Reviewer ’s report  
 
Title: A cross -sectional evaluation of HIV testing practices amo ng women in the rural 
Dominican Republic  
 
Version: 1 Date: 07 Mar 2018  
 
Reviewer: Maria Augusta Carrasco  
 
Reviewer's report:  
 
General Comments  
 
The study is interesting and it fills a gap in the literature around HIV testing behaviors in rural 
areas in the DR.  There are three important shortcomings that should be addressed to merit 
publication:  
 
1. The IRB approval to conduct the study collecting data from human subjects is not 
provided.  This information should be provided in the manuscripts.   
 
2. Throughout the text the authors seem to imply that there is high prevalence of HIV 
among women in rural areas in the Dominican Republic or that incidenc e is high or that 
women in rural areas in the Dominican Republic are at high risk of contracting 
HIV/AIDS.  However, the references to support these assertions are not provided.  
References for these statements need to be provided.  In absence of evidence,  these are 
suppositions or conjectures that should be clearly stated as such.  
 
3. Authors are generalizing your conclusions to rural areas in the DR.  However, you have a 
small sample from a small community in a rural area.  Authors should be careful with 
how you generalize the results of the analysis.  
 
 
Specific Comments  
 
1. The sentence in page 4, line 31 "These barriers may interact and compound each other" is 
not very clear.  Please clarify or delete.  
 
2. The sentence in page 5, lines 20 -21 is not clear:    "In May 2016, the World Outreach 
Foundation (Kansas City, Missouri) in collaboration with the United States Peace Corps 
conducted medical clinics conducted in Constanza, DR."  Please update.  
 
3. On page 6, at the end of the methods section, you include a l ine indicating IRB approval 
of the review of needs assessment data.  Can you please include information about IRB 
approval to collect the data?  Additionally, please specify the consent process and 
whether participants received any incentives.  
4. In page 8 , line 47, it says "… despite high epidemiological risk of acquiring HIV."  It is 
not clear that there is high epidemiological risk. Please make this case more clearly.  
 
5. In page 9, line 9, you indicate that "this may be offset by high HIV prevalence in t he 
community or risk behaviors of male partners."  This is speculative.  You have not 
provided epidemiological information to indicate that this is the case.  Please make sure 
that speculative statements are differentiated from facts.  
 
6. In page 9, lines 9 -11, it says that "Heterosexual intercourse is the primary HIV 
transmission risk behavior in the DR."  Please note that there is some information that 
MSM behavior is also an important mode of transmission.  See 
http://files.unaids.org/en/media/unaids/cont entassets/documents/countryreport/2010/2010
11_MOT_DominicanRepublic_en.pdf.  Please update the statement with recent 
information about the modes of transmission in the DR.  
 
7. In page 9, lines 42 -47, the authors indicate that there is "high rate of HIV tran smission 
among women in the DR."  This is not correct.  Please look at most recent data to look at 
overall rates of transmission.  Transmission is high among female sex workers but not 
among women in the general population.  
 
8. The descriptive statistics pr ovided are often provided on very small subsamples of the 
already small sample size.  For example, the reasons for unwillingness to take HIV test 
information is provided for the 34 (out of the sample) who had never been tested.  
Among the 34, 3 indicated n o perceived risk.  These numbers are very small.  
Generalizing results to rural communities in the Dominican Republic is not warranted.  
 
9. In page 9, line 58, the authors write: "Despite high HIV incidence in rural DR…"  They 
have not provided information about high incidence in the introduction.  To make this 
claim, please add a citation.  
 
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 controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would y ou recommend an  
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimb ursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly 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 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 interests in relation to this paper?  
 
If you can answer no t o all of 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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