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| Reference: | 3592 |
| Country: | Switzerland |
| Multiple country event: | Yes |
| Region: | EURO |
| City: | Geneva |
| Start date: | 15 July 2011 |
| End date: | 1 December 2011 |
| Estimated duration: | |
| Status: | Completed - Complété |
| | (The mission has taken place) |
|
| Title: | Systematic reviewer(s) for development of WHO Policy Guidance on Anti-tuberculosis Drug Susceptibility Testing |
| Type: | Mission |
| Terms of Reference: | The WHO Stop TB Department has initiated development of Policy Guidance on Anti-tuberculosis Drug Susceptibility Testing. This guidance would serve as an update to the 2008 WHO “Policy guidance on drug-susceptibility testing of second-line anti-tuberculosis drugs”
(http://whqlibdoc.who.int/hq/2008/WHO_HTM_TB_2008.392_eng.pdf), with an expanded scope to also include first-line drugs. Furthermore, the proposed guidance would undergo the WHO GRADE process (http://www.gradeworkinggroup.org/), a systematic process for evaluation of evidence.
The questions to be answered by the guidance are as follows:
1. For each of the first- and second-line anti-tuberculosis drugs (as defined in WHO
Guidelines for treatment of tuberculosis and WHO Guidelines for the programmatic management of drug-resistant tuberculosis): If a patient strain is found to be susceptible to a drug using a phenotypic method (with specified critical concentrations or minimum inhibitory concentrations) will the use of the drug in a treatment regimen lead to improved patient outcomes (a. treatment success, b. survival), compared to use in a treatment regimen when the strain had not been tested for resistance?
2. Would testing for rifampicin resistance alone compared to testing for resistance to both
rifampicin and isoniazid result in improved outcomes (a. decreased cost, b. decreased time for diagnosis of MDR-TB, c. reduced transmission of MDR-TB), while not negatively affecting patient outcomes (a. treatment success, b. survival)?
3. Can molecular methods for the detection of mutations conferring resistance to rifampicin
alone or in combination with the detection of mutations conferring resistance to isoniazid
replace conventional first-line DST , while not negatively affecting patient outcomes (a.
treatment success, b. survival)?
4. Within each class of anti-tuberculosis drug (as defined in WHO Guidelines for treatment
of tuberculosis and WHO Guidelines for the programmatic management of drug-resistant
tuberculosis), will testing for resistance to one drug within each class and consequent treatment decisions result in improved outcomes (a. decreased costs, b. decreased delay before start of treatment) and not negatively affect patient outcomes (a. treatment success, b. survival), compared to testing for resistance to individual drugs within each class? (e.g. can in vitro testing for resistance to ofloxacin be sufficient to guide the use of moxifloxican in a treatment regimen)?
In the context of this work, the WHO Stop TB Department is issuing a call for expressions
of interest to provide systematic reviews of the literature, including compilation, synthesis
and grading of evidence, to answer the aforementioned questions. Respondents are
welcome to express interest in one or more (or all) of the above questions.
Expected deliverables are as follows:
By August 20, 2011
a. Identify systematic reviews and primary studies relevant to the questions
b. Provide written methods to WHO (inclusion and exclusion criteria, study selection,
data extraction, assessment of study quality, data analysis), which WHO will share
with the Guidelines Development Group
c. Conduct literature search and screen citations
d. Retrieve and screen full-text articles
e. Provide a list of included articles. Provide a list of excluded articles with reasons for
exclusion
f. If Guidelines Development Group members identify any additional evidence, review
it for in/exclusion
g. Assess study quality
h. Perform data extraction, collation, and meta-analysis (if appropriate)
i. For each question, produce one GRADE evidence profile using the GRADE
template. Include detailed footnotes explaining the judgments that were made.
j. Provide first draft of GRADE evidence profiles to WHO.
k. Document search strategy and summarize it for inclusion in Methods section of the
Guidelines
l. Review wording of questions and outcomes, and the compilation of comments
received to date from the Guidelines and External Review Groups
m. Offer revisions to Question(s) for WHO review.
n. Delineate secondary (related) analyses
o. Incorporate input from WHO and Guidelines Development Group subject matter
experts, and other Centre working on related question(s)
By September 15, 2011: Finalize GRADE tables, prepare for Geneva meeting
a. Incorporate input from WHO and finalize GRADE tables for distribution to Guidelines
Development Group in advance of the in-person meeting in Geneva
b. Participate in 2-3 phone meetings to plan the Geneva meeting
c. Provide draft powerpoint presentation 3 weeks before the Geneva meeting, and
incorporate 1 round of input from WHO
October 6-7, 2011: Participate in Geneva meeting, provide additional documentation
a. Compile a list of suggestions for future research questions to address the literature
gaps identified
b. Provide bibliographic file of articles for citation in materials for Guidelines
Development Group and in the revised Guidelines
c. Provide PDF files of all full-text articles (included and excluded) reviewed, so WHO
can compile a CD for Guidelines Development Group
d. Present at Geneva meeting
October to December 2011: follow up to Geneva meeting
a. Review and comment on two rounds of the Summary of Evidence to be included in
Guideline
b. Prepare peer reviewed article on findings. Before an article which contains the results
of the work being commissioned is prepared for submission to a journal, the provider will
involve WHO and the methodologist of the Guidelines Development Group to contribute
as co-authors
Applicants will be expected to:
i) Have experience in recent years in the development of WHO Guidelines in
accordance with the conditions required by WHO's Guideline Review Committee
(GRC).
ii) Have a solid knowledge of tuberculosis and laboratory diagnostics.
Interested candidates for the proposed work are asked to provide:
- A letter of interest that clearly indicates the past experience in conducting systematic
reviews, and indicates which question(s) are the subject of the Expression of interest
- Detailed CV(s) of those undertaking the work
- The expected costing of the project, given the above-described scope of the project
The anticipated dates of the contract will be 15 July - 1 December 2011.
Submissions are to be made via email to Wayne van Gemert (vangemertw@who.int) by 30 June 2011. |
| Training Opportunity: | No |
| Website: | |
| Purpose 1: | Drug Resistance Surveillance (DRS) |
| Purpose 2: | |
| Purpose 3: | |
| Other purpose: | Systematic review - drug susceptibility testing |
|
| Entered by: | WHO/HQ |
| Partner 1: | |
| Partner 2: | |
| Partner 3: | |
| Contact name: | Wayne van Gemert |
| Contact email: | vangemertw@who.int |
| Other agencies: | |
|
| Funding needs: | No |
| Funding source: | Eli Lilly MDR Partnership |
| Other funding source: | |
| Available funding: | $ 0 |
| Funding gap: | $ 0 |
| Global Fund reference: | |
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| Comments: | |
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There are no documents attached associated with this event. There are no experts (roster) associated with this event. There are no experts (non-roster) associated with this event.
Date Created: 16 June 2011
Entered By: Drug Resistance Surveillance
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