- Email: [email protected]
Does the world need another AIDS authority?
Correspondence
We are disappointed and concerned about inaccuracies and misinterpretations contained in Dan Billingham’s World Report (Nov 11, p 1639).1 In it, he discusses the clinical review project by BMJ Knowledge in collaboration with the Liverpool School of Tropical Medicine, and presented by one of us (DT) at the European Health Forum in Gastein, Austria. The purpose of our project was to apply systematic review methods, as used in the BMJ’s Clinical Evidence, to address clinical questions relating to the management of HIV/AIDS in resource-poor countries. We feel that Billingham’s report misrepresents this work and its objectives in several respects. First, the report relies heavily on an interview with Delon Human, a representative of Health Diplomats, which Billingham describes as an international pressure group. We want to make it clear that, contrary to the implication in the World Report, Human is not part of the BMJ Knowledge team and does not speak on their behalf. Second, Billingham quotes DT as criticising WHO guidelines, and “[arguing] that [the BMJ] is better equipped than either WHO or UNAIDS to raise the bar on disseminating accurate HIV/AIDS information”. This is a grave misrepresentation. It does not reflect either DT’s expressed views in the meeting, or his subsequent conversation with Billingham. Furthermore, it runs counter to the spirit of the project which has from its inception sought to work with WHO, UNAIDS, and other agencies. In communication with Billingham, DT and others described only positive experiences of working with HIV agencies including WHO and UNAIDS. During his presentation, DT also described how, during the course of the BMJ Knowledge project, WHO had released two relevant guidelines www.thelancet.com Vol 368 December 2, 2006
that had been very consistent with our own findings. Furthermore, our own reviews are not, and were never intended to be, guidelines. However we do hope that they might be useful to people tasked with the job of creating guidelines in resource-poor settings. Finally, Billingham suggests that we support a call for “a new single HIV/ AIDS information authority”. This is another serious misrepresentation and was not a question that we even considered. Our project aimed to supplement, rather than replace or replicate, reports prepared elsewhere. We intended to work within the grain of other bodies, and not to compete against them. This was made clear in the Gastein meeting and subsequently. It is a pity that Billingham’s report did not reflect this essential principle often expounded by The Lancet. We are grateful to the many individuals working in the HIV/AIDS community for providing encouragement and support for our work. We hope it will not be harmed by Billingham’s report.
*Angela Obasi, David Tovey [email protected] Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK (AO); BMJ Knowledge, BMJ Group, BMA House, Tavistock Square, London, UK (DT) 1
Billingham D. Does the world need another AIDS authority? Lancet 2006; 368: 1639–40.
Dan Billingham’s World Report on BMJ Knowledge1 contains several inaccuracies and omissions concerning the methods used by WHO and UNAIDS to produce AIDS statistics and evidencedbased technical guidelines. The global AIDS statistics published annually by UNAIDS and WHO are based on all pertinent, available data— including sentinel and populationbased surveys, case reporting, and other public-health information. The estimates are based on methods and on parameters that are informed by the UNAIDS Reference Group on HIV/AIDS
Estimates, Modelling and Projections, which is made up of leading researchers in AIDS, epidemiology, demography, and related areas. While the methods used to produce the estimates are constantly improving, at any one time the estimates are the product of the best information and modelling that can be applied across countries in a consistent way. Criticism of “the mixed messages caused by the current situation of having many different health agencies involved in publishing AIDS statistics” neglects the effective collaboration between WHO and UNAIDS in producing AIDS statistics over many years and it is unclear from Billingham’s report how BMJ Knowledge would improve on the current method. Referring to “a muddle of organisations seeking to offer leadership”, Billingham neglects to mention the division of labour agreed between UN agencies in the area of HIV/ AIDS or the mandate given to WHO by its 193 Member States to build expert consensus and provide global technical guidance in a number of areas, including HIV treatment. WHO’s HIV treatment guidelines are developed through a rigorous process that recognises the need for evidencebased guidance that is of high quality and adaptable to a wide range of settings. In 2006, for example, WHO published a series of new or revised global guidelines on HIV treatment and care in resource-limited settings.2–5 The recommendations represent the consensus of experts from all regions of the world and are made on the basis of different levels of evidence from randomised clinical trials, high-quality scientific studies, observational cohort data, and expert opinion. Importantly, consideration is given to the operational challenges of scaling-up HIV treatment and care in settings where individualised patient management by HIV specialists is mostly not feasible. These guidelines and the public-health principles that inform them aim to the extent possible
The printed journal includes an image merely for illustration AP
Does the world need another AIDS authority?
