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Challenges in developing national HIV guidelines: experience from the eastern Mediterranean.

Abstract：

OBJECTIVE:To appraise the process of development and clinical content of national human immunodeficiency virus (HIV) clinical practice guidelines of countries in the eastern Mediterranean and to formulate recommendations for future guideline development and adaptation. METHODS:Twenty-three countries in the World Health Organization (WHO) Eastern Mediterranean and United Nations Children's Fund Middle East and North Africa regions were invited to submit national HIV clinical practice guidelines for review. The guideline development methodology was assessed using an adaptation of the Appraisal of Guidelines Research and Evaluation (AGREE) instrument and guideline content, using a checklist to evaluate concordance with WHO 2006 generic guidelines. FINDINGS:Twelve countries submitted 20 guidelines developed between 2004 and 2009. Median scores were poor (i.e. < 0.6) for the methodological quality domains of rigour of development, stakeholder involvement and applicability and flexibility. Scores were better for the domains of scope and purpose (median: 0.82, interquartile range, IQR: 0.58-0.89) and clarity and presentation (median: 0.67, IQR: 0.50-0.78). Concerning guideline content, recommended first-line treatment and eligibility criteria for antiretroviral therapy (ART) in adults were in line with WHO recommendations in most guidelines. However, recommendations on antiretroviral prophylaxis for the prevention of vertical HIV transmission, diagnosis and treatment of HIV infection in infants, monitoring patients on ART, treatment failure and co-morbidities were often lacking. CONCLUSION:The large majority of national HIV clinical practice guidelines had methodological weaknesses and content inaccuracies. Countries require assistance with the adaptation process to ensure that guidelines are valid and up to date and accurately reflect WHO global clinical care recommendations for patients with HIV.

journal_name

Bull World Health Organ

journal_title

Bulletin of the World Health Organization

authors

De Weggheleire A,Bortolotti V,Zolfo M,Crowley S,Colebunders R,Riedner G,Lynen L

doi

10.2471/BLT.10.083790

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

442-50

issue

eissn

0042-9686

issn

1564-0604

pii

BLT.10.083790

journal_volume

pub_type

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Challenges in developing national HIV guidelines: experience from the eastern Mediterranean.