Book traversal links for 1.2.5 Evidence Grading and Formulation of Recommendations
Coordinated action is often enhanced by the provision of a framework that facilitates the implementation of multi-component guidelines. Although recommendations are placed into a framework, no level of evidence is given for use of this framework. Those implementing these guidelines could decide for themselves whether this framework is useful.
While assessment of the quality of evidence is given for all recommendations, this level, as detailed in the explanations in each recommendation table, is derived from evidence assessments found in other guidelines as well as results of the various components of the evidence-gathering process described. For the provision of isoniazid preventive therapy (IPT) for example, systematic reviews were available that determined the efficacy of this measure in preventing TB. The impact of antiretroviral therapy on reduction of TB incidence in HIV positive patients had also already been documented. As provision of these medications should be considered as part of a package of prevention, treatment, care and support for health workers, these are included in these guidelines.
All recommendations are graded 'strong', in accordance with the grading recommendations of the WHO Handbook for Guideline Development (2010), that only recognizes two categories; strong and weak, whereby the strength of a recommendation reflects the degree that the desirable effects of a strong adherence to the recommendation outweigh the undesirable effects.
Note that the strength of the recommendations took into consideration not only the quality of evidence as rated in traditional Cochrane-style systematic reviews, but also whether advantages outweighed disadvantages and the strength of the values on which the recommendations were based, as well as cost and feasibility considerations. Values, preferences, and ethical considerations were informed by input from healthcare workers, citizens, clinicians and individuals living with HIV. A 'strong' recommendation is one in which there was a very strong consensus among guideline group members that this recommendation is essential to the achieving of the desired outcomes. The procedure for grading of evidence from the Cochrane-Style Systematic Review is provided elsewhere.