Reviewer's report 
 Seroprevalence of hepatitis C and associated risk factors among an urban population in Haiti Title: 
 1  31 August 2004 Version: Date: 
 enea spada Reviewer: 
Reviewer's report: 
General 
The paper by Hepburn MJ and Lawitz EJ describes the seroprevalence of HCV infection and the 
associated risk factors among 500 healthy subjects who utilized hospital services in Cap-Haïtien, 
Haiti, and were considered to be representative of the urban population. The study is well conducted 
and written, but it doesn’t seem to be particularly original and is not free from some flaws, which 
somehow diminish the potential contribution of this paper to knowledge of the epidemiology of HCV 
infection in this Caribbean country. ------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
1. Methods (page 4). In which year were the subjects recruited and when HCV testing was 
performed? 2. Methods (page 4). Were the subjects frequenting the hospital and clinical services utilised to recruit them (how many services? In which areas of the city?) really representative of the overall 
urban population? This point is important to evaluate the degree of generalization of the results 
obtained in this survey. 3. Methods (page 4). The risk factors investigated do not include some important possible parenteral
ways of transmission such us dental therapy, medical or surgical invasive procedures (including 
haemodialysis), other beauty treatment (other than tattoos) or cohabitation with a HCV positive 
subject (including sexual partner), which all represent risk factors very common in the general population. 4. Methods (page 4 and 5). Age and sex are two variables associated with anti-HCV positive status 
and with sexual activity and drug abuse. It is not clear whether in the multivariate model used, with 
stepwise backward elimination of non-significant variables, an adjustment for age and sex was performed 5. Results. Table 1 would have been more explicative and informative whether the characteristics 
and survey responses of the population studied were also reported for both anti HCV positive and 
negative subjects. 6. Results ( page 5, first paragraph) and Discussion (page 7, second paragraph). As suggested above, the search for additional r risk factors other than those examined in this study, it would have 
been important to better define the possible risk of infection among the 22 subjects who reported no 
drug use, few lifetime sexual partners and who had no tattoos. 7. Discussion. Contrary of the authors’ opinion, I would not be so sure of the low rate of condom usage in this population, since this datum has been inferred from a study in which only youth aged 
15-19 years were investigated. 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None 
Reviewer's report 
 Seroprevalence of hepatitis C and associated risk factors among an urban population in Haiti Title: 
 1  31 August 2004 Version: Date: 
 enea spada Reviewer: 
Reviewer's report: 
General 
The paper by Hepburn MJ and Lawitz EJ describes the seroprevalence of HCV infection and the 
associated risk factors among 500 healthy subjects who utilized hospital services in Cap-Haïtien, 
Haiti, and were considered to be representative of the urban population. The study is well conducted 
and written, but it doesn’t seem to be particularly original and is not free from some flaws, which 
somehow diminish the potential contribution of this paper to knowledge of the epidemiology of HCV 
infection in this Caribbean country. ------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
1. Methods (page 4). In which year were the subjects recruited and when HCV testing was 
performed? 2. Methods (page 4). Were the subjects frequenting the hospital and clinical services utilised to recruit them (how many services? In which areas of the city?) really representative of the overall 
urban population? This point is important to evaluate the degree of generalization of the results 
obtained in this survey. 3. Methods (page 4). The risk factors investigated do not include some important possible parenteral
ways of transmission such us dental therapy, medical or surgical invasive procedures (including 
haemodialysis), other beauty treatment (other than tattoos) or cohabitation with a HCV positive 
subject (including sexual partner), which all represent risk factors very common in the general population. 4. Methods (page 4 and 5). Age and sex are two variables associated with anti-HCV positive status 
and with sexual activity and drug abuse. It is not clear whether in the multivariate model used, with 
stepwise backward elimination of non-significant variables, an adjustment for age and sex was performed 5. Results. Table 1 would have been more explicative and informative whether the characteristics 
and survey responses of the population studied were also reported for both anti HCV positive and 
negative subjects. 6. Results ( page 5, first paragraph) and Discussion (page 7, second paragraph). As suggested above, the search for additional r risk factors other than those examined in this study, it would have 
been important to better define the possible risk of infection among the 22 subjects who reported no 
drug use, few lifetime sexual partners and who had no tattoos. 7. Discussion. Contrary of the authors’ opinion, I would not be so sure of the low rate of condom usage in this population, since this datum has been inferred from a study in which only youth aged 
15-19 years were investigated. 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None 
Please review this paper.
user
Reviewer's report 
 Seroprevalence of hepatitis C and associated risk factors among an urban population in Haiti Title: 
 1  31 August 2004 Version: Date: 
 enea spada Reviewer: 
Reviewer's report: 
General 
The paper by Hepburn MJ and Lawitz EJ describes the seroprevalence of HCV infection and the 
associated risk factors among 500 healthy subjects who utilized hospital services in Cap-Haïtien, 
Haiti, and were considered to be representative of the urban population. The study is well conducted 
and written, but it doesn’t seem to be particularly original and is not free from some flaws, which 
somehow diminish the potential contribution of this paper to knowledge of the epidemiology of HCV 
infection in this Caribbean country. ------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
1. Methods (page 4). In which year were the subjects recruited and when HCV testing was 
performed? 2. Methods (page 4). Were the subjects frequenting the hospital and clinical services utilised to recruit them (how many services? In which areas of the city?) really representative of the overall 
urban population? This point is important to evaluate the degree of generalization of the results 
obtained in this survey. 3. Methods (page 4). The risk factors investigated do not include some important possible parenteral
ways of transmission such us dental therapy, medical or surgical invasive procedures (including 
haemodialysis), other beauty treatment (other than tattoos) or cohabitation with a HCV positive 
subject (including sexual partner), which all represent risk factors very common in the general population. 4. Methods (page 4 and 5). Age and sex are two variables associated with anti-HCV positive status 
and with sexual activity and drug abuse. It is not clear whether in the multivariate model used, with 
stepwise backward elimination of non-significant variables, an adjustment for age and sex was performed 5. Results. Table 1 would have been more explicative and informative whether the characteristics 
and survey responses of the population studied were also reported for both anti HCV positive and 
negative subjects. 6. Results ( page 5, first paragraph) and Discussion (page 7, second paragraph). As suggested above, the search for additional r risk factors other than those examined in this study, it would have 
been important to better define the possible risk of infection among the 22 subjects who reported no 
drug use, few lifetime sexual partners and who had no tattoos. 7. Discussion. Contrary of the authors’ opinion, I would not be so sure of the low rate of condom usage in this population, since this datum has been inferred from a study in which only youth aged 
15-19 years were investigated. 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None 
assistant