Title: Determinants of HIV voluntary counseling and testing: a multilevel modelling of the
Ethiopian Demographic and Health Survey
Version: 0 Date: 30 May 2021
Reviewer's report:
This paper titled “Individual and community level determinants of HIV voluntary counselling
and testing among reproductive-age women in Ethiopia” reports on the uptake of voluntary
counselling and testing services among “reproductive age women” in Ethiopia and its associated
factors. The authors utilized a nation-wide demographic and health survey data as a source to
answer their research question.
The manuscript is mostly clear and well written. However, I recommend the following changes:
Abstract:
The statement in the abstract line 21-22, which reads as “very high proportions of people living
with HIV are unaware of their status in sub-Saharan African countries including Ethiopia” is
vague. It is better to precisely mention the proportion of people unaware of their status in sub-
Sahara and Ethiopia rather than vaguely saying “very high proportion” and provide relevant
reference in support of your arguments in the body (background section) of the manuscript.
Provide AOD and 95% intervals for the following variables:
increased age (> 25 years),
having education and
higher wealth index in the abstract.
Background
Whenever using abbreviations for the first time in the paper first write the abbreviation in full
then use the abbreviation later in the text.  For example, PLWHA line 53.
Line 66: The statement which reads as “Despite the many advantages of VCT and availability
of the services, the number of people who are screened for HIV is still very low …” is vague.
What are these many advantages and what is considered very low?  What availability of service
are you referring here?
Methods:
The construction of community level determinants is not clear. Are they constructed based on
the women in the sample or based on the whole EDHS sample? This should be clarified. The
community factors/characteristics may not necessarily be the same if constructed based on the
whole sample and the sample women included in this paper.
Results:
The main contribution of this paper is its attempt to assess the influence of community level
factors in addition to individual women related factors in VCT uptake.
However, the distribution of women who have ever been tested for HIV according to community
level determinants is not provided in the manuscript. For example, how many women in the low
community wealth index group have ever been tested for HIV? How many haven’t been? How
many in high community education group have ever been tested? how many in low education
group have ever been tested?  Provide the actual number and proportion of women tested and
not tested according to all community level determinants in the paper.
Revisions in terms of language and correct grammatical uses here and there throughout the paper,
especially in the result and conclusion section are required.
Discussion:
The discussion section is at times appear repeating what is provided in the result section.
Conclusion:
The conclusion of the paper needs to consider including the practical implication of the findings.
VCT uptake is influenced by individual and community level determinants. So what? There is
a statement which reads as “strengthening community intervention” in the conclusion section
which is unclear/vague.  A clear statement highlighting the practical implication of the findings
is important.