Revie wer’s report  
 
Title: Factors associated with high -risk human papillomavirus test utilization and infection: a 
population -based study of uninsured and under insured women  
 
Version: 0 Date: 03 Jun 2018  
 
Reviewer: Margaret Cruickshank  
 
Reviewer's report:  
 
Factors associated with high risk HPV test utilisation and infection; a population -based study of 
uninsured and underinsured women  
The authors provide data on a large and relatively recent cohort of uninsured and underinsured 
women in a defin ed region which is well characterised in terms of ethnicity, place of birth and 
deprivation in relation to cervical cytology and hrHPV test uptake and results.  This has allowed 
them to perform multivariable logistic regression to estimate associations wit h uptake of test and 
results.  
There are several limitations as described by the authors.  This limits the implications of the 
findings and what it contributes to cervical screening and the programme.  
The current cervical screening guidelines cited in the abstract are not referenced.  For a 
population -based study, the population is not clearly defined so we do not know what the uptake 
of screening is or the difference between attenders and defaults.  Th e results appear to relate only 
to those who have attended screening and not the target population which may have been more 
useful in understanding how to improve uptake.  It also limits the generalisability and 
implications or HPV uptake and results since  these are derived from possibly a self -selected 
population or one which has been specifically targeted to increase uptake of screening. Perhaps 
more information on how the screening programme is run would help to put the results onto 
context.  For example , identification of the target population and how the programme organises 
call and recall and manages defaulters.  I suppose the aspect that I least understand is a 
programme where women can have cytology or a co -test.  Without this, I am unable to 
underst and uptake of HPV testing.  Does this rely on the women or the screening provider or 
smear taker?  Are there costs implications for choosing one or other strategy?  
Over  all, this read as a well and thoroughly conducted service evaluation where the results  9for 
example figure2) will be of importance to the programme and providers on improving uptake of 
screening.  
  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary con trols?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics  in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quali ty of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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