Reviewer’s report
Title: 
Challenges and opportunities associated with cervical cancer screening
programs in a low income, high HIV prevalence context
Version: 
1 
Date: 
29 Nov 2020
Reviewer's report:
I thank the researchers for this important study that adds to the knowledge about
factors that facilitate/hinder uptake of preventative services. We need more
qualitative studies which help us better understand nuances around cervical
cancer prevention. This study is particularly important in the context of the
WHO ambitious elimination strategy of cervical cancer by 2030. The findings
also highlight the unintended consequences of services that are only targeting
WLHIV because of 1. the stigma associated with HIV, 2.the exclusion of HIV
negative women, who are also at risk of developing cervical cancer especially as
they get older. This study will be helpful to those on us who advocate for
cervical cancer prevention services that are inclusive.
It is unfortunate that this was nested within another study that excluded
previously screened for and diagnosed with cervical cancer. It would have been
interesting to see if these differed from the ones never screened/diagosed.
The authors have adequately addressed the comments raised by the reviewers
and I will be happy to support publication of the manuscript once the following
minor comments have been addressed:
General comment: Why have you chosen to write out cervical cancer with a
hyphen?
Background:
Line 15: Suggest remove "and treat" from that sentence as the Pap smear and
HPV testing are screening methods, not treatment methods.
Line 20: I disagree with "low cost" as both HPV vaccination and HPV DNA
testing are not "low cost".
Methods:
Sample selection:
Line 23-4: I find this sentence ambiguous. Does 'each category' refer to
categories of HIV +ve and HIV -? Which of the discussion groups were the men
invited to join? Please consider re-writing to make it less confusing.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes