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Is it possible to develop guidance for HIV care in resource-poor settings with evidence from resource-poor settings?

David Tovey and Paul Collini.
Clinical Evidence, BMJ, UK.

paulcollini doesnotexist@cochrane.org doctors.org.uk

Objective: To discuss and develop ideas as to what strategies might enable maximal use of evidence from resource-poor settings when developing guidelines for HIV care in such settings.

Summary: The HIV pandemic presents many challenges to those delivering medical care in resource-poor settings. As antiretroviral based HIV care is rapidly scaled up it is more important than ever that clinicians have access to sound evidence-based information and guidance to maintain best practice. But there is a problem: HIV care in resource-poor settings is not equivalent to care in resource-rich settings - the people, the virus, the HIV associated illnesses and the infrastructure for care delivery are all different to name a few. Yet guidelines for HIV management continue to rely heavily on evidence from studies in resource-rich settings. Inevitably there are questions concerning the directness and generalisability of such evidence from one setting to the other. The root cause of this problem is of course the paucity of high quality evidence from randomized controlled trials in resource-poor settings. Nevertheless, evidence does exist that deserves consideration. By way of introduction, we will briefly present our own progress and the challenges faced in trying to find, appraise and summarise such evidence and an analysis of its worth using GRADE criteria. This will then open into a discussion about how to overcome the methodological challenge of using limited but direct evidence from resource-poor settings alongside the less direct but more abundant evidence from resource-rich settings to provide usable guidance for clinicians delivering the care. By the close of the workshop we aim to summarise the discussion with some ideas as to which strategies are appropriate and where the pitfalls may be in this endeavour.


Level of knowledge required to attend: intermediate.