Title: Frequency of Human Papilomavirus and associated factors in gypsy and quilombola
women
Version: 2 Date: 11 Aug 2022
Reviewer's report:
The present manuscript is interesting on peer review. The study was carried out with a
quilombola and gipsy population, with recognized vulnerability. The authors have identified an
important research question and have tried to address it in a paper, which fits with the style of
the BMC Women’s Health. However, I have some concerns that are presented below, divided
in sections.
Title
It is concise, precise and informative.
Abstract
The abstract reflects the paper and describe the message succinctly and accurately. The
objectives described in the abstract match those in the paper.
Minor criticisms
# Page 2, Results section. The sentence (in lines 37 and 38) about the analysis needs to be rebuilt.
# Page 2, Conclusions section. As a suggestion, the statement “Due to limitations, the virus
lineages and sublineages were not evaluated” could be removed (lines 43 and 44).
Background (Introduction)
The size of this section is suitable, as well as the literature review, it states the question the
authors tried to answer in the study. However, the introduction does not follow a logical sequence
and it does not stablish clearly the relation between HPV and the cervical cancer. The first
paragraph tries to justify the proposed study, and it is quite repetitive. It also does not have
references. I suggest to reformulate it and use it before the objectives of the study (line 88, page
4).
Objective
The objectives are consistent with the study.
Methods
The methods section is not easy to understand, it does not describe how the authors obtained the
main results of the study. It seems to me it needs a review of the language.
Some concerns are presented below:
Major criticisms
# Page 5, paragraph 1. Did the study include adolescent women under 18? If it did, as stated
in line 100, has any social action been taken in order to protect these girls? Did they agree to
participate of the study and signed an informed consent, as well as their caregiver? This is a very
sensitive matter, especially because this is already a vulnerable group of women.
# Page 6, paragraph 1. The authors stablish a hypothesis that could not be addressed with the
collected data, as it did not include the general population.
# Page 6, paragraph 2 (lines 129-131). As the authors did not explain the variables used in
the study, it was not possible to understand the analysis. It is necessary, for each variable of
interest, to give sources of data and details of methods of assessment. Also, all the outcomes
and exposures need to be defined.
# Page 5, paragraph 3. Why the data collection was so long? How did covid-19 pandemic affect
the research? Could frequency of HPV be higher due to the pandemic and the lack of access
to public services?
Minor criticisms
# Page 4, lines 93-95. It is not necessary to explain a cross-sectional study.
# Page 4. As a suggestion, it would be interesting to describe more the setting (communities)
where the study was conducted, as they are mentioned widely in the results. Are the gipsy
communities close to the quilombola ones? Are both of them rural communities or urban ones?
# Page 5, paragraph 1. Regarding the sampling method, the population universe was called
“sample”. It is also not clear if the obtained sample size (n=145) assured an adequate power to
detect statistical significance.
# Page 5, lines 111-112 mention the informed consent, however, ethical procedures were written
in lines 134-135.
# Page 5, paragraph 3. How was the questionnaire built? Was it validated?
Results
The results section is very extensive and is not organized chronologically. It is probably the
section that needs more attention from the authors. Figures 1-2 and Tables 1-3 compose it. Some
major concerns are presented bellow:
Major criticisms
# This entire section needs to be reviewed by the authors. Some results are not described in the
methods section (for example, lines 155-166). Others have differences between the way it is
presented in the tables and in the text (for example, lines 152-154).
# The English translation compromised understanding. Sometimes the words in the tables are
in the original language.
# I was not able to find the numbers of individuals at each stage of study (numbers of potentially
eligible, examined for eligibility, confirmed eligible, missing data).
# Page 9. Table 3 shows a comparison among quilombola and gipsy populations, however, the
sample was not estimated for this purpose (and the obtained sample of gipsy women is too small).
# Page 11. Figure 2 shows a large number of unidentified HPV types. Why did this happen?
The authors mention that quilombola group had “a greater diversity of genotypes” while gipsy
group had “only 2 genotypes”. Is this fact due to the small sample of gipsy women?
Discussion
The discussion needs to be highly improved. It focuses more in the data of other authors, than
in the main results of the paper. Some major concerns are presented bellow:
Major criticisms
# Page 12, paragraph 1. Authors start this section with the found results from other study. As a
suggestion, this paragraph could summarise key results with reference to study objectives.
# Despite the study has been conducted during covid-19 pandemic, the authors did not mention
it. How could pandemic affect the prevalence of HPV infection? Could it affect differently
quilombola and gipsy women?
# The discussion about the HPV types does not explain the main differences among them and
the rationale for this report. It is not clear for the readers why this description is important.
# I could not find a discussion about the limitations of the study and sources of potential bias
or imprecision.
Conclusions
Main conclusions drawn are not backed up by the data.