Reviewer ’s report  
 
Title:  Understanding women's motivat ions to participate in MTN -003/VOICE, a Phase IIb HIV 
prevention trial with low adherence  
 
Version: 0 Date: 01 Oct 2018 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER COMMENTS: To view the full report from the academic peer reviewer, 
please see the attached file.  
 
 
REVIEWER COMMENTS FROM REPORT: This is a well written p aper which contextualizes 
and summarizes among other things, participants reasons for joining and remaining in a study 
trial. The authors have provided a fairly good background to the issue. Although the authors 
could do well to include relevant literature  in the field to back up and support some of their 
arguments. Overall though, the paper provides important information to add to the existing body 
of literature.  
 
 
REQUESTED REVISIONS:  
 
The author could talk about how future trials could be tailored for pa rticipants to understand the 
reasons for participating in studies and how participants own motivations to joint trials can align 
with priorities of researchers. The authors should also note that participants motivation to join a 
study trail can be informed  by local socio -cultural norms.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
General comment: Please ensure that the revised manuscript does not exceed the allowable word 
limit.  
 
Introduction:  My suggestion to the authors is to revise the introduction section by in cluding 
similar literature to the VOICE trial in sub Saharan Africa. This will provide useful background 
on the topic and orient the audience on the subject matter. Further, providing a short context on 
patterns of nonadherence and participants' misreporti ng adherence from VOICE -D would 
strengthen the argument the authors are trying to make in their findings.  
 
Methods: Other than using nicknames rather than participant's names to protect confidentiality, 
can the authors explain other measures taken to ensur e participants confidentiality was 
maintained. Also, the authors state that the study was reviewed by RTI IRB and by the regulatory 
infrastructure of the U.S. 107 National Institutes of Health and the Microbicide Trials Network 
(MTN). The point however is,  was the protocol subjected to review by local ethics research 
ethics committees? If this was not the case what was the reason behind the decision.  
 
Also, can the authors clarify the step by step process of data analysis? In some respect, the 
description o f the analysis process described falls short of the rigor required for qualitative 
analysis.  
 
 
Results:  
 
General comment:  The results are presented well however the authors should explain their 
measure of SES used in the study. The readers would also bene fit to know what SES is in full. 
Similarly, women in VOICE -D commonly reported that they participated in VOICE to receive 
personal health benefits. My question therefore is, how do the authors explain desire for HIV 
testing  in the trail vis -à-vis the alre ady high HIV testing rates for women in Uganda. How 
common did these women report prior HIV testing? Were women responses subjected to further 
probing on why they  preferred to get tested at the study facilities over testing at public sector 
facilities whi ch also provide HIV testing at no cost?  
 
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 controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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.  
 
Not relevant to this manuscript  
 
Quality 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 n ow 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 received 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 y ou 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these r eviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for review s such as this are paid regardless of the reviewer 
recommendation.  
 
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