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Review
. 2012 May 28:12:386.
doi: 10.1186/1471-2458-12-386.

Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people

Elie A Akl  1 , Caitlin Kennedy, Kelika Konda, Carlos F Caceres, Tara Horvath, George Ayala, Andrew Doupe, Antonio Gerbase, Charles Shey Wiysonge, Eddy R Segura, Holger J Schünemann, Ying-Ru Lo
Affiliations
Review

Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people

Elie A Akl et al. BMC Public Health. .

Abstract

Background: The World Health Organization (WHO) Department of HIV/AIDS led the development of public health guidelines for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines.

Methods: The development of the guidelines followed the WHO guideline development process, which utilizes the GRADE approach. We identified, categorized and labeled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication.

Results: We describe how we dealt with the following challenges: (1) heterogeneous and complex interventions; (2) paucity of trial data; (3) selecting outcomes of interest; (4) using indirect evidence; (5) integrating values and preferences; (6) considering resource use; (7) addressing social and legal barriers; (8) wording of recommendations; and (9) developing global guidelines.

Conclusion: We were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development.

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Figures

Figure 1
Figure 1
Example of an outcome framework for a testing and counseling intervention.
Figure 2
Figure 2
Example of an outcome framework for a prevention intervention.
See this image and copyright information in PMC

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