Reviewer ’s report  
 
Title: Factors assoc iated with high -risk human papillomavirus test utilization and infection: a 
population -based study of uninsured and underinsured women  
 
Version: 0 Date: 23 May 2018  
 
Reviewer: Michelle Silver  
 
Reviewer's report:  
 
The authors examine factors associated with HPV test utilization and infection among uninsured 
and under -insured women in NJ, finding relatively low test usage.  There are several questions 
and areas in need of clarification.   
 
Abstract:  
 The author's mention they examine clinic -level covariates in the background, but no clinic -
level covariates are included in the model.   
 
Background:  
 Page 4, Lines 48 -53: The authors mention low utilization in other studies, but several more 
recent studies have shown higher rates of co -testing ( Watson et al. Prev. Med Rep 2018; 
Silver et al Cancer Causes Control 2018)  
 
Methods:  
 Why does the inclusion criteria include women who are 29 years of age when co -testing isn't 
recommended until age 30?   
 
 Why was non -Hispanic white used as the reference for minority residents?  
 
Results:  
 Page 10, Lines 19 -20: The author's mention women who enroll ed in NJCEED at an older 
age…  Do we know that this was their enrollment visit or was it just the first visit that 
occurred in your study window?  
Discussion:  
 Page 12, Line 33: extra word 'have'  
 
 Page 12, Lines 53 - next page: The group out of Hopkins has published 2 more recent papers 
showing higher rates of cotest  usage  
 
 Page 12, Lines 16 -21: Cotesting wasn't approved until 2004, so we wouldn't expect to see co -
testing beginning in 2001  
 
 Page  13, Lines 55 -58: How do you explain the difference in effect from quintile 4 to quintile 
5? 
 
 Page 15, Lines 22 on: I don't follow how your findings lead to the conclusion of difference 
HR-HPV types in different sub -populations.  While this might be a tru e statement, your data 
do not support this as you don't have type specific data.  You're overall HR -HPV prevalence 
rate includes all the HR types, thus masking any differences in distribution.  Without type -
specific data, none of the rest of that paragraph  are relevant to your findings.   
 
 Page 16: Lines 19 -22: Should acknowledge that Pap only screening can still guideline 
concordant.  
 
 What is the NJCEED screening policy?  Do they recommend cotest or is the choice left to the 
physician?  Are policies on a clinic level or a state level?  
 
Table 1: How are there people in the dataset with 0 Pap tests?  
Tables 2 and 3: Column %s don't make sense here.  We what to know the actual proportion of 
women of women in each category who are tested or who are positive.   
Figure 1: What determines enrollment into NJCEED?  How do the patients not enrolled in 
NJCEED differ from those enrolled in NJCEED?  
Figure 2: Just graph the percent tested and percent positive by clinic.  It's too hard to tell the rates 
like this.  
Are the methods appropriate and well described?  
If no t, 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.  
 
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 recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify 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 reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially 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?  
 
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below.  If you r reply is yes to any, please give details below.  
 
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