{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:34Z","timestamp":1772168914010,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.158796.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000}}],"reference-count":21,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background Cervical cancer poses a significant health threat, especially for women living with HIV, who are at increased risk of developing premalignant cervical lesions. Large Loop Excision of the Transformation Zone (LLETZ) is a standard treatment for cervical intraepithelial neoplasia (CIN) to prevent progression to malignancy. This study explores the experiences of HIV-positive women who underwent LLETZ in Vhembe District, South Africa, where access to such specialized treatments remains limited. Methods Using a qualitative, phenomenological approach, this study engaged seven HIV-positive women who underwent LLETZ, capturing their lived experiences through in-depth, unstructured interviews. Thematic analysis identified key themes and subthemes to elucidate their psychological, physical, and social encounters related to the procedure. Results Analysis revealed eight central themes: psychological and physical experiences, psychosocial and financial support, misconceptions, education, recommendations, and time-related factors. Participants reported anxiety, fear, and initial stress about the procedure, coupled with resilience and acceptance over time. Physical effects such as pain and bleeding were common, though recovery experiences varied. Social support from family and community played a critical role in coping, while financial constraints impacted access to and continuity of care. Misunderstandings about the LLETZ procedure underscored the need for enhanced patient education. Participants emphasized timely screening and support systems to improve treatment outcomes and reduce psychological distress. Conclusions The study highlights the multifaceted impact of LLETZ on HIV-positive women, including the psychological and financial burdens and the importance of clear communication and patient education. Improved support structures, timely result communication, and access to follow-up care are essential to enhance patient outcomes. Recommendations advocate for health system improvements, partner involvement, and proactive counselling to address the specific needs of HIV-positive women undergoing cervical cancer prevention treatments.<\/ns3:p>","DOI":"10.12688\/f1000research.158796.2","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T14:11:20Z","timestamp":1757081480000},"page":"382","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Experiences of women living with HIV who underwent long loop excision of the transformation zone (LLETZ) in selected hospitals of Vhembe district, Limpopo province, South Africa"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4579-6108","authenticated-orcid":false,"given":"Mabareki Cecilia","family":"Machaba Sikhwetha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1689-9308","authenticated-orcid":false,"given":"Lufuno","family":"Makhado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"9-19","DOI":"10.7575\/aiac.ijels.v.5n.2p.9","article-title":"The interpretative phenomenological analysis (IPA): A guide to a good qualitative research approach.","volume":"5","author":"A Alase","year":"2017","journal-title":"International Journal of Education and Literacy Studies."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"313-317","DOI":"10.7727\/wimj.2013.223","article-title":"Cervical intraepithelial neoplasia in a cohort of HIV-positive women at the University Hospital of the West Indies: Management and outcome.","volume":"62","author":"I Bambury","year":"2013","journal-title":"West Indian Med. 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Health."},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.17605\/OSF.IO\/BKNS5","article-title":"Experiences of women living with HIV who underwent long loop excision of the transformation zone (LLETZ) in selected hospitals of Vhembe district, Limpopo province, South Africa.","author":"L Makhado","year":"2025, March 23"}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/14-382\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/14-382\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/14-382\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T19:10:35Z","timestamp":1763665835000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/14-382\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":21,"URL":"https:\/\/doi.org\/10.12688\/f1000research.158796.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.158796.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.187671.r414049","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.187671.r414049","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/14-382\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.174437.r375660, Mygirl Lowane, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 12 Apr 2025, version 1, 1 approved, 1 not approved","URL":"https:\/\/f1000research.com\/articles\/14-382\/v1#referee-response-375660","order":0,"name":"referee-response-375660","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.174437.r375659, Chemtai Mungo, University of North Carolina, Chapel Hill, Carolina, 12 Jun 2025, version 1, 1 approved, 1 not approved","URL":"https:\/\/f1000research.com\/articles\/14-382\/v1#referee-response-375659","order":1,"name":"referee-response-375659","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>LUFUNO