Title: Association between HIV serostatus and premalignant cervical lesions among women
attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda:
a comparative cross-sectional study
Version: 1 Date: 03 Jul 2023
Reviewer:  Sylvia Kusemererwa
Reviewer's report:
Thank you for the opportunity to review the article entitled: Association between HIV serostatus
and premalignant cervical lesions among women attending a cervical cancer screening clinic at
a tertiary care facility in southwestern Uganda: a comparative cross-sectional study. The topic
of interest is of public health importance as thoughts of integration are being put forward.
Background:
Line 73 to 108 would probably be better placed in the discussion as has been done
Line114 to 115, the term “scientific evidence” would probably be better used for an experimental
or systematic review study design.  The phrase “no study has been conducted in Uganda” may
provide a sense that information does not exist. There is some information available by sero-
status. The wording could be rephrased.
See references provided below:
Mutyaba T, Mirembe F, Sandin S, Weiderpass E. Evaluation of'see-see and treat'strategy and
role of HIV on cervical cancer prevention in Uganda. Reproductive health. 2010 Dec;7:1-9.
Namale G, Mayanja Y, Kamacooko O, Bagiire D, Ssali A, Seeley J, Newton R, Kamali A. Visual
inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study
highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical
lesions in Kampala, Uganda. Infectious agents and cancer. 2021 May 11;16(1):31.
Methods:
Line 136, what age group attends this clinic?
Line 138 to 142, what guidelines are being used? Please provide reference
Line 159, what is the inclusion and exclusion criteria for the study?
Line 166-168: What about abnormal glandular lesions? Were these put into consideration? Or
did the study only focus on squamous cell lesions? Please clarify and probably include as a
limitation if not considered.
Line 172- rephrase to socio-demographic
Line 182: what tests were used? What testing algorithm?
Line 184: Eligibility determination is a study procedure and usually done after informed consent
is obtained. Please clarify
Line 203: Please clarify the order of study procedures. Informed consent should be obtained
prior to conducting any study procedures. Part of the consent would include consent for pap
smears to be done. Or we these done as part of care?
Results:
Line 235-. Would be interesting to present overall data first then the details.
Line 245 to 246, probably review to sexual debut.
Line 253, table 1-What age group was eligible to participate? As indicated earlier, what was the
inclusion and exclusion criteria?
Level of education: Does this refer to complete primary/secondary education?
What is the definition for smoking status: Current, ever or never?
Line 270: Better to present positive results first.
Line 273- approximately 2.4 times instead of 2.3 times.
Table 3: Column for No PML could be replaced with overall information on characteristics
instead.
Discussion:
Line 291- is a repetition.
No study strengths have been mentioned.
Line 355, how were the study limitations dealt with?
Ethics:
Line 385- 387. Was study approved by the Uganda National Council for Science and
Technology?
Include reference numbers for the approvals
Line 388: Did the study include any experiments?
Line 389-390 can appear in the methods section.
Line 393: No formal education would not imply that one is illiterate. Individuals who are able
to read and write in their local languages would be considered literate.
Line 394:  Would need rephrasing. To indicate an impartial witness was present when consent
was being obtained from an illiterate participant.
Line 402-403:  What kind of care were those PML positive linked to and where? What happened
to those who tested HIV positive?