Addressing HIV-related stigma and discrimination in healthcare settings: development and contextualization of guideline recommendations

Abstract Objective This objective of this project was to develop and contextualize guideline recommendations to reduce HIV-related stigma and discrimination (SAD) in Ethiopian healthcare settings. Results A multidisciplinary expert panel comprising 13 experts was established. The panel suggested that the guideline should target both healthcare worker behaviors and attitudes, and institutional practices and programs. A systematic review of systematic reviews and best practice documents was conducted. An initial list of 31 recommendations was drafted through a content analysis of the included documents. Strength and quality of evidence were assigned for each recommendation using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The initial recommendations were framed under the following themes: structural, information-based and skills building, contact and empowerment, biomedical, measurement of SAD, and steps to integrate SAD reduction into healthcare settings. The tentative recommendations were evaluated both internally and externally through a series of Delphi surveys using Guideline Implementability Appraisal (GLIA V2.0) checklist. Finally, we explored facilitators and barriers to implement the guideline using key informant interviews to develop a framework to guide dissemination, implementation, and evaluation of the guideline in the local health system of Ethiopia. Key words: Guideline development, guideline evaluation, HIV-related stigma and discrimination, Healthcare settings, Ethiopia