Title: Determinants of Precancerous Cervical Lesion Among HIV Infected Women on ART in
Woldia Comprehensive Specialized Hospital NorthEast Ethiopia
Version: 1 Date: 04 May 2023
Reviewer:  Yitagesu Habtu
Reviewer's report:
General comments
• The study aimed to address one public health important problem in Ethiopia. From the
scientific point of view, the research design as a whole and the chronology of the manuscript
are good. However, I have doubts about the contribution of this study to  add  new
knowledge to the currently available studies from various corners of the country. To mention
some, South Ethiopia(e.g. https://pubmed.ncbi.nlm.nih.gov/33688268/), North-East Amhara,
in the same study area of the current study (https://pubmed.ncbi.nlm.nih.gov/31123433/),
North West  Ethiopia (https://doi.org/10.2147/HIV.S310905),Southern Ethiopia
(https://doi.org/10.1371/journal.pone.0084519), and a systematic review of 17
studies in Ethiopia (https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/
s13643-021-01840-0). Therefore, what is new with their findings?  And these works have to
be acknowledged by the authors in their literature review and discussion section. Moreover, the
knowledge gap was not articulated or indicated in the manuscript. The paper can be published as
it has academic merits rather than its impact on policymakers. There are some typos and vague
words in the manuscript that needs to be corrected. I provided my specific comments below:
Following are my specific comments:”
• Grammatical, punctuation  and typological errors are there in the manuscript.
• Acronyms should be defined at first use in the document, eg. PLHIV
Abstract
• “…studies on the risk factors of pre-cancerous cervical lesions among the risk population (HIV
infected) relative to the general population were limited.” Is not the sufficient justification due
to the reasons I previously raised.
• A punctuation mark is required between the first and second sentence in “conclusion” section.
• Conclusion section, all the strategies recommended/mentioned by the authors have already
been implemented in Ethiopia and additional vaccination program have been implemented.
Therefore, what is the new for conducting this study?  Does the study area a different context
where those risk factors operate differently? Or have those recommendations not been equally
implemented yet?
Background
• Paragraph 1 to 3, even 4 describes the scope of the problem and it can be summarized in at
most  2 paragraphs. Don’t dump everything regarding the scope of the problems, but describe
magnitude of   the problems, what have been done so far,  what other studies generated evidences
to informing policy makers, and what evidences are remaining to inform policy makers and
implementers
• Citation is needed in “To address this serious public health problem, Ethiopia adopted
Sustainable Development Goal (SDG), and World Health Organization (WHO) strategies and
designed the National Cancer Control Plan (NCCP).”
• The last paragraph need to be splinted
• The justification mentioned in the manuscript to conduct, the author says that “However,
factors associated with premalignant cervical lesions remain poorly documented. …. Few studies
have explored the role of risk factors and even controversies among them. This attribute the
gap in public awareness on predictive risk factors of PCL in the setting of the study area and
Ethiopia as well.” It would have been justified on the other way round because of there are many
evidences in different corners of the country including at the study area.
• The last paragraph also needs to be coherently narrated.
Methods
• Keep the order of the sub-sections to be presented in methods section/follow the journal’s
guideline
• Split “Study design, study period, and setting” into two: “Study area and setting”, “Study
design”
• Some subsection are not clearly described eg. Sample size determination should be splinted
from the subsection “ Study population and sampling” and clearly defined with its assumptions.
• Because you can easily narrate, table 1  is not necessary.
• Inclusion and exclusion criteria should be clearly articulated in separate subsections.
• In the subsection, “Data Collection Tool and Procedure”,  was the same level of health care
providers responsible to diagnose the PCL  in the hospitals?”  Citation is required “According
to the World Health Organization (WHO) guidelines …)
• Which types of logistic regression was performed? Why multi-collinearity checked for logistic
regression ?  Does checking such assumptions make sense in logistic regression analysis?
Among which variables you checked for it?
• What does “Both verbal and written forms was given by participants to indicate their
willingness to participate.” mean? in subsection of Ethical consideration
Result
• Check the authors guideline for tables  and graphs
• I don’t think that some of the estimation of effect sizes are correct e.g. Family History of
cervical cancer, ever had a history of STI in table 6. I fear that this  goes to the other estimations.
Discussion
•  Discussion is too, superficial and the authors should show the implication of the study findings.
This must be mentioned in the discussion and conclusion sections of the manuscript.
• Why “Precancerous cervical lesion reveals a significant public health problem among HIV-
infected women unless special consideration is taken.” appear in the conclusion section as long
as you have said it several times in your introduction section.
• The statement in 1st  paragraph of  conclusion section “These women are those who had
multiple sexual partners, a History of sexually transmitted infections, had a history of early
(before age 18 years) initiation of sexual intercourse, had Baseline CD4 count Less than 200/
mm3 had a significant association with a precancerous cervical lesion.” needs rephrasing. Can
you really reach in such kind of conclusion only from your findings??
• Other implications in the discussion are solely depend on your estimation of effect sizes