Reviewer's report
Title:Using Verbal and Social Autopsies to Explore Health-Seeking Behaviour
among HIV-Positive Women in Kenya: A Retrospective Study
Version: 2Date:4 June 2013
Reviewer: Maria Lahuerta
Reviewer's report:
All comments are major compulsory revisions unless indicated otherwise.
ABSTRACT
1. Include the definition of “poor”
2. This sentence is not clear: “poor knowledge and clear understanding…”
3. Objective: see comment below in the introduction
INTRODUCTION
The introduction should be edited to the objective of the study. There is currently
too much data not relevant to this analysis and it’s hard to follow.
1. Update with most recent UNAIDS data
2. Discretionary revision: Add data on HIV prevalence in urban and rural areas.
3. Minor revision:Why describe the HIV prevalence of key populations (female
sex workers, male prisioners…) if not relevant to this study? I suggest deleting.
4. Minor revision:Third paragraph. What is the relevance of condom use for this
analysis?
5. Objective: The way the objective is described it’s not clear. It will seem as if
they are exploring factors among women living with HIV, while in reality it
explores factor among women living with HIV that have died. Also, it should say
in Kenya and not resource-constrained settings as it is not necessarily
generalizable.
METHODS
The methods section is week and needs to be edited to better understand how
the study was conducted and study population selected.
1. Six districts: please specify from how many provinces to give the reader an
understanding on how representative the results will be. Please also describe the
location and characteristics of these six districts.
2. Please explain what is the output –based aid as it’s not clear now. Did it have
anything to do with verbal autopsies?
3. Study population. How were these 218 women selected? Have all of them
been diagnosed as HIV-positive or was the test post-mortem?
4. The description of the 218 women, their characteristics and Table 1 should go
in the results section.
5. When was data collected? Include the study period
6. Add definitions. How was “poor” defined?
7. The distinction between verbal and social autopsy is not quite clear. Was the
interviewee the same person?
8. Were the 218 caregivers interviewed for the qualitative component? If not, how
many and how were they selected?
9. Is HIV care and treatment free in the six districts in Kenya? This would have
implications for the interpretation of results.
10. How were caregivers contacted?
RESULTS
1. Move Table 1 and description of study population to the results section. Also
consider merging Table 1 and 2 as they all describe the study population.
2. Careful with the p-values! The authors present some results as if they were
significant: “Women from poor households were more likely than non-poor
women to seek care from informal sources…”. However, the p-values indicate
that there is no significant differences and therefore some of the statements are
incorrect.
3. Page 7, results from multivariate logistic regression. Add 95% CI
4. Table 3 and 4. Indicate what is the N in both models
5. Figure 1, Indicate with an asterisk those that are significant or add the p-value
for each
6. Discretionary: Given the relevance of being poor in the results, consider
stratifying table 1 and 2 by socioeconomic status to show overall and then poor
and non-poor.
DISCUSSION
1. See previous comment about the objective of this study
2. The discussion seems to be focused mainly in the results from the qualitative
study.
3. Limitations: Throughout the discussion, the authors should emphasize that
findings are from caregivers of deceased women. Not only it is a limitation in
terms of recall bias but it is definitely a selection bias as the findings might not be
representative to all HIV-positive women in these districts.
4. Also, is this the only limitation the study has?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have no competing interests.