Title: Prevalence of high-risk Human Papillomavirus infection and associated factors among
women of reproductive age attending a rural teaching hospital in Western Uganda
Version: 2 Date: 01 Jan 2023
Reviewer:  Emmanuel Ochola
Reviewer's report:
I thank the authors for this useful endeavor in an area of public health importance, with
possibility of  disease preventing interventions.
Major Concerns to be addressed
1.  Sample size and sampling: If the sample size determination was statistical, what was the
purpose of doing consecutive selection? Did you do a census study? Was there a screening drive
for which people were invited during the study period? This would introduce bias
2.  Associated factors: it is well known that the number of life time sexual partners may be a risk
factor for both HPV and HIV. Do you think there was confounding or interaction?
3. Recommendations seem to be restricted to the first objective, with little said related to
the associated factors found.. Please consider including recommendations like intensification
[maybe specific strategies] of screening among HIV postives, or in ART clinics, or prompts
from GYN clinics upon PV discharge.
4. Limitations section needs to bring out the implication of the stated limitations on the effect
measure.
Other concerns
5. Please improve the discussions by bringing out the implications of your findings for policy,
practice, research, so that recommendations can be derived. For now you focused more on the
comparative study than the meanings and explication of your findings.
6. Abstract:  Recommendations related to the vaccines available in Uganda should have been
discussed. As stated above, recommendations lack derivation from associated factors.
7. Background: remove 'first' from line 50- "...first most frequent..."
8. B/g: explicate the statement on line 62-63 "effectiveness of HPV treatment"
9. What was the reason for excluding virgins, yet they may make part of the GYN clinic?
Furthermore, there is evidence of congenital transmission of HPV
10. Sample size should be rounded to the next whole number- in your case, 217 and not 216.
11. Sampling technique- it's unclear why you preferred consecutive to probability methods.
Additionally,  the third sentence onwards seem misplaced.. on distancing, and variables
collected.
12. Diagnostics: it would be good to include the qualification of the laboratory scientists, or
status of laboratory accreditation.  Additionally, please provide the specificity and sensitivity
of the tests used.
13. You can delete "in text" before using a pie chart. A text explanation of every output is
expected.
14. Figures 1 and 2, it would be good to put both number and percentage in the labels./legend
15. Results: please cite table 1 in the characteristics of the study population. It would have been
good to have a frequency+ percentage.
16. Factors associated: you have used univariate and bivariate interchangeably [line 1 under
factors compared to table2]
17.  Table 1: the age disaggregation's are too many... consider re-categorising with larger
intervals. Additionally,  what is the relevance of the occupation, e.g. public vs private sector-
make it relevant to the study risk factors. You could combine formal employment, business, etc.
18: Discussions- from line 253
a. you can delete the statement "and we would not anticipate a very broad deviation" which
seems to be a repetition.
b. Your comparisons : is 16.7% "largely varying" from 21 or 10% as you portray it, I would
consider them similar or slightly more/less.
c. I propose that you break down the very long paragraph 2 under discussion [e.g. could start
another paragraph at "HIV seropositivity increases...]- and consider rewriting to remove some
redundant statements.
d. I would also recommend that you split the long section on associated factors, to have a
paragraph each on each associated factor, and explain better the implication, so that anybody
can derive a recommendation. You could break the paragraphs at : "Similarly, our results are
consistent with those reported in Brazil...", next split at "In disagreement with our findings...'
and last paragraph at: "Our findings on abnormal vaginal discharge..
19. Referencing: refine this to remain consistent- e.g. Ginindza et al 2017 vs, Naima T Joseph
et al, 2021)
20; Limitations- as above- relate them to the effect measure
21. Conclusions- good to make recommendations relating to all/some of the associated factors
as well. The recommendation related to "other high risk genotypes..." has not been discussed at
all, so it would be good to mention that under discussion before it appearing here.