Attitude Toward Quoting Research Evidence In Technical Guidelines On The Nigeria Hiv/Aids Program

Background: In 2013 Nigeria was home to 9% of PLHIV, 10% of new infections and 14% of AIDS related deaths. HIV programs are directed by relevant evidence based National guidelines; providers in Nigeria have however continued to use various guidelines for patient management, stating the availability of evidence based research from various sources in other guidelines. Methods & Materials: We sought to review the Nigerian National guidelines for availability of references to determine the number and characteristics of research references cited. This was intended to give a picture of the access to, the demand and value attached to published research and evidence base among professionals in this field at both policy and implementation level. We conducted a comparative study of 17 national guideline to the PEPFAR 2012 Guidance for OVC. We collected data on the presence, frequency, nature, origin, level of evidence and recentness of research referenced in the guidelines. We also analysed the average distribution of references per size of documents; and the ratio of quoted research references to none-research references. Results: In the 17 National guidelines reviewed, a total of 2685 pages of HIV information (mean= 158 pages per document) was reviewed. Only 3 (18%) had a reference section; while 14 (82%) were published without a reference section. A sum of 115 references were quoted; 42 (37%) of which was research evidence, with one of the guidelines being responsible for 71% of all the research evidence quoted. The average number of references per page in the 17 National guidelines was 60 times less than was obtainable in a single PEPFAR guideline. The average ratio of none-research to research references quoted was 1:0.5 in the National guidelines as opposed to 1:17 in the PEPFAR guidelines. Conclusion: There is a limited access to quoted research evidence in Nigeria National HIV program guidelines. The lack of reference in National guidelines may cast doubt on quality of evidence therein and question the continued use of non-local evidence to direct interventions.