Using AGREE II to assess the methodological quality of clinical practice guidelines for Chagas disease

Tags: Poster
Colpani V1, Migliavaca CB1, Stein C1, Cruz LN1, Falavigna M1
1Hospital Moinhos de Vento

Background: Chagas disease is caused by the protozoan parasite Trypanossoma cruzi and is classified by World Health Organization (WHO) as a neglected tropical disease. This disease is endemic in more than 20 countries in Latin America, especially in rural areas. In addition, nowadays it has been spread to other continents, mainly due to migration, and it is estimated that more than 8 million people are infected worldwide. Despite its importance, it is unclear the existence of trustworthy guidelines for this condition.

Objectives: To identify and assess the quality of clinical practice guidelines (CPGs) for Chagas disease.

Methods: We performed a systematic search in MEDLINE and National Guidelines Clearinghouse for CPGs for Chagas disease published up to July 2016. We contacted experts in order to identify additional documents. No date or language restriction was applied. A reviewer assessed the quality of CPGs using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. Results are presented as median and range.

Results: We identified 10 CPGs from eight countries (six CPGs from Latin America, two from Spain, one from the USA and one from WHO). The most recent document was published in 2012. All CPGs provided recommendations for diagnosis and treatment. Overall, the methodological rigour was poor: only one CPG used a systematic method for evidence search, four CPGs evaluated costs and four CPGs described conflicts of interest. Median scores were 78% (range: 44-100) for scope and purpose, 44% (0-67) for stakeholder involvement, 17% (12-60) for rigor of development, 78% (56-94) for clarity of presentation, 27% (8-63) for applicability and 8% (0-67) for editorial independence.

Conclusions: There is no high-quality evidence-based CPGs for Chagas disease. Overall, the available CPGs have low methodological quality and there are important concerns related to editorial independence and applicability. Therefore, considering the high prevalence of Chagas disease in different countries, trustworthy CPGs are required for worldwide use.