Reviewer's report
Title:Intimate partner violence among women with HIV infection in rural Uganda:
critical implications for policy and practice
Version: 1Date:28 April 2011
Reviewer: Joseph Ntaganira
Reviewer's report:
This is potentially an important manuscript which could influence efforts to
address IPV in HIV/AIDS services. However, several methodological issues need
to be addressed.
Minor revisions
A. Introduction
1. Second paragraph: although we have references [14-19], specific references
should be provided at the end of sentences:
– …which in turn contributes to their inability to protect themselves from HIV
infection [ ].
– …the behaviors promoted after testing positive increase risk of HIV acquisition
[ ].
– …and contraception to avoid unwanted pregnancy can trigger IPV [ ].
2. Third paragraph:
– Reference [18] does not correspond to the mentioned study. In addition the
study was community based while the intention is to insist on IPV screening in
HIV/AIDS services, in clinics/hospitals. The authors should provide references on
studies that have analyzed IPV among HIV clients in the clinic setting and
preferably in Uganda, first, and then in other neighboring countries.
– Provide information/evidence whether gender-based violence screening is
integrated or not in HIV prevention programs. Are there any studies conducted
among women attending PMTCT or VCT services in Uganda?
B. Results
1. 1st paragraph
– Table 1 shows two categories for age group of respondents: Provide reasons
for selecting 24 years as a cut-off point? Are the categories based on an
international definition?
– In the study, 6.9% were adolescent: what is your definition? It would be better
to mention that X participants were under Y age?
– 233 were married or cohabiting: the table shows that only 227 were currently
married! Also, split ever married into divorced and widows.
2. 2nd paragraph
– Table 2: title should change “Antiretroviral therapy” instead of “Drug therapy”.
Major revisions
A. Methods
1. Study design, participants and data collection procedure
Provide information on the selection process: What were the selection criteria?
Did you select all HIV+ women who attended your center during the study period
(317)? How many clients refused to participate in the study (proportion)? What is
the proportion of participants when compared to the total number of women who
attended the center during the study period?
2. Sample size
What is the basis of assuming that the prevalence of physical violence in the
study population is 28%? It is preferable to provide prevalence of physical
violence from studies conducted in Uganda instead of South Africa, Nigeria or
India. Usually, when the prevalence in the study population is unknown, p in the
sample size calculation is equal to 50%.
3. Ethical considerations
– IPV is a very sensitive topic. Provide details on the interviewers who conducted
the interviews, their qualification, training before the study…, and the issue of
confidentiality.
– How the issue of minor participants (under age 18?) was handled?
– Elaborate on the support provided to victims of IPV.
B. Results
1. 2nd paragraph
– Life time prevalence of IPV was reported by 36.6%: provide details on types of
physical violence and the respective proportions. This can allow comparison with
other studies (HIV + or – women, Uganda versus other countries).
– The mean duration of ARV therapy was 3.3 months, proof that they were quite
recently put on that treatment. However, 30.6% had already changed their
treatment regimen due essentially to side effects (58.8%). This information is
very important and should be discussed in the discussion section. Is this
generally observed? Particular to women? Type of first line regimen used in the
hospital?
– The section on psychosocial violence is not clear! What was the prevalence of
psychosocial violence in the study population?
2. Third paragraph
– Table 3: Age, religion of respondent, parity should be “categorical”. It is unclear
how a crude odds ratio was computed! For the bivariate analysis, it is a 2X2 table
where odds of one category are compared to odds of another group. In addition,
for the logistic regression, the reference group should be specified. For instance,
if a clear explanation is provided, age could be represented as in table 1: <24
versus >24.
– OR for “antiretroviral therapy” is >1 at both bivariate and multivariate levels.
This means that clients on ARVs are more likely to face IPV that those who are
not on treatment. The prevalence of IPV is apparently higher in participants on
treatment!! Your interpretation is totally different! This result seems very strange
unless you have an explanation. I would recommend to check the coding of this
variable.
3. Fourth paragraph
– Table 4: The title is confusing. What is the purpose of associating sexual, a
physical violence, with psychological violence? It would be more interesting to
consider “psychological violence” separately because “physical violence”
including sexual violence was analyzed in table 3?
– The same comments for age, religion of respondent, parity (see third
paragraph).
– Antiretroviral therapy: same comments as in table 2 (paragraph 3).
C. Discussion
– 1st Paragraph: “Our findings are in agreement with research…..”: this research
is a cross-sectional study for which the direction of causal relationships cannot
be determined. Therefore, it is difficult in this study to conclude that violent
partners put women at risk of HIV infection.
– Second paragraph: review the statement pertaining to antiretroviral therapy.
There is a positive association between ARV treatment and IPV.
– Third and fourth paragraph: the discussion is generally on predictors of IPV but
not specifically supported by findings from the study. What are the key results of
the research?
D. Conclusion
– Review the section with respect to ARV treatment.
– Provide limitations of the study and specific recommendations.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.