Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
KIT (Royal Tropical Institute), Amsterdam, The Netherlands.
Trop Med Int Health. 2018 Mar;23(3):279-294. doi: 10.1111/tmi.13031. Epub 2018 Feb 6.
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 decision-making 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.
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.
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.
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.
国际准则建议各国将抗逆转录病毒疗法（ART）扩大到所有艾滋病毒感染者，并通过公平程序，针对其他治疗、预防和缓解干预措施，在地方一级制定优先事项。然而，对于这种优先事项制定过程，并没有提供实际的指导。循证审议进程（EDP）填补了这一空白，它结合了利益攸关方的审议，将相关的社会价值观纳入到基于这些价值观的证据的理性决策中。本研究报告了首次在艾滋病毒控制中实施和评估循证审议进程的情况，该进程是为支持印度尼西亚西爪哇省艾滋病委员会制定 2014-2018 年战略计划而组织的。
在省艾滋病委员会的负责下，采用六个步骤实施循证审议进程，以选择优先干预措施：（一）形势分析；（二）组建多方利益攸关方协商小组；（三）选择标准；（四）确定和评估干预措施的绩效；（五）审议；以及（六）选择供资和实施机构。一名独立研究员对小组成员进行了深入访谈（n=21），以评估该进程。
协商小组包括 23 名利益攸关方。他们确定了 50 项干预措施，并根据四项标准对这些干预措施进行了评估：对疫情的影响、减少污名化、成本效益和普遍覆盖。经过审议讨论，协商小组优先考虑了几种治疗、预防和缓解干预措施的组合。
循证审议进程提高了利益攸关方的参与度和战略规划过程的证据基础。EDP 填补了国际准则和当前艾滋病毒控制战略规划工具未涉及的重要空白。
