Reviewer ’s report  
 
Title: Awareness, attitudes and perceptions regarding  HIV and PMTCT amongst pregnant 
women  in Guin ea-Bissau - a qualitative study  
 
Version: 1 Date: 12 Apr 2016  
 
Reviewer: Lora Sabin  
 
Reviewer's report:  
 
I enjoyed reading this interesting manuscript, written on an important topic: knowledge and 
views of HIV and PMTCT in pregnant women in Guinea -Bissau, a country with a high degree of 
HIV among pregnant women. Clearly, this  study collected data on a topic worthy of attention. In 
an era when Option B+ is being scaled up in many countries, it is critical to understand the 
barriers and facilitators that bear on effective HIV testing and treatment for pregnant women. 
While small , the study seems to be well designed and implemented, with interesting results and a 
discussion section that many will find useful. I have just a few thoughts and suggestions that I 
hope are helpful to the authors.  
 
 
 
Introduction  
 
1. Just a suggestion, bu t given the push underway in many parts of sub -Saharan Africa to 
scale up Option B+, and because the motivation behind the scale - up is so closely related 
to the desire to strengthen PMTCT, I think some mention of the link between PMTCT 
and Option B+ would  be good to include in the background section. I understand that 
Guinea -Bissau is not one of the countries now scaling up Option B+, but perhaps it will 
do so in coming years. Either way, I think making the connection would be a good idea. 
(A good website for information on which countries are now implementing Option B+ is: 
http://emtct -iatt.org/b -countries -and-pmtct -regimen/ ) 
 
 
 
Methods  
 
2. What was the sample size based on? If it was due to budget and/or time constraints, that's 
acceptable, but some rationa le for the sample size is always good to include. Also, why 
so many IDIs with postpartum women as opposed to pregnant women?  
 
 
 
3. In the section describing the in -depth interviews, and specifically the interview guide, 
could the authors provide one or two o f the questions that were asked? That would be 
helpful for the reader.  
Results  
 
4. I really like the direct statements by study participants, but I think there are perhaps too 
many in some places and too little text describing the results more broadly. Fo r example, 
on page 11, under the section, "Difficulties with counselling, testing and treatment," there 
is only one sentence, followed by 3 statements, and then a cycle of one sentence followed 
by one statement. At the beginning of that section, the text s ays, "Key informants voiced 
important concerns about peripartum HIV counseling and testing. I think it would be 
good to add text here that summarizes these concerns. Then some illustrative statements 
can be provided. As it reads now, you must read the stat ement and hope you glean from it 
what the authors intend for the readers. Overall I would recommend removing 1 -2 
statements in each of the sub -sections on pages 11 -14.   
 
 
 
5. On page 12, at the beginning of the section entitled, "Motivation for and against HIV 
testing," I suggest summarizing the main points before starting to describe specific 
opportunities. Even just, "There were many reasons given for why women chose to be 
tested. Some viewed …."  
 
 
 
 
6. One option that often works well is to place statements into a table organized by theme. 
This can help focus the text of the manuscript while also allowing readers who are 
interested to take their time and look through the statements in the table. With this 
approach, the authors can reduce the direct statements  in the text itself to just the really 
illustrative (best) direct statements and keep the text crisp and moving along.  
 
 
 
 
Discussion  
 
7. In the limitations section, on page 19, lines 475 -76, the authors point out the small 
number of participants in the study . I would add that this limits the ability of the authors 
to generalize their findings in any meaningful way. This is an obvious point to many 
readers, but it's always good to point it out.  
 
 
 
 
Overall  
 
8. The language is awkward or incorrect grammatically in  a number of places. See for 
example, page 4, line 101, the sentence beginning with "Broadly, these establish at 
individual, community, national and international level…." Similarly, on page 9, line 
233, the sentence that reads "Those accrediting the exist ence of HIV quoted…." seems a 
bit awkward. There are also numerous places where a word is missing or used 
incorrectly. In addition, there are some word choices that may strike some readers as odd 
or unclear. For instance, it might be helpful to define "nul liparous" and "index 
pregnancy" to help readers who are not intimately familiar with these terms related to 
pregnancy. It is important that a native English speaker read and edit the manuscript in its 
entirety before being resubmitted.  
 
 
 
 
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 con trols 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 recom mend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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 que stions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
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2. Do you hold any stocks o r 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 y ou received reimbursements, fees, funding, or salary from an organization 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 in terests in relation to this paper?  
 
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