Reviewer ’s report  
 
Title: Evaluation of human -papillomavirus testing and visual inspection for cervical cancer 
screening in Rwanda  
 
Version: 1 Date: 17 Feb 2018  
 
Reviewer: Lydia Pleotis Howell  
 
Reviewer's report:  
 
Interesting and well -designed study with important findings for low -resource settings.  My main 
criticism is regarding writing style:  there are too many complex sentences which m akes reading 
and understanding difficult.  Separating these into two simpler sentences would be more 
effective.  Also, an excessive number of sentences begin with "However", "Although", 
"Nonetheless", particularly in paragraph 2 of the Background section.   
 
Examples of dense, difficult to digest complex sentences include:  
 Background, page 4, lines 8 -11: "Furthermore, in order to reduce cervical cancer among 
older cohorts of women unprotected by the vaccination program, in 2013, the Rwandan 
Ministry of H ealth (MoH) initiated a screening campaign based on primary careHPV testing 
and the use of visual inspection with acetic acid (VIA) to triage careHPV -positive women for 
treatment [2]."  
 
 Discussion, page 12, lines 5 -7:  " Our results confirm that, although  careHPV did not perform 
quite as well as a reference PCR HPV test, a careHPV screen -and-treat approach would have 
treated more hHSIL+ than VIA screen -and-treat, albeit with a higher treatment rate overall. 
However...."  
 
 Discussion, page 13, line 21 -23:  "Although it should be noted that whilst gold -standard 
studies obtain biopsies, directed by colposcopy, in the present study, as in other similar 
evaluations,[7] they were directed by VIA only.  
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 speci fy 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 wou ld 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 Engl ish 
Please indicate the quality of language in the manuscript:  
 
Needs some language co rrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursemen ts, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an org anization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all o f the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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