Reviewer’s report
Title: KNOWLEDGE AND EXPERIENCE OF A COHORT OF HIV-POSITIVE AND 
HIVNEGATIVE GHANAIAN WOMEN AFTER UNDERGOING HUMAN PAPILLOMAVIRUS
AND CERVICAL CANCER SCREENING
Version: 0 Date: 10 Aug 2018
Reviewer: John Luque
Reviewer's report:
This article reports the results of surveys and focus groups conducted with HIV positive and negative 
women in Ghana about knowledge and experience of HPV and cervical cancer screening. Overall, the 
article is well written and organized and provides some interesting findings about knowledge and 
attitudes of these women toward HPV and screening. My comments will follow the manuscript by 
section.
Background: The article would benefit from another paragraph about what is known about HPV 
knowledge in this population instead of simply stating there are few studies. Also, these few studies are  
not referenced.
Rather than "attendance of screening" the authors could write about "screening participation." The 
acronym WLHIV is not necessary to use, and the language should be adjusted to limit the number of 
acronyms used.
Methods: 
Study design and population: There should be a short section on the focus groups. Who organized and 
facilitated them? Why were only 2 groups chosen (HIV+ vs. HIV-)?
Quantitative methods: The cut-off of 50% for adequate knowledge on the 19-item knowledge scale 
should be further explained. In addition, in the table with the knowledge results, there should be 
information to detail which questions were in the counseling information and should have been known 
to participants. The knowledge results are not presented the same way as described in the Methods.
Qualitative methods: It was stated the participants did not know their HPV results, but was not stated if 
participants knew each other's HIV status in the focus groups.
Results:
The results with percentages were presented confusingly by having 2 percentages (by HIV status). It 
would be better to compare more precisely in the sentence structure, for example 86% (HIV+ group) 
compared to 85% (HIV- group).
Some more section headers, such as starting on page 11 to distinguish the introduction of the focus 
group results would help the organization of the Results.
The quote on Page 11, line 201, should be rephrased for comprehension.
Please delete the participant ID numbers, perhaps age of the woman could be used instead.
There were multivariate results mentioned, but no multivariate methods or results were presented. 
Please remove mention of multivariate results if more description and corresponding table is not 
provided.
Discussion:
There should be more context presented in this section in terms of trust in healthcare facilities, quality 
of laboratory facilities, and cervical cancer screening rates found in this study compared to national 
data for Ghana. Some of this background information might also be appropriately added to the 
Background section. These were mentioned in the Results, so some explanation in the Discussion are 
warranted.
The issue of stigma is raised, but it was unclear if HPV stigma was related to or simply a byproduct of 
HIV-related stigma. Was there any information to clear this up in the focus group discussions?
References:
There were at least 5 duplicate references. Please clean up the references in the manuscript.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
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manuscript, either now or in the future?
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3.Do you hold or are you currently applying for any patents relating to the content of the
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4.Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
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