The World Health Organization (WHO) Global TB Programme convened a webinar on the WHO guideline development process, with a focus on guidelines for the management of multidrug-resistant TB (MDR-TB). The webinar was held on 27 February 2018, based on a request from civil society participants at a WHO meeting in January 2018 to discuss the process, format, and dissemination of WHO guidelines. The webinar was attended by more than 60 participants. Tereza Kasaeva, Director of the WHO Global TB Programme, opened the event and welcomed participants. The webinar was moderated by Haileyesus Getahun, Coordinator of TB/HIV and Community Engagement, Global TB Programme.
Nathan Ford, Chair of the WHO Guidelines Review Committee presented an overview of the WHO guidelines process including the composition of members of the guidelines development group who should be free from conflict of interest and should be representative with regard to geography, gender and all groups affected by the recommendations (download the presentation). He reiterated the importance of evidence based recommendations, which should be based on high quality systematic reviews. Ernesto Jaramillo, Medical Officer, Global TB Programme, presented the development process of WHO Guidelines on MDR-TB Management (download the presentation). He also highlighted current WHO plans to further update the guidelines and consolidate them in 2018. Additional inputs were provided by two civil society representatives (Lindsay McKenna from Treatment Action Group, USA and Jamilya Ismoilova from Project HOPE, Tajikistan) and Deputy Directors of National TB Programmes in South Africa (Norbert Ndjeka) and Belarus (Alena Skrahina).
Key issues discussed during the webinar are outlined below:
- WHO guidelines are widely adopted by countries because they are trustworthy. Making them clearer simple, consolidated, and available in multiple languages was emphasized.
- The stronger role and potential of WHO country offices in assisting the earlier uptake of guidelines and introducing them to the national programmes.
- There are very good country experiences and best practices on the rapid scale up and use of WHO guidelines, as well as the companion documents for implementation, such as the handbook for MDR-TB treatment guidelines.
- The transparent process of the WHO TB guidelines development was noted, with the information that statements on biographies and declarations of interest of guideline development group members are posted on the WHO website. A suggestion was made to make these easily accessible by consolidating them in one web page for WHO TB guidelines. It was also proposed that better ways of communication be developed to raise awareness about upcoming guidelines to civil society, partners and other end users.
- The tension between consolidation of guidelines and the need to respond rapidly to important emerging new evidence was noted.
- The recent request endorsed by 39 organizations for WHO to urgently recommend bedaquiline as part of the preferred treatment regimen for MDR-TB and to relegate injectables for use only in more complicated DR-TB cases was raised again by participants during discussions. This will be looked into as per the requirements of WHO guidelines development processes.
- The webinar was appreciated by participants and WHO informed the group that a series of similar TB webinars will be held on different topics in the future.