Title: Women’s perspectives on the acceptability and feasibility of an HPV screen-and- treat
approach to cervical cancer prevention in Iquitos, Peru: a qualitative study
Version: 2 Date: 23 Jun 2022
Reviewer:  John Chapola
Reviewer's report:
Thank you for submitting your paper entitled “Women’s perspectives on the acceptability and
feasibility of an HPV screen-and-treat approach to cervical cancer prevention in Iquitos, Peru:
a qualitative study. I have reviewed the manuscripts and find below my comments.
General comments
The manuscript is addressing an important issue related to HPV screen-and-treat approach to
cervical cancer prevention. Overall, the paper is technically sound, the analysis is of the data and
the methodology has been described really well. However, I do feel some of the claims made
by the authors have not been substantiated with the data which raises questions on whether the
statements made were from the study participants or they were the authors own opinion based
on their interpretation of what the study participants were saying. The author also introduced
new information in the results and discussions sections with no proper explanation on how they
arrived at that information, explained in the methodology section.
Abstract:
• Conclusion: The authors stated that the nearly all participants emphasized that any pain
experienced during the TVT-TA “Was worth it” yet there is no data (quotes) to support that.
There are many quotes talking about the relief women had after receiving treatment knowing
that most of them had oscillating emotions when they received their positive HPV results but
none about whether women felt it was worth it or not. I wonder if the interviewer asked this
question to the participants. There is need for data to support the “was worth it” claim.
Background
• 2nd paragraph: Line 52-53, the author claims that “in many LMIC’s data from the multiple
step follow-up process are not available”. I believe that is a strong statement, I recommend the
author review latest literature on multiple step follow-up process in LMIC, there are several new
publications in sub saran Africa with information about that.
• 6th paragraph: Line 103, the author states that “to the best of their knowledge, no qualitative
data exist describing women’s perceptions, the emotional process or pain associated with a
screen-and-treat procedure using HPV testing and ablative therapy treated conducted at primary-
level. Similar to the comment above I recommend the authors review latest literature, there is
some work that was done in LMIC’s particularly in sub-Saharan Africa about the same.
Methodology.
• Setting: The author did not state when this study was conducted, which year? (particularly
between year A-Year B, or Year A, month A-B)
• Participant selection and procedures: Since purposive sampling was used to select eligible
participants for the study, I would start with that sentence i.e. “we purposively recruited” to
highlight that that’s the sampling technique that was used.
Data collection
• There is no mention of data management. How was the qualitative data managed from
collection to storage? What ethical principles were followed?
• Data Analysis: Describe how the coding was done. Describe the extent to which the 2 different
researchers agreed on how to code the same content (Intercoder reliability percentage)
Results
• There is not much demographic information about the study participants which makes it hard
to picture the women who were interviewed. Apart from age it would have been better to see
“marital status, education and total life partners”.
• Overall at the end of the quotes it could be better to include the age and education (if
possible). Responses may defer based on educational levels and age. It brings more context to
the participant responses.
Physical experience:
• First paragraph, Line 168: There is a need to distinguish between when the quantitative and
qualitative data was collected about the physical experience during, immediately after and
six weeks after the TVT-TA. How the quantitative data was used has been elaborated in the
methodology (the use of visual analog pain scale), but I think it’s mixed up a little which comes
out as confusing somehow.
• Line 193-194: the author states that women were told that the procedure would be painful even
though it was new. The author then says that “it is possible that they had been told a different
procedure”. I am interested to know how the authors arrived at that conclusion if this information
was coming from an obstetrician. The quotes that follow do not suggest that nor do they capture
participants describing a different procedure.
• Line-209-220: The author has provided many summative results with no quotes to support the
statements except for lines 215-220. This needs to be reworked and data supporting the claims
should be provided.
Reflections on the process:
• Line 303: The author states that the participants thought “the treatment process was worth it”.
Similar to the comment raised in the abstract, I would like to know how the authors arrived at
this conclusion. There are no quotes or data backing this assertion.
• Line 315: I think the word “pleased” would fit better than satisfied.
Discussion.
• Line 380: The authors statement that the participants described the treatment process as worth
it is questionable since we don’t have data supporting that.
• Line 390: the author has introduced percentages of adverse effects related to TA (30.6% for
moderate pain and 8.3% for severe pain). Where are these figures coming from? It would be
better if they were shown in the results section and procedure used to collect this data plus the
analysis described in the methods section. Here it comes off as something new. I assume these
are from the visual analog pain scale.
• Line 391-392: are there any references to studies that have looked at providers perspectives of
women’s pain? Otherwise this looks like a sweeping statement.
• Line 411-413: if this was one of the objectives of the study (to refine and update the pre-TVT-
TA counselling and post TVT-TA advice through triangulation) then it should also be introduced
in the background. Otherwise it comes off as something new here. What we gather is that the
study is looking at acceptability and feasibility of the program.
Limitation:
• Line 441-443: I feel the statement about coding and data analysis should also be described well
in the methods section. In the methodology it wasn’t clearly described as to how many people
analyzed the data and the intercoder reliability.
• Line:448-450. The author should clearly explain how they used the visual analog pain scale to
give the readers a clear picture on how they arrived at some of their conclusions.