Using GRADE to develop the WHO guideline on verifying elimination of human onchocerciasis

Issue The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was initially developed to support guideline development for therapeutic decisions and recently was expanded to address diagnostic questions. We used GRADE for a guideline on the decision to stop mass drug administration (MDA) and to verify elimination of a disease. This is this first documented use of GRADE for this type of guideline. Problem Human onchocerciasis is caused by the parasitic worm Onchocerca volvulus and causes skin disease and “river blindness”. Several previously endemic countries have implemented MDA with ivermectin and successfully achieved elimination. Recently, the World Health Organization (WHO) updated its 2001 guidelines for the verification of elimination of onchocerciasis. We developed an analytic framework to describe the pathway from MDA to surveillance and verification of elimination of onchocerciasis. We systematically searched for published and unpublished studies and constructed a “linked evidence” chain. We combined evidence from diagnostic accuracy and observational studies and judged the certainty of the evidence using the applicable GRADE method. We then developed GRADE decision tables to summarize all the evidence for benefits and harms, cost, feasibility, equity, and acceptability. Effects In a face-to-face meeting, the guideline panel used the decision tables to make either strong or conditional recommendations for or against each test under consideration. Where available evidence was of very low certainty the panel members relied on their personal knowledge of data that were not publically available (e.g., internal government or WHO field office reports). Lessons Using an analytic framework and GRADE allowed us to present diverse evidence to the guideline panel in a structured manner; however personal knowledge of programme data played a role in panel decisions although it was not captured in the GRADE evidence summaries. Key messages: Providing evidence support for a WHO guideline on elimination of a disease required us to construct an analytic framework and combine multiple study types in a linked evidence chain The role of regular programme generated data (cf published studies) in informing WHO guidelines developed using the GRADE approach should be explored/defined

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.