusion and recommendations. We have also reduced the keywords from 9 to 6. Page 1, lines 21 to 23, then lines 24 and 25

Comment: Your introduction is well written and captures all the important aspects of the paper. It is clear that you understand the subject area. I am impressed by your knowledge and understanding of the HIV prevention programmes applicable to this cohort and how most of them have been affected by the USAID funding cuts. However, consider reviewing and indicating the relevance of information about low condom use in the United States and Portugal, I do get that you wanted to present a global outlook of the issue but do these countries have the same high rates of HIV incidents as South Africa, could it be that university students there are not using condoms because HIV is not an issue, I know of such sentiments in Australia, where no one even thinks about HIV, and condoms are used for other purposes and not solely to prevent HIV infections. This is just a thought, see whether it is relevant. You can also consider adding a section to your introduction where you discuss the theoretical framework and how it has influenced your study.

Response: Thank you for pointing this out. We agree with the comment and have removed information about condom use in the USA and Portugal, as the risk environments are not comparable. We have compared the systematic review with other young people who attend technical colleges in South Africa. Page 2, lines 59 to 60.

Comment: The rationale and justification of the study are adequately captured; however, you can add more value by also indicating the research questions at the end of your introduction, which will then nicely lead to the materials and methods section.

Response: Thank you for pointing this out. We agree with the comment and have included the research question in the introduction. Page 3, lines 97 to 98.

Comment: Your methodology section is well-written and provides an adequate description of the procedures followed in conducting the study. However, there are some instances where you tend to miss the opportunity to elaborate and rationalise the choices made, e.g, what influenced the inclusion of studies from 2015 to 2025, besides it being a 10-year period, what is significant about this period as far as the topic under investigation is concerned.

Response: Thank you for pointing this out. We agree with the comment and have included the rationale of procedures in the methodology. Lines 113-115. Page 3

Comment: Whilst the inclusion and exclusion criteria are well explained and justified, I think it is a limitation that you did not include grey literature such as dissertations and institutional reports, as such usually provide extremely valuable information. Kindly mention this in your limitations section at the end of the manuscript.

Response: Thank you for pointing this out. We agree with the comment and added the exclusion of grey literature from theses and dissertations as a limitation. Page 13, lines 450 to 451.

Comment: Explain what was in the data extraction chart developed by the researchers, and what specific information this chart sheet was capturing. I feel that you need to include more information on the results of your search, how many articles were identified, how many were excluded, and why they were excluded (NB: reading further, this information seems to be captured in the findings section; however, I feel that it should be presented in the materials and methods section).

Response: Thank you for pointing this out. We agree with the comment. We have included information that was extracted using the data extraction tool. Lines 131 to 133, page 3. We have also included a summary of the decision process in the methods section. Page 3, lines 136 to 138.

Comment: You should provide more information on 2.2. How exactly did you identify the participants to be selected for the study? How and with whom did you negotiate entry? Whilst your exclusion criteria are clear, more information should be provided on your inclusion criteria.

Response: Thank you for pointing this out. We agree with the comment. We have described how students were recruited, and we have noted the gatekeeper as the acting director of post-graduate studies, and indicated that the students were recruited through university campus settings such as student health services. We have also expanded the inclusion criteria noting that we included those who were willing, spoke English, were available during data collection and could speak English or isiXhosa. Line 154 to 164, page 4.

Comment: Whilst your methodology section has good and relevant information, it seems to be too brief and does not adequately elaborate on the methods followed in the study. Please ensure that the following are included in this section: research approach, type of research, research design, population, sampling, method of data collection, method of data analysis, ways of improving the quality of collected data, and ethical considerations. Although you provided some information on these, it is, however, too brief and does not paint a clearer picture. Kindly consider expanding on these issues stated, especially in the data analysis section.

Response: Thank you for pointing this out. We agree with the comment. We have included the study design, the sampling and recruitment method, and the population. We have also described how data was collected through individual interviews and expanded on the data analysis process. Page 4, lines 151-172, then 183-189

Comment: As you rightly noted that this was a very sensitive study. As such, you should provide more information on the ethical considerations. Information provided in 2.3 is too generic and does not reflect deep ethical considerations for such a sensitive study.

Response: Thank you for pointing this out. We agree with the comment. We have detailed how interviews were conducted at the campus health facility in a private space and how we assured participants that confidentiality will be maintained. Page 4, lines 177 to 179.

Comment: Results: As per my comment above, some information in this section could have been in the methodology section. In this section, please consider only presenting the results/findings. For example, the information on pages 4-5 (lines 155-189) could have been better placed under the methodology section. This is just an observation and suggestion; see whether you agree or not. If you feel it is better paced here, it is also okay. Other than that, your results section is solid and well captured, well done. I am impressed by the verbatim from participants, which provides very clear and relevant views from the participants.

