Reviewer ’s report  
 
Title: Utilization of Contraception among Sexually Active HIV Positive Women Attending ART 
Clinic in University of Gondar Hospital: A Hospital based cross -sectional study  
 
 
Version: 0 Date: 29 Jun 2016  
 
 
Reviewer: Celso  Khosa  
 
 
Reviewer's report:  
 
 
This is a survey - cross sectional study assessing the u tilization of contraception and factors 
associated among sexually active HIV positive woman assisted in the ART clinic in University 
of Gondar Hospital in North West Ethiopia. A structured questionnaire (interviews) was 
performed to patients attending to t he clinic in January 8 -20, 2014. Descriptive and summary 
statistic employed and regression used to identify associations.  
 
Specific comments  
 
Title and abstract:  
 
1. No comments  
 
Introduction:  
 
1. Page 1, line 9: Reference?  
 
2. Page 1, line 44: Looks like the  sentence is starting in the middle, should be reformulated.  
 
3. Please consider describing the problem in a more systematic way, enumerating the 
studies in a way the reader can understand the relevance.  
 
Material and methods:  
 
1. Page 1, Setting, line 10 -11: Concerns with sampling method, there is the possibility of 
Selection bias, please discuss.  
 
2. Page 1, Setting, line 30: Although condom is a barrier contraceptive, from the patient 
perspective can be only a HIV transmission prevention method.  
 
3. Page 1, Participants: Sampling strategy is no clear:  Sampling method? Eligibility 
criteria? Definition of very sick patients?  
4. Page 1, Sampling: Please review sample size calculations, please provide enough details.  
 
5. Page 3, Eth ical consideration: I would expect a written informed consent or recorded 
verbal consent, provider were asking the patients to answer to the questionnaires, 
although less than minimal risk involved in this study I would document the consent in a 
one page f orm/recorded.  
 
Results  
 
1. Page 1, Sociodemographic characteristics, line 9 -17: I would expect some standardization 
how results are reported: number (%) vs # (%).  
 
2. Page 1; Reproductive related factors: I do not see a variable "Ever used contraception" 
this would enable to know the reason to stop. There is a need to better define "Side 
effect" as there are many wrong perception regarding contraceptives side effects.  
 
3. Page 1; Predictor of contraceptive utilization: follow standard for reporting regression 
analyses providing: R2, coefficients etc.  
 
Discussion  
 
1. Page 1, line 7 -18:The comparison with other studies consider that there might be different 
definitions of contraception utilization meaning that as we are comparing different 
parameters those differen ces are expected.  
 
2. Limitations: There should be more discussion about confounding variables and how this 
might have affected the associations: socioeconomically status and education etc.  
 
3. Discussion about internal validity of study having in mind the d esign, sampling and 
methods employed, the study was not designed to address the gaps in utilization of 
contraception, a mixed methodology would be more appropriate to expose other the gaps.  
 
Conclusion  
 
1. Not aligned with study objectives; please review.  
 
General comments:  
 
Review and edit language of manuscript.  
 
Concerns with external and internal validity.  
 
Are the methods appropriate and well described?  
If not, please specify what is  required in your comments 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.  
 
No 
 
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.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 now 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 futu re? 
 
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 you 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.  
 
I declare that I have no competing interests  
 
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