Bulletin of the World Health Organization

Challenges in developing national HIV guidelines: experience from the eastern Mediterranean

Anja De Weggheleire, Veronique Bortolotti, Maria Zolfo, Siobhan Crowley, Robert Colebunders, Gabriele Riedner & Lutgarde Lynen

Volume 89, Number 6, June 2011, 442-450

Table 2. Scores on quality domains of the methodology appraisal toola for 20 clinical practice guidelines for human immunodeficiency virus (HIV) infection from national AIDS programmes in the eastern Mediterranean,b 2009

Review team National AIDS programme Guideline subjectc (publication year) Mean quality domain scored
Scope and purpose Stakeholder involvement Rigour of development Clarity and presentation Applicability and flexibility
Team 1 A ART in adults (2007) 0.50 0.42 0.54 0.64 0.48
B Comprehensive (2006) 0.86 0.44 0.04 0.24 0.33
C Comprehensive (2008) 0.58 0.61 0.56 0.50 0.42
Team 2 D Comprehensive (2004) 0.81 0.67 0.23 0.30 0.24
E Comprehensive (2008) 0.97 0.70 0.52 0.78 0.65
Team 3 F PMTCT (2005) 0.89 0.59 0.43 0.67 0.38
OI (2006) 0.81 0.57 0.51 0.67 0.68
ART in adults (2008) 0.78 0.65 0.52 0.69 0.51
G PMTCT (2008) 0.96 0.61 0.44 0.85 0.81
Comprehensive (2005) 0.54 0.50 0.35 0.44 0.44
H Comprehensive (2009) 0.88 0.52 0.44 0.67 0.69
Team 4 I PMTCT (2009) 1.00 0.33 0.58 0.94 0.86
PEP (2006) 0.75 0.41 0.33 0.70 0.65
ART in children (2006) 0.57 0.47 0.35 0.94 0.73
J PMTCT (2006) 0.54 0.17 0.24 0.44 0.46
Comprehensive (2006) 0.83 0.39 0.33 0.50 0.63
Team 5 K PMTCT (2006) 0.83 0.56 0.57 0.78 0.60
ART in adults (2006) 0.85 0.69 0.58 0.70 0.53
ART in children (2006) 0.96 0.75 0.71 0.88 0.75
L ART in adults (2007) 0.50 0.33 0.47 0.57 0.52

AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; OI, opportunistic infection prevention and treatment; PEP, postexposure prophylaxis; PMTCT, prevention of mother-to-child HIV transmission.

a The methodology appraisal tool was based on the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.

b Countries were in the World Health Organization Eastern Mediterranean Region or the United Nations Children’s Fund Middle East and North Africa Region.

c Comprehensive guidelines covered more than one topic: for example, they may have included recommendations on postexposure prophylaxis and on ART for adults and children.

d Standardized scores ranged from 0 (lowest) to 1 (highest). A score of 0.6 or more was regarded as indicating reasonable quality.