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.
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.


CONCLUSIONS
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.
Department of Medicine, State University of New York at Buffalo, NY, USA. elieakl@buffalo.edu
Elie A
EA
Akl
Caitlin
C
Kennedy
Kelika
K
Konda
Carlos F
CF
Caceres
Tara
T
Horvath
George
G
Ayala
Andrew
A
Doupe
Antonio
A
Gerbase
Charles Shey
CS
Wiysonge
Eddy R
ER
Segura
Holger J
HJ
Schünemann
Ying-Ru
YR
Lo
D003906:Developing Countries; D019317:Evidence-Based Medicine / Q000379:methods; D015658:HIV Infections / Q000517:prevention & control / Q000628:therapy*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000628:therapy*; D063106:Transgender Persons; D014944:World Health Organization; D005260:Female