Title: Prevalence of high-risk Human papillomavirus infections and associated factors among
women living with HIV in Shashemene town public health facilities, Southern Ethiopia
Version: 4 Date: 24 Oct 2022
Reviewer:  Gemechu Kejela
Reviewer's report:
The authors studied “Prevalence of high-risk Human papillomavirus infections and associated
factors among women living with HIV in Shashemene town public health facility, Southern
Ethiopia”. They tried to study the problem among high The topic is timely and has a great
contribution for the attainment of sustainable development goals of reducing maternal mortality.
The authors need to address the following comments and work on grammatical and typo issues
before the acceptance of the manuscript. In addition, they have to separate list of tables and lists
of figures from the main manuscript and submit as an independent document.
My comments are as follows;
Title
• You used different health facilities. So, please change to ‘facilities’.
Abstract:
• Method: include the year to the study period.
• HPV=Do not use the abbreviation in the abstract.
Background
• Paragraph 7: “WLWH” Use the full form at first.
• Paragraph 7: ……..”So far no studies have been carried out with the specific aim of
investigating the prevalence and predictors of Hr HPV in the study area”. There are many studies
in every corners of the country. So, you have to have strong justification on why you conducted
the study.
Methods
• Unser ‘Study setting and population’,  …………….., 250 Km from Addis Ababa, from
February 1 to March 30, 2022”. Mot Rephrase it.
• ………...(Shashemene town population statistics ). Put the citation in number (as in
introduction).
• I am unable to understand the importance of the diagraph under this subtitle. Please either
remove it, or convince us with its importance.
Sample size calculation:
• Authors should clearly indicate why they used prevalence of 50%, despite many studies in the
country and other countries with similar setting with Ethiopia.
• “All public Health facilities currently providing HPV testing in the town namely Shashemene
comprehensive specialized Hospital (SCSH), Melka Oda General Hospital (MOGH), and
Abosto health center (Hc) were selected”. They are not selected. Rather, they are simply taken.
• Under data collection tools and procedures, the sentence: “The questionnaire was first prepared
in English and the translated to  Afan Oromo and Amharic language by two independent
translators who are health professionals and can speak both Afan Oromo and Amharic
language(local language of the study area) by two independent translators who are health
professionals and can speak both languages”.  Not clear. The authors need to rephrase this.
• Under variable measurement, “Our iIndependent variables include; age (15-24, 25-34, 35-44
and # 44 years), ethnicity (Oromo, Amhara, others (Wolayita, Tigre)), religion (Muslim,
Orthodox, Protestant, others(Catholic)), Educational status(illiterate, only reading and writing,
primary school, secondary school, and college and above)), marital status (married, widowed
and others (single, divorced)), residence (urban, and rural), occupation (government employee,
house wife, merchants and others (farmer, daily labourer)), husband’s educational level (no
formal education, primary school, secondary school, and college and above)), husband’s
occupation (farmer, merchant, drive, daily labourer and government employee), ever heard
about cervical cancer screening, source of information (health professional, TV/Radio and
neighbors), previous history of CC screening, type of screening (VIA and others (pap smear,
HPV screening)), history of chronic disease (hypertension, diabetes), history of STI, years of
ART Attendance (<2 years and > 2 years), previous change of ART regimen, baseline and end-
line CD4 count (<200cell/mm3 and > 200cell/mm3), baseline and end-line HIV viral-load (<
50 copies/ml and > 50 copies/ml), WHO clinical stage (stage 1 and others (stage 2, 3, and 4)),
cigarette smoking, drinking alcoholic drinks (beer, wine and alcohols), chewing chat, taking
any other drug (other than cigarettes, alcohol or khat), number of birth (<1, and >1), age at
first sexual intercourse (<18 years and > 18 years), number of life time sexual partner (1 and
>1), number of her husband’s life time sexual partner (1 and >1), use of modern contraceptive
methods and history of abortion” I do not think listing all these are important. Please indicate
how you measured some vague variable/s (if any).
• Variable measurement and operational definitions talks the same thing. Please use one of the
two.
Result
• Under ‘socio-demographic characteristics, the word ‘concerning’ is abused. Please use another
word/s
• There is nothing about ‘in come’ in the table. But the authors said ….’middle income…’ and
indicated table 1.
Table 1
• The percentage of ‘others’ for ethnicity is large. It should not exceed 5%.
• Under religion, the category ‘others’ indicates only catholic. So, please replace ‘others’ with
Catholic.
• Under ‘awareness and clinical factors of the women’, …..”Among study participants, 66 (16.3
%) women had cervical cancer screening before this study”. In method section, 486 women
were excluded because they are screened before. Here, you are saying 66 are screened before.
How you see this?
Table 2
• The denominator of the variable ‘sources of information’ should be 402 (those who heard). Not
the whole (406). However, a single respondent may have more than one sources of information.
Please check this again.
• Under ‘Behavioral, sexual and reproductive factors’, ……”any alcoholic drugs like IV drugs,
Shisha, and Hashish” are they alcoholic drugs?
Table 3
• Totally confusing. Please reconstruct it. Remove the variables with ‘0’ in the cell.
The number of ‘Figures’ are not correctly ordered.
Table 4
• Please remove p-value from the table. It is confusing. Not known whether it is p-value for
COR or AOR.
Discussion
• The discussion is too shallow. Please discuss all in detail.
• Discussion paragraph 3…………...” it is inconsistent with study conducted in Brazil [32]” is
it ‘consistent’? Or ‘inconsistent’?
• Discussion paragraph 5: ………………….” similar study conducted in the rural Eastern Cape
of South Africa, Denmark, and Brazil [20]”. Three studies with a single reference? The reference
you indicated is only for the first study (rural Eastern Cape of South Africa). Please cite the
left two studies.
Conclusion
• The last statement is part of a recommendation. Please take it to recommendation section.