Table 1 Summary of the challenges and applied solutions
Challenge | Solution applied |
|---|---|
Heterogeneous and complex interventions | · We defined a priori the classification of complex interventions (e.g., classifying behavioral interventions into individual, group and community levels) |
· When interventions were combined, we considered separately each component intervention to the extent that the available evidence allowed it | |
Paucity of trial data | · We considered evidence for effectiveness from observational studies |
· We used cross sectional studies to derive baseline risk appropriate for low, intermediate, and high risk groups | |
Selecting the outcomes of interest | · We selected outcomes in a transparent and comprehensive manner, and a priori |
· We developed outcome frameworks depicting causal pathways | |
Using indirect evidence | · For each intervention, we made judgments about the importance of the indirectness of the population (e.g., when applying evidence from MSM population to a transgender population) and of the setting (e.g., when applying evidence from high income countries to low- and middle-income countries) |
· We downgraded the quality of evidence when indirectness was judged as serious | |
Integrating values and preferences | · Community representatives were involved in the development and review of the guidelines |
· We conducted a survey of community members about the values and preferences they attach to the outcomes and interventions considered in the guideline questions | |
Considering resource use | · We did not consider this factor in a systematic and formal way |
· For each question, experts made judgments about the implications of resource use | |
Addressing social and legal barriers | · We issued ‘good practice recommendations’ based on the principles of medical ethics and human rights |
Wording of recommendations | · We used the term ‘conditional’ (instead of weak) for non-strong recommendation |
· We explained for each recommendation what the “conditions” for adoption are | |
Developing global guidelines | · The survey of values and preferences recruited participants globally. |
· We prioritized evidence of from low- and middle-income countries when available | |
· The panelists prioritized the perspective of low- and middle-income countries |