Title: Understanding the effect of gender-based violence on uptake and utilisation of HIV
prevention, treatment, and care services among transgender women: a qualitative study in the
Greater Kampala Metropolitan Area, Uganda
Version: 0 Date: 18 Jul 2022
Reviewer's report:
This manuscript addresses an important topic, i.e.,  gender-based violence and HIV among
transgender women; and it provides data from a region under-represented in the scientific
literature on transgender women.  Unfortunately, the manuscript is not suitable for publication
as currently written.
MAJOR CONCERNS
1.  The manuscript does not follow the WPATH guidelines for respectful language to use when
writing about transgender people.  In particular, terms such as "born male" and "biological sex"
are explicitly described as in appropriate in those guidelines.
2. The manuscript does not follow UNAIDS people first and respectful language guidelines and
uses outdated terms such as "high risk sex" which are non-specific and stigmatizing.
3. Many of the references used for the Background section are more than a decade old. Much
more recent data are available. Many of the claims made in the Introduction are not supported
by the data cited. For example, there are not data indicating that transgender women with HIV
have a higher HIV-related mortality than non-transgender people living with HIV.
4. The different types of violence are never defined nor examples provided for what is meant
by these terms.
5. The conceptual framework that the study proports to use  in the Introduction is not used for
the methods section or the results section, nor really discussed in the Discussion.
6. The methods section is lacking key details such as questions asked during the interview, a
description of the key informants in the study population section, a rationale for use of both
FGDs and IDIs; how the sample size was determined (e.g. what theme was used to determine
saturation,? With such even numbers, the sample  sizes must have been selected in advance, so
how did they determine that this sample size would be appropriate to reach saturation? Why
was a notetaker necessary when IDIs were being recorded?   Did the team use a priori codes
or emergent codes or both? How was the conceptual framework of access to care (described
in the introduction) used in coding and/or analysis? Were transcripts double coded or divided
among coders? How was any disagreement among coders handles. What were the steps taken
to categorize codes into themes?
7. No mention of steps taken to ensure methodological rigor are described. Lincoln and Guba
(as well as others) have published recommendations for rigor in qualitative research, including
taking actions such as member-checking, peer debriefing, etc. However, none of these steps are
reported.
8. The results section includes no participant characteristic information on the key informants nor
does Table 1 distinguish the characteristics of the FGD participants from and the IDI participants.
9. Statistical language is used to describe these qualitative data, e.g. the Discussion states that
emotional violence had the greatest effect. However effect sizes are not possible to determine
using qualitative analyses.
MINOR CONCERNS
The manuscript needs careful review for typos, repeated/redundant sections, and unclear
sentence construction.