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Open Access Highly Accessed Correspondence

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 Akl12*, Caitlin Kennedy3, Kelika Konda4, Carlos F Caceres5, Tara Horvath6, George Ayala7, Andrew Doupe8, Antonio Gerbase9, Charles Shey Wiysonge10, Eddy R Segura11, Holger J Schünemann2 and Ying-Ru Lo9

Author Affiliations

1 Department of Medicine, State University of New York at Buffalo, New York, USA

2 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada

3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

4 Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru

5 Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru

6 Cochrane Review Group on HIV/AIDS, University of California, San Francisco, USA

7 The Global Forum on MSM & HIV, Oakland, CA, USA

8 Independent Consultant, Broadbeach Waters, Australia

9 Department of HIV/AIDS, World Health Organization, Geneva, Switzerland

10 Institute of Infectious Disease and Molecular Medicine & Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa

11 Universidad Peruana Cayetano Heredia, Lima, Peru

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BMC Public Health 2012, 12:386  doi:10.1186/1471-2458-12-386

Published: 28 May 2012

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.