Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinics

Torgyn Issa; Aisha Babi; Alpamys Issanov; Ainur Akilzhanova; Kadisha Nurgaliyeva; Zauresh Abugalieva; Azliyati Azizan; Saleem A. Khan; Chee Kai Chan; Raushan Alibekova; Gulzhanat Aimagambetova

doi:10.1371/journal.pone.0261203

Peer Review History

Original SubmissionApril 9, 2021
8 Oct 2021 Decision Letter - Stanley J. Robboy, Editor PONE-D-21-11756Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinicsPLOS ONE Dear Dr. Aimagambetova, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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In your Methods section, please provide a justification for the sample size used in your study, including any relevant power calculations (if applicable). Finally please provide additional information regarding further treatment for women whom where identified as HPV positive during the study (for instane whether they were referred to a medical specialist for further treatment upon knowledge of their diagnosis). 5. Thank you for stating the following financial disclosure: "This study was supported by the Faculty Development Research Grant Program 2019-2021 (Funder Project Reference: 110119FD4528, title: A molecular epidemiological study to determine the prevalence of oncogenic HPV strains for CC prevention in Kazakhstan). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. GA. is a PI of the project." 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Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a very good manuscript. A very interesting and actual topic, which was very clear and well presented by the authors. The study design and statistical analysis are appropriate. The refferences are very well chosed. However, there are some minor issues that have to be addressed. 1. There are some minor ortographic erors (highlighted in the reviewed manuscript) 2. In the tables is better to present the results as: numbers (and percentage) in order to be more explicit and to have a more real image of the values. For example: 10 (3.25). 3. A cross-sectional study CAN NOT BE a prospective study!!!!!! A cross-sectional study means like "a snapshot". A prospective study involves following up the subjects over a period of time (longitudinal collection of data). 4. Usually in the "Conclusions" section the authors do not present figures and percentage form the "Results/ Discussions" sections. They present the general conclusions of the study, which were very well highlighted for the current research below the phrase with the figures, in the Conclusions section of the manuscript. Reviewer #2: Knowledge and awareness of HPV infection and HPV vaccine among Kazakhstani women Issa et al present the findings from the well done study “Kazakhstani women’s Knowledge and awareness of HPV infection and HPV vaccine.” The tables and figure are clear and concise. The text, in contrast, especially in RESULTS is difficult to read and needs to be simplified. For example, is it necessary to repeat the data from the tables, especially that contained in parentheses (e.g., AOR=0.73.; CI: 0.39-1.34, referent=age group of 18-25). L217: The text states that women age 46 and over were aware of HPV, which I take to mean this is an important finding. To me it then implies that younger women likely are not. Is it then necessary several lines later to actually state that younger women were not. L235-L240 The text repeats data in results. The entire RESULTS section should be made more readable L243: (Among those who were aware about HPV vaccine (N=1,215), less than half of the respondents (46.36%) knew that HPV is the major cause of cervical cancer). If I interpret the authors’ meaning correctly, fewer than half of the 1215 women who were aware of the vaccine understood what the vaccine treated because they were not aware that HPV is the cause of cervical cancer. If so, the implication the implication for the need for education is important: What is cancer and how does it come about; what are vaccines and what do they treat. L297-L304: Largely repeats the introduction. It should be truncated or eliminated. Much of the remaining DISCUSSION unnecessarily repeats the results and can be truncated. The CONCLUSION section repeats too much of the results, but insufficiently says what was learned from the study. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: MIOARA MATEI Reviewer #2: Yes:** Stanley J Robboy [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-21-11756_MM_august 2020.pdf https://doi.org/10.1371/journal.pone.0261203.r001
Revision 1
4 Nov 2021 Author Response Response to the Reviewers #1 Dear Reviewer, Thank you very much for the careful evaluation of our manuscript. We appreciate your time, efforts, valuable comments and suggestions that helped us to improve the manuscript quality. Please find below our point-by-point responses for all your comments. Reviewer #1: This is a very good manuscript. A very interesting and actual topic, which was very clear and well presented by the authors. The study design and statistical analysis are appropriate. The refferences are very well chosed. However, there are some minor issues that have to be addressed. 1. There are some minor ortographic erors (highlighted in the reviewed manuscript) Response: Thank you very much for the comment. A careful editing of the manuscript have been performed. Errors and typos are removed. Please see the manuscript submitted with the track changes. 2. In the tables is better to present the results as: numbers (and percentage) in order to be more explicit and to have a more real image of the values. For example: 10 (3.25). Response: Thank you for the comment. All table were recomposed and the results are presented in numbers (and percentages) as was suggested. Please see the manuscript submitted with the track changes. 