Reviewer’s report
Title: 
Challenges and opportunities associated with cervical cancer screening
programs in a low income, high HIV prevalence context
Version: 
1 
Date: 
16 Dec 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
N/A - there are no statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
An interesting study, driven by the ecological model. Proofreading is needed as
there are some grammatical errors.
REQUESTED REVISIONS: 
L26,P2 to Ls1-4, P3 - please add references to the statements made.
L9, p3 - add 'SSA', after Central Africa
L16 - L20, p3 - add references, and explain whether the previous studies used a
socio-ecological model to investigate the problem.
L3-4, p4, I would suggest to delete 'an indepth' from the sentence because the s-e
model is to discover factors at multilevel, not to investigate the issues in depth.
Also suggest to consider the term 'human interaction' and its use in the sentence -
interaction with what? 
In the same paragraph, the next sentence describes the goal of the study - 'explore
and describe multilevel behavioral and structural challenges and opportunities'.
This statement doesn't flow logically from the previous which stated 'human
interaction and these facilitate...". Also, how do we know before the study that
there are already opportunities and challenges that the research will identify? I
suggest to standardize the terms used in this paragraph. I think it would be
better-- 'the aim or goal' of the paper--not the 'study'.
The sampling selection - the 2-stage systematic approach is unusual for a
qualitative study. This approach is used for representation sampling in a
quantitative study. I am unsure why this approach is used when participants can
easily be recruited from the large pool with those who expressed interest to
participate. The reasons for a systematic sampling approach needs to be justified.
In addition, the authors need to specify if a purposive sampling approach is used
in recruitment.
The 8 individual interviews on top of the FCGs - why the additional IDIs?
How was informed consent obtained in this study? Explain what is '...complete
an informed consent process'? 
In the Measures section. Did the authors use the s-e model to develop/design the
questionnaire? Was the questionnaire adopted/adapted from a previous tool?
In the Data processing section. Do all the researchers involved understand the
local language before transcription of the interviews in stage 2 in particular?
This needs to be stated. What is the 'larger research team'? Did data saturation
occur and when did this happen through the FCGs and IDIs? What are
similarities within the findings between the FCG and IDI data?
In the analytical approach section. The first sentence needs elaboration, because
the next sentences described the analysis process, not the model used to structure
the findings. 
Results section onwards. Suggest to include a table to present the findings - this
will help the readers to quickly find out the findings of the study. There needs to
be more than 1 quote to describe the interpretation for 'Awareness and
knowledge' 
in L13-21, p11. Any interpretation provided should be reflected with
quote(s).
The authors might want to consider restructuring the findings into 2 broad
categories 'challenges' and 'opportunities' since this is the title. The challenges
and opportunities appeared only at the Discussion and should be earlier on the
paper since the goal is to describe these.
ADDITIONAL REQUESTS/SUGGESTIONS: 
The paper needs proofreading. The English is currently not at the scientific
publication level.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes