title: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat, Antwerp, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: De Weggheleire
authors.forename: Veronique
authors.initials: V
authors.lastname: Bortolotti
authors.forename: Maria
authors.initials: M
authors.lastname: Zolfo
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crowley
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Gabriele
authors.initials: G
authors.lastname: Riedner
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Lynen
mesh_terms: D000352:Africa, Northern / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D004493:Education; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D038622:Internationality; D019083:Mediterranean Region / Q000453:epidemiology; D008877:Middle East / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014480:United Nations; D014944:World Health Organization