3. A cross-sectional study CAN NOT BE a prospective study!!!!!! A cross-sectional study means like "a snapshot". A prospective study involves following up the subjects over a period of time (longitudinal collection of data). Response: Thank you or the comment. The error was removed and the sentence now appears as follows: “A prospective cross-sectional study among women from five cities of central (Nur-Sultan, the capital city), southern (Almaty), western (Aktobe), northern (Pavlodar), and eastern (Oskemen) parts of Kazakhstan was conducted from May 25, 2019, until December 2020.” 4. Usually in the "Conclusions" section the authors do not present figures and percentage form the "Results/ Discussions" sections. They present the general conclusions of the study, which were very well highlighted for the current research below the phrase with the figures, in the Conclusions section of the manuscript. Response: Thank you for the comment. The conclusion section was recomposed as was suggested and now appears as follows: “The results of this cross-sectional study suggests that the awareness of HPV among women visiting gynecological clinics in Kazakhstan is relatively high. However, the knowledge that HPV causes cervical cancer and awareness of HPV vaccination should be improved. As the success of the governmental programs for cervical cancer prevention largely depends on the population's knowledge and awareness of HPV and cervical cancer, there is an urgent need for educational intervention; both formal and informal. Population-based informational programs need to enhance the knowledge and awareness, which would increase understanding of the risks related to the HPV infection and its association with cervical cancer. Overall, this could improve the public's acceptance of the cervical cancer screening program in Kazakhstan.” #2 Dear Reviewer, Thank you very much for the careful evaluation of our manuscript. We appreciate your time, efforts, valuable comments and suggestions that helped us to improve the manuscript quality. Please find below our point-by-point responses for all your comments. Reviewer #2: Knowledge and awareness of HPV infection and HPV vaccine among Kazakhstani women Issa et al present the findings from the well done study “Kazakhstani women’s Knowledge and awareness of HPV infection and HPV vaccine.” The tables and figure are clear and concise. The text, in contrast, especially in RESULTS is difficult to read and needs to be simplified. For example, is it necessary to repeat the data from the tables, especially that contained in parentheses (e.g., AOR=0.73.; CI: 0.39-1.34, referent=age group of 18-25). L217: The text states that women age 46 and over were aware of HPV, which I take to mean this is an important finding. To me it then implies that younger women likely are not. Is it then necessary several lines later to actually state that younger women were not. Response: Thank you very much for the comment. We are very sorry for the issues with the test. For non-native English speakers it is challenging. The manuscript text has been reviewed by the coauthor, Professor from Touro University, USA, Azliyati Azizan. The text was made more simple and clear. The results section was simplified. L235-L240 The text repeats data in results. The entire RESULTS section should be made more readable Response: The results section was recomposed and repetitions in the text and tables were removed. L243: (Among those who were aware about HPV vaccine (N=1,215), less than half of the respondents (46.36%) knew that HPV is the major cause of cervical cancer). If I interpret the authors’ meaning correctly, fewer than half of the 1215 women who were aware of the vaccine understood what the vaccine treated because they were not aware that HPV is the cause of cervical cancer. If so, the implication the implication for the need for education is important: What is cancer and how does it come about; what are vaccines and what do they treat. Response: Thank you very much for the comment. We agree with the reviewer that the educational intervention is of a great importance and we highlighted it in the conclusion. L297-L304: Largely repeats the introduction. It should be truncated or eliminated. Much of the remaining DISCUSSION unnecessarily repeats the results and can be truncated. Response: Thank you for the comment. The discussion part was revised to eliminate repetitions between the discussion and the introduction and results parts. Please see the manuscript submitted with the track changes. The CONCLUSION section repeats too much of the results, but insufficiently says what was learned from the study. Response: Thank you for the comment. The conclusion section was recomposed as was suggested and now appears as follows: “The results of this cross-sectional study suggests that the awareness of HPV among women visiting gynecological clinics in Kazakhstan is relatively high. However, the knowledge that HPV causes cervical cancer and awareness of HPV vaccination should be improved. As the success of the governmental programs for cervical cancer prevention largely depends on the population's knowledge and awareness of HPV and cervical cancer, there is an urgent need for educational intervention; both formal and informal. Population-based informational programs need to enhance the knowledge and awareness, which would increase understanding of the risks related to the HPV infection and its association with cervical cancer. Overall, this could improve the public's acceptance of the cervical cancer screening program in Kazakhstan.” Attachments Attachment Submitted filename: Response to the reviewers.docx https://doi.org/10.1371/journal.pone.0261203.r002
29 Nov 2021 Decision Letter - Stanley J. Robboy, Editor Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinics PONE-D-21-11756R1 Dear Dr. Aimagambetova, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Stanley J. Robboy, MD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0261203.r003
Formally Accepted
3 Dec 2021 Acceptance Letter - Stanley J. Robboy, Editor PONE-D-21-11756R1 Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinics Dear Dr. Aimagambetova: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Stanley J. Robboy Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0261203.r004

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