|Developing HIV/AIDS Treatment Guidelines (UNAIDS, 1999, 43 p.)|
|Part 2: Developing valid HIV/AIDS guidelines|
|Steps in developing HIV/AIDS treatment guidelines|
The ultimate measure of the impact of guidelines is their effect on health outcomes. When improvements occur, the guidelines can be said to be useful and, if not, then there is a need to review them to identify the cause. The development of HIV/AIDS guidelines has policy implications in several areas of society that need to be examined, since the guidelines cannot be based only on the clinical criteria, without considering resource limitations and feasibility issues.
Practice guidelines may not be feasible if there are no resources to pay for the changes required in drug supply and in the capacity of the community to pay. In the field testing of the Uganda guidelines it was found that, if they were to be followed, the recommended drugs and supplies must be available. If these services cannot be paid for by the individual or the government, the whole exercise of guideline development becomes a futile attempt to improve prescribing. A cost analysis of the suggested treatment regimens would have to be considered as part of the guideline development, especially when expensive treatments are being considered for inclusion.
The recommendations in the guideline may also require a change in policies for the prescription of medicines. A review of the legal implications of each recommendation should therefore be made to keep in line with existing law or to recommend appropriate changes.
Other feasibility issues for consideration are: ability to use and remember the guideline; available staff and equipment; the use of the guidelines by the target population; and time pressures.