A very low number of national adaptations of the World Health Organization guidelines for HIV and tuberculosis reported their processes

J Clin Epidemiol. 2016 Dec;80:50-56. doi: 10.1016/j.jclinepi.2016.07.017. Epub 2016 Aug 24.


Background: Low- and middle-income countries adapt World Health Organization (WHO) guidelines instead of de novo development for financial, epidemiologic, sociopolitical, cultural, organizational, and other reasons.

Objective: To systematically evaluate reported processes used in the adaptation of WHO guidelines for human immunodeficiency virus (HIV) and tuberculosis (TB).

Methods: We searched three online databases/repositories: United States Agency for International Development (USAID) AIDS Support and Technical Resources - Sector One program (AIDSTAR-One) National Treatment Database; the AIDSspace Guideline Repository, and WHO Database of national HIV and TB guidelines. We assessed the rigor and quality of reported adaptation methodology using the ADAPTE process as benchmark.

Results: Of 170 eligible guidelines, only 32 (19%) reported documentation on the adaptation process. The median and interquartile range of the number of ADAPTE steps fulfilled by the eligible guidelines were 11.5 (10, 13.5) (out of 23 steps). The number of guidelines (out of 32 steps) fulfilling each ADAPTE step was 18 (interquartile range, 5-27). Seventeen of 32 guidelines (53%) met all steps relevant to the setup phase, whereas none met all steps relevant to the adaptation phase.

Conclusion: The number of well-documented adaptation methodologies in national HIV and/or TB guidelines is very low. There is a need for the use of standardized and systematic framework for guideline adaptation and improved reporting of processes used.

Keywords: ADAPTE; AGREE; AIDS; Adaptation; Adoption; GRADE; Guidelines; HIV; Tuberculosis.

Publication types

  • Review

MeSH terms

  • Guideline Adherence / statistics & numerical data*
  • HIV Infections / diagnosis
  • HIV Infections / therapy*
  • Humans
  • Practice Guidelines as Topic*
  • Tuberculosis / diagnosis
  • Tuberculosis / therapy*
  • World Health Organization*