Title: HPV knowledge, screening barriers and facilitators, and sources of health information
among women living with HIV: perspectives from the DC community during the COVID-19
pandemic
Version: 1 Date: 22 Sep 2021
Reviewer's report:
This research adds relevant information about HPV and cervical cancer knowledge and
behaviour in the specific high risk group of women living with HIV. And it also investigates
ways of distribution of health information to this specific target group and how to improve
this. However, some sections in the manuscript can use some textual adjustments to make the
information flow better.
Abstract
- Lines 52-53: “Screening barriers also included decreased accessibility to cervical cancer
screenings, a novel issue caused by the Coronavirus 2019 (COVID-19) pandemic.”  Were there
no restrictions in accessibility before the pandemic? For example due to the distance to a health
center or for women without health insurance?
Background
- I would prefer if paragraph 6 (lines 108-122) would be written in a different order. So to start
with describing the two ‘similar’ studies and follow with why these do not provide sufficient
information to give insights into your area of interest. But try not to give away your specific
aim/research question until the last paragraph of the background.
- Lines 108-111: “We have not come across any other study that qualitatively explored the
knowledge of cervical cancer prevention methods and screening barriers and facilitators among
WLH in the Washington-Baltimore Metropolitan Area (WBMA); a topic that should be explored
further since WLH in the DC area have a higher incidence for cervical cancer (0.7 per 1000)
[5].”  Do you specifically need other studies among WLH in the WBMA or can other areas be
representative as well? Also, is this incidence specific for WLH in the WBMA or is it expected
to be increased for all WLH (in the USA/western countries)?
- In my opinion the background is a little long, can you try to shorten it and make it more to
the point?
Methods
- Were participants equally assigned to one focus group (so five or six per group) or were some
focus groups smaller or larger? Or did women participate in multiple focus group sessions?
Results
- Lines 184-185: “DC is divided into eight jurisdictions known as Wards (numbered 1-8).” For
me it would be more clear if you change the order of information here so that you first explain
the division into wards and which represent areas of interest and follow with the distribution
of participants.
- Can you add a table or figure which shows how often a certain answer was given per question?
This can help to quantify how often something was said/confirmed by the women.
Discussion
- Lines 277-282: “It was also unclear to our participants as to when a first Pap smear should
be initiated: some mentioned that it should be initiated upon a woman’s first menstrual cycle,
whereas the Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults
and Adolescents with HIV [23] currently recommends that Pap screening for WLH should
commence within one year of the onset of sexual activity regardless of the mode of HIV
transmission (e.g., sexual activity, perinatal exposure) but no later than age 21.” Please add the
recommendation to the background and add the recommendation for ‘healthy’ women.
- Lines 331-332: “… highly educated (over 80% had a high school diploma or higher) …” What
is your definition of highly educated?
Conclusion
- The study is on knowledge, barriers, facilitators, and sources of health information, but the
conclusion is mainly about sources of health information. Can you add a line to the conclusion
about the knowledge, barriers and facilitators results?