|Developing HIV/AIDS Treatment Guidelines (UNAIDS, 1999, 43 p.)|
|Part 2: Developing valid HIV/AIDS guidelines|
|Steps in developing HIV/AIDS treatment guidelines|
Guidelines can be deterministic or branching in structure, or a combination of the two. The choice of which form is most appropriate depends on the target group and the recommendations of the guideline.
Deterministic guidelines comprise a fixed list of elements to be followed regardless of what information is available to the clinician. An example would be guidelines developed to deal with a life-threatening condition. These would be restrictive and less appropriate for use in routine practice as they ignore the deductive and interactive nature of decision-making9.
Branching guidelines recommend a course of action at each stage of a situation, depending on the information available to the clinician. These are usually presented as algorithms (flowcharts) or as a narrative. An example of this is WHO s HIV clinical management guidelines for adults and children, which are presented as algorithms with annotations giving options on actions to take at each point of the decision tree. This allows the guidelines to be more detailed, comprehensive and useful. This format is also useful for training/teaching purposes and for reference. A disadvantage, however, is that it makes for bulky guidelines that are not easy to carry around, especially for the busy clinician.
HIV/AIDS recommendations can be incorporated into general medical practice guidelines. The expense of developing these guidelines is lower as they deal with other medical problems besides HIV/AIDS in one volume. Examples are the Essential drugs list for Zimbabwe10 and the Standard treatment guidelines for Malawi11 which incorporate HIV/AIDS treatment recommendations. These are often more convenient to use on clinical ward rounds.