Title: Health Related Quality Of Life Among Pregnant Women Living With HIV In Kenya,
Results From Comparing A Patient Generated Index And The Euroqol 5 Dimension 3 Level
Version: 5 Date: 14 Dec 2021
Reviewer's report:
Review BMC Womens Health
Title: Health-related quality of life among pregnant women living with HIV in Kenya, results
from a patient generated index and the Euroqol 5 dimension 3 level
General comments
The revised manuscript is much improved with a more concise discourse. However, there are still
some minor clarifications which should be addressed before publication. Although the language
and grammar has improved, the text should be edited thoroughly for correct English grammar,
consistency and rigour throughout.
Also, the title may be a bit misleading. As the authors point out in their response, the aim is not
assess HRQoL in pregnant WLWH, but to compare the two instruments in this population. Both
the title and aim should reflect this.
Abstract:
The study aim in the abstract should be the same as the study aim in the main text. The aim
in the abstract is focused on comparing the two instruments, while the study aim in the main
text is to provide a better understanding of HRQoL (by comparing the two instruments). But
as highlighted by the authors in their response, the manuscript aimed to compare the PGI and
EQ-5D-3L, and not assess HRQoL per se.
Line 20 and 25: The use of the word “interview” in this context is confusing, as interview is often
associated with qualitative research. Writing that the women were interviewed in the abstract,
may lead som readers to believe that this is a qualitative study. Suggest replacing “interview”
with survey, questionnaire or similar or at least highlighting that the interview was structured.
Line 58. The use of referencing is not correct.
Background
Line 97.  “Efforts to eliminate perinatal transmission of HIV among pregnant women living
with HIV to their newborns warrant a holistic approach to assessing the wellbeing of pregnant
women living with HIV.” This is valid point as to why women living with HIV are an area of
interest, however the authors have not previously mentioned the association between perinatal
transmission of HIV and wellbeing of pregnant women living with HIV. If the authors wish to
make this argument, more emphasis should be on the association between wellbeing/HRQoL
and risk of perinatal transmission. This is especially important, as BMC Women´s Health is not
an HIV specific journal.
Methods
Eligibility criteria, line 118: suggest adding “Pregnant women, irrespective of gestational age,
above 18 year…”, highlighting that duration of pregnancy was not a criteria.
Study parcipants, line 127: As noted above, the use of the word “interview” may be confusing.
Suggest adding “structured interview” or similar to avoid confusion with a qualitative interview.
When was the study conducted? Please add the study period or at least the enrollment period.
Data collection: As noted above, “interview” should be specificied as a structured interview to
avoid confusion with a qualitative interview.
Data analysis, line 182: Why is table 2 presented before table 1? Also, the tables that refer to
results (in this version of the manuscript table 2) should be presented in the results section of the
manuscript and not in the methods sections. Suggest deleting the reference to Table 2 in the data
analysis section. Table 1 refers to the methods used for calculating PGI score and is therefore a
methods table, which correctly should be presented under the Data analysis section.
Discussion
Line 297: Suggest adding a “negatively” to the sentence …to the women that are (negatively)
affected by HIV, to highlight that the focus is on areas which are experienced as a burden because
of HIV.
Study limitations, line 309-311: please check grammar and abbreviations (e.g. sometimes
research assistances are abbreviated as RA, sometimes it is written in full)
Study limitations, line 314-315. …especially if they had to fill it on their own without the
support of a research assistant”. In their response, the author states that the PGI was interviewer-
administered, which is also stated in the prior paragraph. Did some of the participants complete
the PGI on their own? If so, how many?