(P101) Quality assessment of the Brazilian guidelines for Sexually Transmitted Infections that cause urethral discharge, using the AGREE II instrument

Background: Sexually Transmitted Infections(STIs) that cause urethral discharge can lead to severe health consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs(PCDT-IST). Since guidelines aim to raise the quality of STIs management and offer guidance to policymakers and stakeholders, our objective was to develop for the first time a study to assess the quality of PCDT-IST(2021).

Methods: PCDT-IST(2021) quality was independently assessed by four appraisers using the Appraisal of Guidelines Research and Evaluation instrument version II(AGREE II) to identify strengths and weaknesses (Figure 1). We established a cut-off point of 60% to classify a domain between high and low scores.

Results: The AGREE II instrument received scores ranging from 35% (Applicability) to 82% (Clarity and Presentation). Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%) had scores above 60%; and three domains had scores below 60%, Rigor of Development (58%), Applicability (35%) and Editorial Independence (38%). Although PCDT-IST has evidence-informed clinical and practical recommendations, it needs to be stated how they identified, selected, and summarized the available evidence. Regarding Applicability, the low score highlights the need to address potential barriers to guideline implementation and monitoring criteria to assess a guideline’s impact during its development. In the case of editorial independence, low scores were mainly assigned due to poor reporting on these topics. Guidelines must contain clear information about the description of competing interests and how they influenced the guideline process and development of recommendations. The overall score attributed by the appraisers to the PCDT-IST was 67%, and all recommended the guideline, three of which indicated methodological adjustments. One appraiser stated that no modification would be necessary.

Conclusions: AGREE II is an important instrument to improve the transparency of the guideline’s development process. Even though the study results point out that the quality of PCDT-IST(2021) is good, key domains such as Applicability, Rigor of Development, and Editorial Independence must be better ensured in future PCDT-IST updates. The comparison with guidelines published by international agencies would help select which key topics should be addressed as a priority in the following document update.