Translating international HIV treatment guidelines into local priorities in Indonesia

Abstract

Abstractobjective International guidelines recommend countries to expand antiretroviral therapy (ART) to all HIV-infected individuals and establish local-level priorities in relation to other treatment, prevention and mitigation interventions through fair processes. However, no practical guidance is provided for such priority-setting processes. Evidence-informed deliberative processes (EDPs) fill this gap and combine stakeholder deliberation to incorporate relevant social values with rational decisionmaking informed by evidence on these values. This study reports on the first-time implementation and evaluation of an EDP in HIV control, organised to support the AIDS Commission in West Java province, Indonesia, in the development of its strategic plan for 2014-2018.methods Under the responsibility of the provincial AIDS Commission, an EDP was implemented to select priority interventions using six steps: (i) situational analysis; (ii) formation of a multistakeholder Consultation Panel; (iii) selection of criteria; (iv) identification and assessment of interventions' performance; (v) deliberation; and (vi) selection of funding and implementing institutions. An independent researcher conducted in-depth interviews (n = 21) with panel members to evaluate the process.results The Consultation Panel included 23 stakeholders. They identified 50 interventions and these were evaluated against four criteria: impact on the epidemic, stigma reduction, cost-effectiveness and universal coverage. After a deliberative discussion, the Consultation Panel prioritised a combination of several treatment, prevention and mitigation interventions.conclusion The EDP improved both stakeholder involvement and the evidence base for the strategic planning process. EDPs fill an important gap which international guidelines and current tools for strategic planning in HIV control leave unaddressed.

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

“…The overall concept of EDPs stems from the general principle of legitimacy, the definition of four elements is a practical translation of the Accountability for Reasonableness framework, 5 the definition of practical steps is based on existing HTA methods and tools, whereas related recommendations on best practices are inferred from observed practices of HTA bodies around the world. The development process itself was geared through academic knowledge exchange 15,[18][19][20][21][22][23][24][25][26][27][28] and the experience of implementing EDPs in several countries. We also surveyed HTA bodies and experts around the globe on their need for guidance.…”

“…EDPs are currently employed by national health authorities in Ghana, Iran, Moldova, Pakistan and Ukraine for revision of their health benefit packages, 12 and its principles were previously applied for similar use in Kazakhstan, Thailand, 13 the Netherlands 14 and Indonesia. 15 A companion paper reports on the development of the conceptual framework of EDPs. 8 This paper first describes the development process of practical guidance on EDPs.…”

Stakeholder participation on the path to universal health coverage: the use of evidence‐informed deliberative processes

“…After a deliberative discussion, the committee prioritised a combination of several treatment, prevention and mitigation interventions, and identified the organisations to implement and fund the prioritised activities. This evidence‐informed deliberative process improved both stakeholders’ involvement and the evidence base of the strategic planning process .…”

On Fundamental Premises for Addressing "Context" and "Contextual Factors" Influencing Value Decisions in Healthcare Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis"

“…Efforts are being made to clarify how value decisions in healthcare in real-world settings – acknowledged as inevitably contextualized under the influence of factors that do not promote ideal, rational decision-making – may still be turned into reasonable decisions. 3,4 …”