Response: Thank you for pointing this out. Some of the information has been included in the methodology as earlier indicated. However, we have also left the information here to align with the PRISMA-SCR reporting guidelines.

Comment: Your discussion section is solid and well presented. I am impressed with how you managed to integrate information from the scoping review with information from the participants and further supported it with literature sources. What also makes this section stronger is that it paints a global and regional perspective on the issue, well done. However, what is missing in this section is the influence of your theoretical framework; maybe this is because your introduction section did not provide a solid theoretical framework for the study. May you kindly revisit this issue? It will further strengthen your discussion and implications section. Other than that, the discussion section is well thought out and well written. Keep up the good work.

Response: Thank you for pointing this out. We agree with the comment and have included the theoretical framework as discussed in the introduction has also been discussed throughout the discussion section. Page 13.

Comment: Your conclusion section has all the relevant information; however, I feel that you need to revisit and restructure it so that you can clearly articulate and elaborate on the issues indicated therein. To do so, consider adding the following subheadings to your conclusion section:

Conclusion – here you provide your traditional conclusion, like what you have done

5.1. Significance and implications of the study - here you explain why this study is significant and to which field of practice, you can also identify the different roles to be played by different professionals and practitioners to illuminate the significance of the study to practice. You can also further indicate its significance to policy.

5.2. Limitations – here you indicate the limitations of the study, both of the scoping review and of the interviews. It is good that you have already identified some of the limitations. In addition to the limitations already identified, kindly identify more, e.g, the exclusion of grey literature, the sensitivity of the topic might have led to socially desirable responses. The study was conducted in only two provinces, which might not be a reflection of the university students in the universities in other provinces, etc.

5.3. Recommendations – It is good that you have already provided some recommendations; consider expanding the points and identifying more recommendations. You can also use the information in the limitations section to identify recommendations for further research.

Response: Thank you for pointing this out. We agree with the comment, and we have restructured the conclusion to include the three sections: 1. significance, 2. limitations, and 3. recommendations. The recommendations have also been expanded so that limitations are addressed. The significance to health care professionals has also been articulated, and the limitations have included the issue of grey literature and the small sample size from the individual interviews. Page 14.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the manuscript "Human Immunodeficiency Virus (HIV) Prevention Practices Among South African University Students: A Scoping Review".

This study is a review that seeks to understand HIV prevention practices among university students in South Africa. It shows that, although students have knowledge about prevention methods, the adoption of actions such as HIV testing and condom use is still low, influenced by factors such as stigma, lack of access to adequate preventive methods, and risk perceptions. Although the study identifies and highlights important and coherent points, there are two considerations to make for the authors (or the opportunity to see their stance):

1) The search was conducted in three databases (PubMed, Scopus, and Google Scholar), in addition to a manual search for references. This scope may limit the inclusion of relevant studies, especially gray literature (institutional reports, studies by public agencies, and non-indexed theses) and other databases (Web of Science, SocINDEX, and CINAHL). The exclusion of this literature reduces the potential for a more comprehensive and up-to-date view of the topic.

2) There are restrictive inclusion criteria. The exclusion of studies that were not in English and of systematic reviews that included contexts beyond South Africa may introduce selection bias. However, such restrictions may limit the understanding of the regional context. Although the justification for the language to avoid translation is understood, the evaluation of studies published in African languages can present relevant findings for the scope review.

Considering the two points, I believe it would be intriguing to expand the data search. In this way, I request an adjustment in the data search and, consequently, the necessary implementation in the manuscript, or that the authors justify in the text the absence of the development of the search considering such points.

Author Response

Thank you for the opportunity to review the manuscript "Human Immunodeficiency Virus (HIV) Prevention Practices Among South African University Students: A Scoping Review".

Response: Thank you for pointing this out. We agree with the comment and expanded the data search. This was effected by including two additional database searches, which include OVID and Web of Science. We have updated the search strategy accordingly, as indicated in Supplementary Files A, B, and C, and made changes to the results, which included an additional article and adjustments to the decision process and summary of findings. Pages 6 to 10.

Response: Thank you for pointing this out. We agree with the comment. We acknowledge the restrictive inclusion criteria, which exclude grey literature and systematic reviews that include other African countries, and this has been included in the limitations. Page 14, lines 506 to 507.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

After the modifications, the manuscript "Human Immunodeficiency Virus (HIV) Prevention Practices Among South African University Students: A Scoping Review" (Manuscript ID youth-3807588) turned out very well. Congratulations to the authors! I recommend the publication of this manuscript in Youth.