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Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the ‘SPRINT’ principles
BMJ Global Health ( IF 7.1 ) Pub Date : 2021-08-01 , DOI: 10.1136/bmjgh-2021-006406
Victoria Haldane 1 , Savithiri Ratnapalan 2, 3 , Niranjala Perera 2, 3 , Zhitong Zhang 2 , Shiliang Ge 4 , Mia Choi 5 , Lincoln L Lau 2, 5 , Sudath Samaraweera 6 , Warren Dodd 7 , John Walley 8 , Xiaolin Wei 9
Affiliation  

Introduction The COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs). Methods We used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt. Results We describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency. Conclusions Guideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译:

在中低收入国家共同制定 COVID-19 感染预防和控制指南:“SPRINT”原则

简介 COVID-19 大流行要求快速制定全面的指南来指导卫生服务的组织和提供。然而,大多数指南都基于高收入环境中的资源,在资源受限环境中可以实施的示例较少。本研究描述了在低收入和中等收入国家 (LMIC) 中调整和制定针对 COVID-19 感染综合预防和控制的特定角色指南的过程。方法 我们使用协作式自动人种学方法来探索制定 COVID-19 指南的过程。在这种方法中,多位研究人员贡献了他们的思考,通过对话进行了联合分析,反思并考虑经验知识和多学科观点,以确定和综合促成因素、挑战和关键经验教训。结果 我们描述了菲律宾的指南制定过​​程和斯里兰卡的适应过程。我们提供通过这项工作确定的关键推动因素,包括旨在授权团队将他们的专业知识带入流程的灵活领导;通过公平的所有权分担责任;跨学科团队;并与当地专家合作。然后,我们详细阐述了挑战,包括根据国情解释其他指导方针;理想与可行和用户友好之间的紧张关系;适应和更新不断变化的信息;并应对与大流行相关的挑战。根据吸取的主要经验教训,我们综合了一套新的原则,用于在突发公共卫生事件期间制定指导方针。SPRINT 原则以态势感知、优先级和平衡为基础,对变化做出响应,由跨学科团队创建,共同承担责任和透明度。结论 大流行期间的指南制定需要稳健且对时间敏感的范式。我们总结了“SPRINT 原则”中的学习,以便在中低收入国家的流行病背景下调整指南。我们强调,这些原则必须以协作或共同设计过程为基础,并为现有的国家应对措施增加价值。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。SPRINT 原则以态势感知、优先级和平衡为基础,对变化做出响应,由跨学科团队创建,共同承担责任和透明度。结论 大流行期间的指南制定需要稳健且对时间敏感的范式。我们总结了“SPRINT 原则”中的学习,以便在中低收入国家的流行病背景下调整指南。我们强调,这些原则必须以协作或共同设计过程为基础,并为现有的国家应对措施增加价值。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。SPRINT 原则以态势感知、优先级和平衡为基础,对变化做出响应,由跨学科团队创建,共同承担责任和透明度。结论 大流行期间的指南制定需要稳健且对时间敏感的范式。我们总结了“SPRINT 原则”中的学习,以便在中低收入国家的流行病背景下调整指南。我们强调,这些原则必须以协作或共同设计过程为基础,并为现有的国家应对措施增加价值。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。结论 大流行期间的指南制定需要稳健且对时间敏感的范式。我们总结了“SPRINT 原则”中的学习,以便在中低收入国家的流行病背景下调整指南。我们强调,这些原则必须以协作或共同设计过程为基础,并为现有的国家应对措施增加价值。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。结论 大流行期间的指南制定需要稳健且对时间敏感的范式。我们总结了“SPRINT 原则”中的学习,以便在中低收入国家的流行病背景下调整指南。我们强调,这些原则必须以协作或共同设计过程为基础,并为现有的国家应对措施增加价值。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。
更新日期:2021-08-27
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