WHO guidelines for the treatment of human African tripanosomiasis: web annex B: PICO questions, EtD tables, GDG recommendations
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World Health Organization
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17 p.
The document provides the PICO questions, evidence-to-decision (EtD) tables and recommendations developed to support the 2024 "WHO Guidelines for the treatment of human African trypanosomiasis". It presents the evidence appraisal and decision-making process underpinning recommendations on the use of fexinidazole as first-line treatment for first- and second-stage Trypanosoma brucei rhodesiense infection, and on the use of pentamidine as an alternative treatment in specific circumstances. Using the WHO guideline development methodology, the annex defines the PICO questions, summarizes the available evidence, and assesses benefits and harms, certainty of evidence, patient values, resource requirements, cost-effectiveness, equity, acceptability and feasibility. The publication reports the resulting conditional recommendations, together with the rationale supporting each decision, implementation considerations, subgroup-specific issues, and monitoring requirements. It outlines circumstances in which alternative treatments may be preferred, highlights practical aspects of fexinidazole administration and follow-up, and discusses considerations for special populations, including pregnant women and children. By documenting the evidence-to-decision process in a transparent manner, the annex supports the interpretation and implementation of the WHO recommendations while providing the methodological basis for clinical and public health decision-making in the management of rhodesiense human African trypanosomiasis.
The document provides the PICO questions, evidence-to-decision (EtD) tables and recommendations developed to support the 2024 "WHO Guidelines for the treatment of human African trypanosomiasis". It presents the evidence appraisal and decision-making process underpinning recommendations on the use of fexinidazole as first-line treatment for first- and second-stage Trypanosoma brucei rhodesiense infection, and on the use of pentamidine as an alternative treatment in specific circumstances. Using the WHO guideline development methodology, the annex defines the PICO questions, summarizes the available evidence, and assesses benefits and harms, certainty of evidence, patient values, resource requirements, cost-effectiveness, equity, acceptability and feasibility. The publication reports the resulting conditional recommendations, together with the rationale supporting each decision, implementation considerations, subgroup-specific issues, and monitoring requirements. It outlines circumstances in which alternative treatments may be preferred, highlights practical aspects of fexinidazole administration and follow-up, and discusses considerations for special populations, including pregnant women and children. By documenting the evidence-to-decision process in a transparent manner, the annex supports the interpretation and implementation of the WHO recommendations while providing the methodological basis for clinical and public health decision-making in the management of rhodesiense human African trypanosomiasis.