Annex 2. GDG processes and decision-making

For every GDG meeting PICO questions were drafted by the WHO steering group and were presented to the respective GDG for discussion and modification. The WHO steering group has been making an initial list of patient-important outcomes, including desirable and undesirable effects and has solicited feedback from the Guideline Development Group to identify any other outcomes. The outcomes were further rated, according to the procedure described in WHO handbook for guideline development (2nd edition)

The GDG meetings in 2010 and 2018 were conducted as face-to-face meeting, whereas in 2022 in the format of half day sessions for 10 days as a virtual meeting considering the situation with COVID-19 and related travel restrictions. A descriptive analysis of qualitative data, the economic analyses were presented during the introductory webinars along with the process for assessing the evidence for each of the PICO questions. In every meeting decisions were based on consensus (preferred option) or else by voting (with simple majority rule) only if consensus is not achieved. Concerns and separate opinions by members if any were noted and included in the final Evidence-to-decision tables. The guideline narrative were undergoing several iterations (managed by the WHO steering group).

In an online setting, the meeting participants were required to include their names as identifiers, so as various types of meeting participants, i.e. steering committee members, GDG members, systematic reviewers can be easily identified. Participation in discussion were prioritized for GDG members. Steering committee members and consultants with specialized technical expertise were invited by chair-persons to provide feedback when necessary. Observers participation were limited to the feedback after all above-mentioned categories of the meeting participants. All three last categories of the meeting participants were excluded from recommendation deliberation and voting.

Draft WHO policy guidance based on the consensus recommendations will subsequently be prepared by the WHO steering group and reviewed by both the Guideline Development Group and the External Review Group, before finalization.

⁷ Handbook for Guideline Development 2nd Ed. Geneva: World Health Organization; 2014 ( item/9789241548960, accessed 1 June 2018)

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