APPLYING EVIDENCE MAPPING METHODOLOGIES TO THE WORLD HEALTH ORGANIZATION’S TUBERCULOSIS GUIDELINES

Abstract

Background: Tuberculosis (TB) is the number one infectious disease killer in the world. TB is both preventable, and curable. Since 1997, the World Health Organization’s (WHO) Global TB (GTB) Programme has released evidence-informed publications to guide member states. In their EndTB strategy, the WHO set a mandate to eradicate TB by 2035, in part by intensifying TB research and innovation. As an effort towards this goal, this project applies evidence mapping methodologies to published WHO TB recommendations, in an innovative process called “recommendation mapping” (RM). Objectives: The prime objective of RM is to allow guideline developers and key stakeholders to identify gaps and clusters of recommendations across publications, serve as an instrumental tool in the sequence of guideline development (from intelligent priority setting, to the assembly of final recommendations) and increase the accessibility of key guideline components. The secondary objective of this work is to poise guideline components for live update and refinement in a rapidly learning health system. Methods: In this mixed methods study, a methodological framework for mapping guideline components is proposed, with both a quantitative and narrative assessment of raw data and final map outputs. A qualitative analysis from the perspective of key stakeholders, policy-makers, researchers and WHO-GTB liaisons working in guideline development is also included. For the methodological piece, all publications containing WHO TB recommendations were eligible for the mapping exercise. Each recommendation was extracted according to all subdomains of their PICO backbone. Subsections of recommendations are coded using existing ontologies (SNOMED-CT, ATC, ICD-11). A centralized database containing extracted and coded recommendations was then presented in an online and interactive schematic. For the qualitative assessment of palatability of this approach within the organization, semi-structured interviews and a survey was delivered to eligible participants at two Guideline Development Group meetings for WHO tuberculosis treatment and screening guidelines. Results: The notable result of this work is the development, refinement and application of recommendation mapping methodologies. 20 WHO-GTB guidelines underwent an application of the novel recommendation methodologies proposed in this thesis to create an interactive map, and a searchable database. In-depth interviews and survey results with 21 participants (WHO GTB staff, WHO TB- guideline development group members and technical experts) pointed to concerns in the current accessibility and organization of WHO-GTB guidelines. Conclusions: Recommendation mapping may have utility in charting the terrain of recommendations, inform priority setting, and provide a scaffold for the future transition to living guidelines.