Reviewer’s report
Title: KNOWLEDGE AND EXPERIENCE OF A COHORT OF HIV-POSITIVE AND 
HIVNEGATIVE GHANAIAN WOMEN AFTER UNDERGOING HUMAN PAPILLOMAVIRUS
AND CERVICAL CANCER SCREENING
Version: 1 Date: 04 Jun 2019
Reviewer: Laura Marlow
Reviewer's report:
The authors have done a good job of incorporating additional context into the background and 
clarifying the methods used. They have also made a number of edits to the results section to make the 
presentation clearer. As a result I feel most of my comments have been addressed and the manuscript 
has greatly improved. There were three points that I had made which the authors requested me to 
explain further. I have done this below and added two additional points.
1.I find the section on 'loss to follow-up' in the introduction a bit irrelevant in relation to the study  
context. The sentence refers to loss to follow-up as a problem in established screening 
programmes and provides a reference that reviews studies from high-income countries, many 
with national screening programmes that send results to women via the post inviting them to 
return, or telephoning them with their results. In addition, since the aim of the study is to 
"inform the development of effective screening messages, improve information provided to 
women around screening and evaluate whether women living with HIV have different 
information needs" and 'loss to follow-up' is not part of what you are exploring, I think you can 
drop this section.
2.I had asked the authors to clarify whether women were discussing their past experiences of 
cervical screening (i.e. before taking part in the "parent" study and presumably using VIA) 
and/or what test they were referring to when they were discussing their experience. If all of the 
discussions are about experience with screening in the context of the parent-study, perhaps the 
title (or abstract) could say "Knowledge and experience of participating in an HPV and cervical 
cancer screening trial"
3.I had asked the authors to make clear that the lack of significant differences might not be the 
case if a representative sample of HIV positive and negative women were recruited. The authors  
have asked me to clarify. I understand that the study "did not seek to investigate knowledge of 
screening in the general population", but this needs to be acknowledged as a limitation and the 
meaning it has for how the results are interpreted should be considered. Though there were no 
differences between HIV-positive and HIV-negative women, these women had all been 
recruited as part of a larger study and therefore had additional contact with health 
professionals/researchers and been provided with additional information as part of participating 
in the parent-study. It is therefore possible (maybe even likely) that the findings in relation to 
HPV knowledge and screening experiences do not represent women across Ghana and that 
differences between HIV positive and negative women may need to be explored further, beyond  
the context of trial participation.
4.I had suggested removing "to highlight similarities and differences" because I did not feel this 
was appropriate and the asked that I explain why. At the moment the authors say "Findings from  
both quantitative and qualitative aspects are presented together to highlight similarities and 
differences", This suggests that the findings have been synthesized, however they haven't really 
done this, rather they simply report the quantitative data followed by the qualitative data. This is  
fine, but means that saying they have "highlighted similarities and differences between the 
qualitative and quantitative findings" doesn't really represent what has been done.
5.One of the newly added sentences is a bit difficult to follow, could the authors re-word it: "Both  
Papanicolaou smears and VIA are available in public and private health clinics apart from the 
screening program, on request, and at cost to the patient since the national health insurance does  
not cover it
Typo: "none have investigated the experience of women receiving screening"
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.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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