Title: Patient perspectives on delays in cervical cancer screening and follow-up care in
Botswana: A mixed methods study
Version: 2 Date: 09 Apr 2022
Reviewer:  Sandra Y. Oketch
Reviewer's report:
Overall the manuscript is well written though needs some minor revisions from the comments
below. There is also need for thorough formatting and editing of the manuscript. In future, you
could consider a page layout that has line numbers and not just the page numbers for easier
referencing of the reviewer while providing reviewer comments.
A. Abstract:
Methods - Include sample size description and clearly specify the qualitative research methods
used. Was there a method to determine saturation?
Results – Check on your abbreviation for women living with HIV currently written an (LWH).
Please specify the interviews --- whether IDIs, KII etc. in the section that reads ‘In interviews,
participants expressed limited awareness of needing to be screened prior to symptoms’ on page 2
B. Methods:
Please give a description of the sample size and sampling procedures for both the quantitative
and qualitative methods.
Is there a published protocol or article that provides a description of this larger study? That is
the larger clinical cohort study that you have mentioned on page 5. If available, please provide
a reference.
Please give a further description of the statement ‘cancer diagnosis (appraisal, help-seeking, and
diagnostic phases)’ on page 5 and provide a reference.
Under the eligibility and recruitment section on page 6:
a. Please provide a description of the ‘eligible patients’
b. Indicate the full name for PMH the first time you use the word
c. Rephrase this statement to make it more understandable. Does it mean that women experience
long wait times before being seen by a clinician due to the mentioned factors including the MDT
meetings every day? Make this statement more understandable
‘Patients do not have scheduled appointments but are rather seen based on when they arrive;
thus, many women come early and wait in the designated waiting room. As is customary to this
setting, the clinic usually begins with a short hymn and prayer followed by discussion of any
cancer-related topics, led by the clinical research manager (MM).
d. Clarify this statement – ‘During this discussion, the research coordinator introduced the
study and reviewed the charts for eligibility for any women who expressed interest in being
interviewed’. – Is this MDT discussion or discussion with patients – this is not clear.
It is not clear whether a written or verbal or both consent was provided. The last section on
eligibility
and recruitment mentions verbal consent provided while the first statement under data collection
mentions written consent is provided. Please clarify this.
Under the data collection section on page 6. Please specify the qualitative research method
instead of ‘audio-recorded semi-structured qualitative interview’.
Under the qualitative interview section on page 8.  Provide some brief description and a reference
for the statement – ‘Guided by the domains across the Model of Pathways to Treatment’
The statement under the patient and public involvement section on page 9 is not clear. Please
revise.
C. Results:
The statistical analysis methodology not clear and does not depict what used.
What bivariate test was used? Did you mean bivariate logistic regression? There is no table
corresponding to the bivariate analysis e.g. When using bivariate log regression, we could expect
see the crude odds ratio or odds ratio and 95% confidence interval.
Below statement form page 12 is not clear ‘For many women, like these two participants, this
fear stemmed from both general avoidance of care and concerns of treatment itself’. Does this
mean concern to treatment or provider/ health facility attitude? It seems to mean the latter from
the quotations given
This illustration on page 12 does not depict fear or concern “Sometimes we tend to
brush off some issues. We delay [screening] and only become alert when the signs start
showing.” (Late-50s, PLWH)
D. Discussions:
Under the Limitations  section. The sample size and procedures not indicated in the texts apart
from the sample size of 42 interviewed stated in the results and the tables. This seems like a very
small sample size therefore could be stated as a limitation.
E. Comments from the filled COREQ (COnsolidated criteria for REporting Qualitative research)
Checklist
I realize some discrepancy from what is filled out in the COREQ against what is actually there
in the manuscript. Some items filled out in the checklist are actually missing in the manuscript
while some were captured in the manuscript but the page numbers provided in the checklist do
not match. Please see below and revise accordingly.
The missing items are 10,11,12, 17,22, 24, 27 (the qualitative software not indicated or whether
manual not stated), 29 (revise the page numbers accordingly), 30,31,32.