{"doi":"10.1002/cncr.35553","title":"Reply to “Assessing the impact of HIV status on cervical cancer treatment outcomes in Botswana: A commentary”","abstract":"We thank Dr Jeyaraj for taking the time to review our article and detailing some areas of further exploration. We hope our response addresses these topics effectively, outlines future directions of our research, and offers valuable ideas for other investigators working with similar data. Regarding your initial commentary on immunologic status, we concur that CD4 and viral load are useful markers. Although we intended to incorporate these into our analysis, the retrospective data revealed a high average CD4 count (>400 cell/mm3) across our cohort. This suggested strong antiretroviral compliance, making it difficult to study meaningful associations. In addition, there were inconsistencies in viral load documentation, limiting our exploration of this marker. Recognizing the importance of these factors, our research team previously investigated the impact of nadir CD4 counts on cancer treatment outcomes.1 We are also conducting a systematic literature review on the association of CD4 count and viral load with preinvasive and invasive cervical cancer and treatment response. With these data and improved documentation of viral loads in our patient population, we plan to incorporate these biomarkers into future studies at our center. In terms of antiretroviral therapy (ART) use, 95% of our study population are on ART, indicating a high usage rate in our population. Therefore, isolating the effects of ART in our patient population proved to be difficult; however, we ensured the inclusion of other studies with various ART levels in our discussion to provide a comprehensive review. We absolutely agree that quality of life is a crucial consideration in cancer care. The side effects of each chemotherapy regimen can vary significantly among patients, necessitating standardized methods to accurately quantify adverse reactions. Our team previously studied chemotherapy toxicities and responses to provide initial insights into adverse effects of which to be mindful.2 Recently, we submitted two articles focused on quality of life: one evaluating measures such as pain and functional status in patients with cervical cancer undergoing chemotherapy, and another offering a systemic literature review of quality-of-life measurements for patients with cervical cancer undergoing surgery and radiation therapy. In the current study, our patient population demonstrated high adherence to their treatment regimens, suggesting an understanding of the benefits versus the adverse risks. In addition, one way we accounted for patient baseline status was by calculating a performance score based on functional status for each patient, which we controlled for in our analysis to examine its relation with survivorship. Preventative screening and precancer treatment are integral parts of cervical cancer care. The site of this study is a multidisciplinary cancer clinic that focuses on cancer treatment. We have outlined our model of care in previous articles3 and will continue to provide updates as our clinic improves in efficiency and feasibility. We hope our documentation encourages others to incorporate similar models in areas with high human papillomavirus burden. We have conducted qualitative research to better understand the challenges of screening and to inform strategies for increasing access and reducing delays in care.4 Currently, we are collaborating with several HIV clinics on a project aimed at identifying gaps in knowledge and access to screening for HIV-positive women. We also acknowledge the importance of socioeconomic factors as potential barriers to care. Our site has conducted a multicountry, qualitative study across Botswana and Zimbabwe to elaborate on these unique barriers faced by different populations and to identify proposed solutions.5 We have used that analysis to help inform our approach for improving accessibility to cancer care. Finally, regarding your commentary on longitudinal analysis, we recognize it is an essential piece in cancer care. 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