See Department of Error page 1964
e-mail submissions to [email protected]
1959
We are disappointed and concerned about inaccuracies and misinterpretations contained in Dan Billingham’s World Report (Nov 11, p 1639).1 In it, he discusses the clinical review project by BMJ Knowledge in collaboration with the Liverpool School of Tropical Medicine, and presented by one of us (DT) at the European Health Forum in Gastein, Austria. The purpose of our project was to apply systematic review methods, as used in the BMJ’s Clinical Evidence, to address clinical questions relating to the management of HIV/AIDS in resource-poor countries. We feel that Billingham’s report misrepresents this work and its objectives in several respects. First, the report relies heavily on an interview with Delon Human, a representative of Health Diplomats, which Billingham describes as an international pressure group. We want to make it clear that, contrary to the implication in the World Report, Human is not part of the BMJ Knowledge team and does not speak on their behalf. Second, Billingham quotes DT as criticising WHO guidelines, and “[arguing] that [the BMJ] is better equipped than either WHO or UNAIDS to raise the bar on disseminating accurate HIV/AIDS information”. This is a grave misrepresentation. It does not reflect either DT’s expressed views in the meeting, or his subsequent conversation with Billingham. Furthermore, it runs counter to the spirit of the project which has from its inception sought to work with WHO, UNAIDS, and other agencies. In communication with Billingham, DT and others described only positive experiences of working with HIV agencies including WHO and UNAIDS. During his presentation, DT also described how, during the course of the BMJ Knowledge project, WHO had released two relevant guidelines www.thelancet.com Vol 368 December 2, 2006
that had been very consistent with our own findings. Furthermore, our own reviews are not, and were never intended to be, guidelines. However we do hope that they might be useful to people tasked with the job of creating guidelines in resource-poor settings. Finally, Billingham suggests that we support a call for “a new single HIV/ AIDS information authority”. This is another serious misrepresentation and was not a question that we even considered. Our project aimed to supplement, rather than replace or replicate, reports prepared elsewhere. We intended to work within the grain of other bodies, and not to compete against them. This was made clear in the Gastein meeting and subsequently. It is a pity that Billingham’s report did not reflect this essential principle often expounded by The Lancet. We are grateful to the many individuals working in the HIV/AIDS community for providing encouragement and support for our work. We hope it will not be harmed by Billingham’s report.
*Angela Obasi, David Tovey [email protected] Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK (AO); BMJ Knowledge, BMJ Group, BMA House, Tavistock Square, London, UK (DT) 1
Billingham D. Does the world need another AIDS authority? Lancet 2006; 368: 1639–40.
Dan Billingham’s World Report on BMJ Knowledge1 contains several inaccuracies and omissions concerning the methods used by WHO and UNAIDS to produce AIDS statistics and evidencedbased technical guidelines. The global AIDS statistics published annually by UNAIDS and WHO are based on all pertinent, available data— including sentinel and populationbased surveys, case reporting, and other public-health information. The estimates are based on methods and on parameters that are informed by the UNAIDS Reference Group on HIV/AIDS
Estimates, Modelling and Projections, which is made up of leading researchers in AIDS, epidemiology, demography, and related areas. While the methods used to produce the estimates are constantly improving, at any one time the estimates are the product of the best information and modelling that can be applied across countries in a consistent way. Criticism of “the mixed messages caused by the current situation of having many different health agencies involved in publishing AIDS statistics” neglects the effective collaboration between WHO and UNAIDS in producing AIDS statistics over many years and it is unclear from Billingham’s report how BMJ Knowledge would improve on the current method. Referring to “a muddle of organisations seeking to offer leadership”, Billingham neglects to mention the division of labour agreed between UN agencies in the area of HIV/ AIDS or the mandate given to WHO by its 193 Member States to build expert consensus and provide global technical guidance in a number of areas, including HIV treatment. WHO’s HIV treatment guidelines are developed through a rigorous process that recognises the need for evidencebased guidance that is of high quality and adaptable to a wide range of settings. In 2006, for example, WHO published a series of new or revised global guidelines on HIV treatment and care in resource-limited settings.2–5 The recommendations represent the consensus of experts from all regions of the world and are made on the basis of different levels of evidence from randomised clinical trials, high-quality scientific studies, observational cohort data, and expert opinion. Importantly, consideration is given to the operational challenges of scaling-up HIV treatment and care in settings where individualised patient management by HIV specialists is mostly not feasible. These guidelines and the public-health principles that inform them aim to the extent possible
The printed journal includes an image merely for illustration AP
Does the world need another AIDS authority?
See Department of Error page 1964
e-mail submissions to [email protected]
1959