MAKHADO<\/b>; \n<i>Posted: 02 Sep 2025<\/i>; \n<b>Point to Point Response to Reviewers<\/b> We sincerely thank the reviewers for their thoughtful and constructive comments, which have helped us improve the clarity, coherence, and scholarly quality of our manuscript. Below, we respond point by point, indicating the revisions made. \n<b>Reviewer Comment 1<\/b> \u201cPlease restructure the Introduction to follow the standard \u2018funnel\u2019 approach\u2014beginning with a broad overview of the field, narrowing to the specific knowledge gap, and ending with a clear statement of the study objective. At present, the objective is placed in the opening paragraph, which disrupts the logical flow and makes the section difficult to follow. See Mensh &amp; Kording, 2017.\u201d \n<b>Response<\/b> We thank the reviewer for this important suggestion. We have restructured the Introduction to follow the funnel approach. It now begins with the global burden of cervical cancer, narrows to the specific issue of LLETZ treatment in HIV-positive women, highlights the lack of tailored recommendations and the absence of qualitative data on women\u2019s lived experiences, and concludes with a clear statement of the study objective in the final paragraph. This aligns with the guidance of Mensh &amp; Kording (2017). \n<b>Reviewer Comment 2<\/b> \u201cPlease relocate the statement of the study objective to the final paragraph of the Introduction, in keeping with conventional manuscript structure.\u201d \n<b>Response<\/b> We agree with this recommendation. The statement of the study objective has been moved from the opening paragraph to the concluding paragraph of the Introduction to ensure a conventional scientific structure and logical flow. \n<b>Reviewer Comment 3<\/b> \u201cThe link provided for \u2018Jo\u2019s Cervical Cancer Trust (2020)\u2019 is inactive, and the source does not appear to be a peer-reviewed reference. Please replace it with a scholarly citation that reports LLETZ efficacy, and specify whether the quoted success rate applies to HIV-negative or HIV-positive women. Published data indicate substantially lower cure rates in HIV-positive cohorts.\u201d \n<b>Response<\/b> We appreciate this observation. The non-peer-reviewed source has been replaced with a scholarly citation: Debeaudrap et al. (2019), which reports pooled cure rates of ~78.6% in HIV-positive women compared to &gt;90% in HIV-negative women. The text has been revised to clearly specify these differences. \n<b>Reviewer Comment 4<\/b> \u201cParagraph 3 of the Introduction contains a typographical error: \u201878,6 %\u2019 should read \u201878.6 %\u2019.\u201d \n<b>Response<\/b> We thank the reviewer for identifying this typographical error. It has been corrected to \u201c78.6 %.\u201d \n<b>Reviewer Comment 5<\/b> \u201cIn the same paragraph, the phrase \u2018the absence of specific recommendations for this high-risk group\u2019 is unclear, given your earlier statement that LLETZ is recommended for CIN 2\/3 in HIV-positive women. Please clarify which recommendations are lacking.\u201d \n<b>Response<\/b> We appreciate this request for clarification. The text has been revised to specify that while LLETZ is recommended for CIN2\/3 in HIV-positive women, there is an absence of tailored recommendations for follow-up intervals, recurrence management, and long-term monitoring in this group. \n<b>Reviewer Comment 6<\/b> \u201cPre-test section: Omit routine details such as checking pens, notebooks, or recorder batteries; these are assumed and do not add value to the manuscript.\u201d \n<b>Response<\/b> We agree with this suggestion. The Pre-test section has been streamlined, and routine details about equipment checks have been removed. The section now focuses only on methodological relevance, such as the refinement of probing techniques. \n<b>Reviewer Comment 7<\/b> \u201cDo not capitalise \u2018participant seven\u2019 or similar descriptors within sentences; they are common nouns.\u201d \n<b>Response<\/b> We thank the reviewer for pointing this out. All instances of \u201cParticipant [number]\u201d have been changed to lowercase (e.g., \u201cparticipant seven\u201d) throughout the manuscript. \n<b>Reviewer Comment 8<\/b> \u201cUnder Theme 1, the term \u2018benignancy\u2019 is uncommon in cervical cancer literature. Consider defining it or substituting a more widely used term.\u201d \n<b>Response<\/b> We appreciate this observation. The term \u201cbenignancy\u201d has been replaced with the more widely accepted phrase \u201cbenign outcome\u201d to ensure clarity and alignment with standard terminology in cervical cancer literature. \n<b>Conclusion <\/b> We are grateful to the reviewers for their careful reading and constructive feedback. The suggested revisions have improved the manuscript\u2019s structure, clarity, and alignment with scholarly standards. We hope that the revised version satisfactorily addresses all concerns. Kindest regards \n<b>Lufuno.<\/b>","URL":"https:\/\/f1000research.com\/articles\/14-382\/v2#referee-comment-14492","order":2,"name":"referee-comment-14492","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.187671.r414049, Tintswalo Victoria Nesengani, University of Pretoria, Pretoria, Gauteng, 01 Oct 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/14-382\/v2#referee-response-414049","order":3,"name":"referee-response-414049","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}