Reviewer ’s report  
Title: Low Uptake Of Cervical Cancer Screening Amo ng HIV Positive Women In Gondar 
University Referral Hospital, Northwest Ethiopia: Cross -sectional study  
 
Version: 0 Date: 05 Feb 2017  
 
Revi ewer: Jean Anderson  
 
Reviewer's report:  
This paper addresses an important issue -cervical cancer screening in the setting of HIV infection. 
The sample size, although obtained in only one month,  is quite large. however, i have several 
concerns outlined below:  
 
Minor comments:  
1. The background should be tightened up significantly. there is a fair amount of redundancy and 
should be more focused. the key points to make are: burden of cervical cancer in less 
developed regions; cervical cancer burden in Ethiopia;  inter-relationship between HIV and 
cervical cancer; and the role of screening.  
2. paragraph 2 on page 4 of the manuscript is a little misleading. the issue is not early detection 
of cervical cancer but detection when it is in a pre invasive stage and the  fact that fortunately 
cervical cancer generally has a very prolonged  pre invasive stage.  
3. Methods: p. 5, line 17: what is GC? line 27 -what is 5th interval?  
4. Table 1: what is the difference between someone who is classified as a housewife and those 
classified as "not employed"?  
5. Figure 1 -not necessary  
 
Major comments:  
1. Methods: no information is given as to whether there has been any education given to e ither 
providers or patients about cervical cancer screening; who does the screening and how often is 
this offered? is it free? do women have to ask for screening or is it routinely offered ?  
2.  primary outcome, the lifetime uptake of cervical cancer scree ning, is low at 10%. however, 
since screening has only been offered since 2013, this is not surprising or particularly 
noteworthy. furthermore, it is not clear whether this service is offered on a regular daily basis 
or less frequently, so that women could  easily have been missed. were providers possibly 
more likely to offer screening to women with lower CD4 counts or those who had been 
infected longer?  
3. Age also appeared to be significantly associated with screening, but is not commented upon. 
Clinical s tage was evidently not included in the analysis?  
4. awareness of screening: was this associated with education, age or other sociodemographic 
variable captured?  
5 the conclusion regarding need for demand creation, while likely true from low rate of 
awarene ss; however, the low screening rate may well be more related to lack of access to 
screening. the recommendation for integration into routine care and treatment is appropriate  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comm ents to the authors.  
No 
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 no t, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what asp ects require further 
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Not suitable for publication unless exten sively edited  
Declaration of competing interests  
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3. Do you hold or are you currently applying for any patents  relating to the content of the 
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4. Have you received reimbursements, fees, funding, or salary from an organization that 
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