From Research to Policy: The WHO Experience With Developing Guidelines on the Potential Risk of HIV Acquisition and Progestogen-Only Contraception Use

Abstract

To develop guidance for women at high risk of HIV, WHO carefully considered the risks of maternal morbidity and mortality from unintended pregnancy against possible increased risk of HIV acquisition with injectable use. Among the many challenges: (1) balancing timeliness of changing the guidance against the potential impact of it; (2) engaging a range of stakeholders; (3) translating complex research and policy messages to clients; (4) needing additional research; and (5) monitoring and evaluating successes and challenges with implementing new guidelines.

FIGURE 1.

Prevalence of Injectable Contraceptive Use and HIV Prevalence by Country Abbreviation: IHC, injectable hormonal contraception. Note: sub-Saharan African countries in red have both high HIV prevalence and high injectable hormonal contraception use. Source: Reproduced from Butler et al. 2013 with permission.

FIGURE 2.

WHO Timeline of Events From Publication of Research on Possible Increased Risk of HIV Acquisition in POI Users to Guideline Dissemination to Policy Implementation Abbreviations: MEC, Medical Eligibility Criteria for Contraceptive Use; POI, progestogen-only injectables; WHO, World Health Organization. § Two webinars in February 2017 prepared 75 WHO country office team members, ministry of health representatives, family planning donors, and researchers for the publication of the updated guidelines. Following publication, a key stakeholder dissemination meeting was held in Johannesburg, South Africa, in April 2017 with 59 participants. Additional webinars to further disseminate the new guidance were held in April 2017 (156 participants) and May 2017 (98 French-speaking participants).

FIGURE 3.

WHO Process of Translating Research to Health Policy Abbreviations: WHO, World Health Organization. The WHO reviews newly published research that has the potential to impact health policy during technical consultations with experts in the field. WHO may commission a systematic review of the topic to help collate data and interpret the potential global public health impact of the findings. Experts at the technical consultation will come to consensus on how the research should inform WHO guidelines. The guidelines are then disseminated to key stakeholders (e.g., ministries of health, NGOs, donors, and civil society) for review and comments. Stakeholders help develop policies at the national to the local service delivery levels and communicate updates to service providers and clients. Service providers and clients may provide feedback about policies, resulting in further changes. WHO and stakeholders evaluate and monitor the policies and their implementation, which then informs guideline updates and identifies research gaps.