Reviewer's report
Title:An assessment of the likely acceptability of vaginal microbicides for HIV
prevention among women in rural Ghana
Version: 2Date:10 July 2012
Reviewer: Elizabeth Greene
Reviewer's report:
Overall, the paper is very much improved upon the last version, the methods and
discussion sections are much stronger, and the organization is better. There are
a few revisions suggested, and throughout the paper there are many
typographical and grammatical errors that need to be addressed before
publication.
Major Compulsory Revisions
1. Throughout the results section, please clarify if percentages given reflect
results of the survey or the FGDs. Percentages should not be used to reflect
results of the FGDs as the group-discussion nature of an FGD is not appropriate
for quantification. This clarification could be made by including a statement
somewhere either before the results section (in the Methods section) or at the
beginning of the results section, discussing how the quantitative and qualitative
data were triangulated, and alerting the reader that any mention of percentages
refers to survey results, and FGD results are provided as illustrative quotes.
2. Page 8, Study Limitations section: This section, while a positive and necessary
addition to the paper, is somewhat weak and full of grammatical errors. The
previous review suggested adding several issues, including among other things:
the quickly changing research findings on microbicides, the fact that the
participants have never used a microbicide and thus their opinions could have
been biased by the way microbicides were presented to them by the researchers,
and the population of rural women which may not be representative of more
high-risk women in urban areas. Currently this section only includes discussion of
the fact that women in the study have never used a microbicide. This is good,
and should remain in this section, but please include mention of other limitations
of the study. Additionally, please reword the current section to be grammatically
correct. Example: A hypothetical microbicide was described to participants - most
of whom were unfamiliar with microbicides, and none of whom were using a
microbicide candidate, placebo gel, or surrogate - and thus their opinions could
have been biased by the way microbicides were presented to them by the
researchers.
Minor Essential Revisions
1. Page 3, Background, para 4: The reference for the first sentence of paragraph
4 is after the period of that sentence.
2. Page 3, Background, para 4: The fourth sentence (beginning with “the VOICE
trial on the other hand…”) is a run-on sentence. Suggest splitting it into 2
sentences or rewording. Example: The VOICE trial on the other hand, which was
anticipated to strengthen the evidence for the CAPRISA study, was discontinued
by the DSMB (*DSMB should be spelled-out, see comment below). Though the
tenofovir gel was found to be safe, it was not effective in HIV prevention among
women in South Africa, Zimbabwe and Uganda.
3. Page 3, Background, para 4: Fourth sentence, spell out DSMB.
4. Page 3, Background, para 4: Fourth sentence, provide some sort of citation for
the VOICE trial, even if it press release or website.
5. Page 3, Background, para 4: The fifth sentence is not worded well – there are
typos and it is difficult to understand. Example: Original reads: “Large scale
effectiveness studies; FACTS 001,a phase III trial testing the same regimen as
CAPRISA 004 is on-going amid considerable expectation that soon an effective
product will be available.” Replace with: FACTS 001, a phase III trial testing the
same regimen as CAPRISA 004, is on-going amid considerable expectations that
soon an effective product will be available. (i.e. remove the words “large scale
effectiveness studies).
6. Page 3, Background, para 4: Provide a citation for FACTS 001 after the fifth
sentence.
7. Page 3, Background, para 5: Typo in the first sentence. Replace the comma at
the end of the sentence with a period.
8. Page 3, Background, para 6: Typo in the second sentence. “Workers” should
not be capitalized.
9. Page 3, Background, para 6: Typos in sixth sentence – add “Africa” after
“sub-Saharan” and change “microbicides” to “microbicide.”
10. Page 3, Background, para 6: Typo in last sentence – sentence should read
“…a seamless incorporation of microbicides…”
11. Page 4, Study Population: The first sentence is not a complete sentence, and
the entire paragraph is not grammatically correct. Suggested wording (changes
are underlined): “Study subjects were pregnant women between 18-40 years of
age presenting at two antenatal facilities in the municipality: These are the
Kintampo Municipal Hospital, a public health facility; and the Prince of Peace
Maternity Home, a private facility. Women were recruited for either the FGD or
the survey as at the time of their routine visit to when they attended the clinic.
12. Page 5, Data Analysis paragraph: Suggest moving this paragraph under the
“Quantitative Analysis” section, as it applies only to the survey, and you have
already discussed data analysis for the Qualitative methods under the
“Qualitative Methods” section.
13. Page 5, Awareness section: Typos in this paragraph. “Awareness” should be
left justified, you are missing a period between the first and second sentences,
and suggest replacing the word “while” at the end of the sentence with “…,
and…”.
14. Page 5, “Comparism with other products” section: “Comparism” is not a word,
replace with “Comparison to”
15. Page 6, second paragraph: “Some women also appeared to be influenced…”
– this sentence does not make sense. Consider rewording to clarify. A
suggestion is: “Because microbicides are to be used immediately before sex,
some women compared them to spermicides, fungicidal suppositories and sexual
lubricants.”
16. Page 6, second-to-last paragraph, beginning “Beyond health-related
facilities”: the wording of this first sentence is very awkward. Consider rephrasing
along the lines of: Places where women felt they would be most comfortable
obtaining free microbicides included health-related facilities (89-97% of women)
such as chemical shops and hospitals, cosmetic shops (39%), and supermarkets
(26%).
17. Page 7-8, Discussion section, general comment: There are many instances
where references for a sentence appear after the period for that sentence.
Please review this section and ensure that references are place correctly.
18. Page 7, para 4 of the Discussion section beginning “One of the important
justifications…”: Beginning with the 7th sentence (“Among women who were
reported…”), it is not entirely clear that you are referring to findings from other
studies. The reference for the 7th sentence should appear directly after this
sentence, rather than after the next sentence. The next sentence should include
language stating that you are referring to findings from several other studies as
well, at which point you can then cite the other studies. The sentence beginning
“It may not be a convincing…” is missing a period at the end. In several
sentences, citations are placed after periods.
19. Page 8, Discussion section, paragraphs 3 and 4: Both paragraphs discuss
microbicide use and sexual pleasure, and seem somewhat repetitive. The two
paragraphs could easily be integrated and some of the wordiness cut out, to
create one paragraph with a rich discussion of microbicides and sexual pleasure,
and tying this study to previous studies.
20. General comment for entire manuscript: There are numerous grammatical
and typographical errors throughout the manuscript. I have tried to address many
of them in my comments, but I would suggest a critical review of the manuscript
by a native English-speaker or someone fluent in English, and with a particular
focus on grammar, sentence structure, the use of commas and periods, and the
placement of citations. It is likely that even using the spell and grammar-check
feature in Microsoft Word would catch many of the errors that are present, and
this is highly recommended.
Discretionary Revisions
1. Page 3, Background, para 6: In the second sentence, do the percentages next
to each high-risk category represent the prevalence of HIV among that group?
Suggest rewording the sentence so that this is clear.
2. Page 4, Data Collection section: Is there a way to make the “Quantitative
Survey” and “Qualitative Methods” section sub-sections under data collection?
Currently the “Data Collection” sections appears as if it stands alone and would
be strengthened by clarifying that the next two sections are sub-sections under
“Data Collection.”
3. Page 7, Discussion section, 1st para: The first paragraph of the discussion
section is very well worded and makes a good point, but seems to reiterate the
purpose of the study and is thus redundant in the discussion section. Suggest
moving it to the background section, perhaps integrating it into already existing
language in that section or replacing other language in that section.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have not competing interests.