Reviewer's report
Title:Preventive health care among HIV-positive women in a Utah HIV/AIDS
clinic: A retrospective cohort study
Version:1Date:16 January 2014
Reviewer: Amanda E Tanner
Reviewer's report:
BMC Women’s Health Review
Preventive health care among HIV-positive women in a Utah HIV/AIDS clinic: A
retrospective cohort study
Thank you for the opportunity to review your manuscript, ‘Preventive health care
among HIV-positive women in a Utah HIV/AIDS clinic: A retrospective cohort
study’. The paper addresses an important and relevant topic – preventive health
services among HIV-positive women. However, there are some critical issues
(detailed below) that need to be addressed before the manuscript could be
published. The two most salient issues are: 1) the data are almost 5 years old so
the relevance of the information is questionable. Since it is from 2009, can you
then look at these women across time (or more recently) to see if the preventive
behaviors/services are the same and what are the differences in health
outcomes? and 2) the organization and presentation of the information makes
the manuscript difficult to navigate. I would recommend a major revision of the
information (especially the order and flow of the introduction and discussion),
including be careful and thoughtful about the assumptions (and stereotypes) you
are making about women being “perceived as high risk “(and define that in the
introduction not the discussion) and remove all ‘value’ words (e.g., however) in
the results.
Key words
•Fine
Abstract
•The order of background information could be changed
•Is this cross-sectional data?
•Remove the sentence beginning: “Women who might be perceived as…” this is
not part of your results
•Define what you mean by “perceived as highest risk” in conclusion
Background
•The organization of the information needs to be cleaned up and transitions
added
oFor instance: combine all the STI information and the barriers to care access
literature
oThe second paragraph seems out of place – consider incorporating some of
these
statistics into the 3rd section about women’s health needs
•Add/update the references from the first paragraph
•Unclear in goals how this study “elucidate their health needs”
Methods
•The methods suggests that the mammography and colorectal cancer screenings
were only considered for a subset of women – please provide the numbers in the
text and ensure that the % in the abstract and results reflect these numbers as
denominators
•You include the provision of contraceptives in methods but it isn’t mentioned
again – please include (especially types – tubal, hormonal, etc)
oThis could allow for a more interesting discussion of “provider bias” related to
HIV-positive women as mothers
•Analysis
oAppropriate
oPlease provide rationale for dichotomizing all the outcome variables
oDefine housing status in methods
Results
•Some of the analysis detail can be moved to the methods – help with cleaner
presentation of data
•Again remove the value words (e.g., however) – present results as statements
•Change “this was a high-risk group of women” to “The women had a variety of
contextual and behavioral risk factors, including…”
•Again make it clear that the mammography & colorectal cancer screening %
reflect the subset of women
oIn the discussion discuss how these percents are similar/different from
HIV-negative
women
•Change substance abuse and mental health “problems” to “issues”
•Provide numbers of women who were non-English speaker and provide more
details about who the other non-English, non-US citizen women are (e.g., where
are they from? Language to they speak?)
Discussion
•Move the second paragraph (In accordance with…) information to the
introduction
•Again be careful with assumptions you are perpetuating related to “women who
might be perceived as high risk”
oEspecially since you don’t include information/data from providers about how
they
make their treatment decisions
oThere is a literature around “provider bias” that you should look at
•Organization is a little off here too
oThe paragraph beginning “These findings may be due…” should not be a new
paragraph as it is directly referring to the information in the previous paragraph
oThe placement of the paragraph “The women including in this study are
clinically…”
seems out of place
•The strengths & limitations paragraph should be cleaned up
oSome clear strengths
oNeed to document and discuss implications of limitations more thoroughly (e.g.,
old
data, what the underestimation bias mean, what other changes may have taken
place besides paper to electronic records)
•More about future research needs
Tables
•Fine
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.