Table 2 Implications of a conditional recommendation according to the factors that affected the strength and/or direction of the recommendation

Balance between desirable and undesirable effects

Consider whether the local incidence of the outcome of interest is high enough to tip the balance of benefits and harms in favor of implementing the intervention

Screening for asymptomatic STIs using nucleic acid amplification tests: “The benefits increase as the [HIV] prevalence increases. The benefits might outweigh the harms and cost if prevalence of asymptomatic urethral and rectal infections is higher than 1–2 %.”

Quality of evidence

Consider the willingness to accept the uncertainty about the effects of the intervention

Targeted internet-based strategies: “low quality of evidence…studies were rated down for study limitations, imprecision and indirectness.”

Values and preferences

Consider the local values and preferences

Male circumcision: The recommendation was conditional against in spite of the possibility of benefits outweighing harms: “participants raised questions about the relevance of circumcision in different cultural settings.”

Costs (resource allocation)

Consider the resources available and/or required locally, the local cost, and the opportunity cost given the local competing public health needs

Community-level behavioral interventions: “Behavioral interventions primarily require human resources for implementation; this may be a challenge in some settings. For these interventions to be successful, the necessary human resources, an enabling environment and adaptation to the local context will be necessary.”