Reviewer ’s report  
Title: Low Uptake Of Cervical Cancer Screening Amo ng HIV Positive Women In Gondar 
University Referral Hospital, Northwest Ethiopia: Cross -sectional study  
 
Version: 0 Date: 08 Dec 2016  
 
Reviewer: Karen Smith -Mccune  
 
Reviewer's report:  
This is an interesting and important study looking at uptake of the cervical cancer screening 
among women receiving care in an adult HIV clinic in Gondar Univ ersity in Ethiopia. Given the 
significance of cervical cancer as a public health issue, especially in HIV+ women, studies of the 
uptake, or lack thereof, of cervical cancer screening in at risk women are necessary from as many 
different global sites as pos sible. This study shows low uptake of cervical cancer screening in at 
risk women (10%) and identifies some of the socio -demographic features that are associated with 
having been screened. These results provide important normative data for future research a nd 
interventions aimed at improving uptake.  
There are several points that would strengthen the manuscript:  
The groups with high uptake of cervical cancer screening had characteristics that indicated more 
frequent interactions with the health care system (p arity, >10 years since diagnosis, lwo CD4 
count). HAART status was not included as a variable, but might also be a surrogate for those 
with more exposure to the health care system and hence more likely to have been screened. Can 
the authors add this variab le to their analysis?  
Another association that might be interesting but was not studied regards the results in Figure 1, 
re women's awareness of cervical cancer and of cervical cancer screening. In the discussion the 
authors propose that the variables asso ciated with screening, such as level of education etc, might 
reflect women's better awareness about cervical cancer screening. But they can study this 
association directly in their dataset - ie were educated women/parous women/>10 years HIV+/or 
low CD4 wome n more likely to know about cervical cancer and/or be aware of screening? (this 
is different than the analysis looking at predictors of who got screening). This would help tease 
apart the role of the women themselves in getting screened versus providers se lectively directing 
some women to screening.  
I would like to see more information about how the system currently integrates the availability of 
VIA-cryo with the HIV clinic. again, it would help to tease apart how much screening is done 
due to patient req uest versus provider discretion.  
 
Other questions/corrections:  
Was IRB review performed?  
 
Methods: random sampling was used in which every 5th woman was selected. How was this 
performed exactly?  
 
Page 5 line 25 - what screening was available before 2013. Results on page 7 line 32 infer that 
women could get screened before the introduction of VIA/cryo in 2013.  
 
Page 5 line 40 - why was 12% chosen for the power calculation (from the Discussion I see there 
is literature that probably informed this choice, but it should be justified in the methods)  
 
Page 6 line 27 - what is the 5th interval?  
 
Table 1 please add Christian after Orthodox - this was not obvious until I found it in the text.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comm ents 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 no t, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what asp ects require further 
assessment in your comments to the editors.  
I recommend additional statistical review  
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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3. Do you hold or are you currently applying for any patents  relating to the content of the 
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no 
 
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