Title: Cervical cancer screening utilization and associated factors among women living with
HIV  in Ethiopia, 2024: systematic review and meta-analysis
Version: 1 Date: 31 Jul 2024
Reviewer's report:
General reflections
The authors picked a timely issue of public health importance. The finding of the study reflects
what was indicated in the objective. The methods is more or less clear.
I observed some editorial problems like misue of capital letters in the middle of a sentence etc.
Comments:
Title: I am doubtful about the availabilty of sufficient number of papers in the area in Ethiopia.
Was that not possible to broaden the geogrphical scope to east Africa or so so that you would
have many papers to include?
Abstract: In the background section, there is a clause saying..... 'Despite the availability of
screening services'......I am skeptical about the availability of cervical cancer screening  services
in all health facilities rendering HIV testing and treatment in Ethiopia.  Please revise this clause
as it might not be the reality.
In the method section of the abstract I suggest the authors to clearly and briefly mention about
the assumptions considered and different tests employed.
The conclusion of the abstract should emphasize on the key findings i.e., on the magnitude of
screening service uptake etc, than the magnitude of cervical cancer.
Introduction: Please try to clearly reflect the strategies curently in place by the ministry of health
of Ethiopia in addressing cervical cancer screening and if there are reports on the challenges
encountered to implementing it.
The objective in the last paragraph of introduction lacks coherence with the one ststed in the
abstract section.
Methods:
Summary of study setting i.e., HIV services with focus on HIV positive women should have
been somewhat descrribed.
I am looking for the a schematic presentation of how the papers were selected (i.e., for inclusion
and exclusion)
Operational defintion for terms like screening for cervical cancer, utilization of cervical cancer
screening etc.....are missing.
The number of papers fulfilled the inclusion criteria seems small.....please provide your
reflections.
I am skeptical about  the term prevalence which is often times employed in community settings
where denominators are given to compute. I suggest you to use the term proportion.
Your computations for publication bias and validity of the studies used were not well indicated.
Rather you were trying to reflect what the statisticians have been advising us to do. Please tell
us the values of your validity, publication bias and hetrogienity or  I2  test results.
Did you consider grey literature which could be available in the repository of universities and
yet could be quiet related to you area of study?
What was the reason for using random effect model? why not mixed effect one?
Results
PRISMA could have been reflected in the method section.
Discussion:
Please re-organize  the discussion section again because you repeated what was already reflected
in the results section.
Focus on the implication of the key findings as well.
Conclusion and recommendation
The key findings were reported like in you results section. Hence, please try to fuerther
summarize  or concluded the key lessons that warrant interventions .
Who should do what has to be clearly specified.