Evolving rapid review methods to meet the needs of evidence-informed decision-making: National treatment guidelines for COVID-19 in South Africa
2Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
3UK funded Better Health Programme South Africa (BHPSA); Right to Care, South Africa
4Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
5Cochrane South Africa, South African Medical Research Council; 6. Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, South Africa
6Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
7Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa
8Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, South Africa
9Department of Medicine, East London Hospital Complex, Eastern Cape Department of Health, South Africa
10Cochrane South Africa, South African Medical Research Council; Health Systems Research Unit, South African Medical Research Council, South Africa
Background: The COVID-19 pandemic highlighted the critical need for access to high-quality evidence to inform management and medicine procurement decisions in South Africa (SA). Through collaboration between the National Department of Health (NDoH), members of the National Essential Medicines List Ministerial Advisory Committee (NEML-MAC) on COVID-19 Therapeutics, and the SA GRADE Network, co-led by Cochrane SA and the Centre for Evidence-Based Health, rapid evidence reviews were produced to inform the SA National Essential Medicines List and Guidelines for COVID-19 management.
Objectives: To describe the efficient and timely evidence-informed decision-making processes for COVID-19 therapeutics in SA.
Methods: The NDoH, NEML-MAC on COVID-19 Therapeutics, and SA GRADE Network developed a methodology for conducting rapid reviews to meet the needs of policy makers. The approach was based on Cochrane’s rapid review methodology and adapted to meet the evidence requirements in SA (Prospero registration: CRD42021286710). The goal was to balance urgency with rigorous methods. The committee prioritised review questions and review teams (including committee and SA GRADE members), and conducted reviews. Reviewers searched for available evidence, appraised evidence quality, and summarised the key findings. Members of the NEML-MAC on COVID-19 Therapeutics then made recommendations using the GRADE Evidence to Decision (EtD) Framework.
Results: Recommendations for 33 molecules reviewed for potential treatment or prevention of COVID-19 have been issued. Sixty-nine rapid review reports (including updates reflecting emerging evidence) have been completed. Methods have been developed for credible, transparent reporting and continue to evolve. Duplication is minimised by partnering with global evidence producers (like Cochrane France and the COVID-nma Living review), adding contextual evidence for local decisions. All reviews and recommendations are made public on the NDoH COVID-19 Online Resource and News Portal (health.gov.za/COVID-19-rapid-reviews).
Conclusions: Rapid evidence-informed decisions are possible by undertaking and using rapid review methods, with iterative real-time collaboration, and accessing available local and global resources, such as living reviews. It is important to keep a consultative process alive despite the rapidness of the review to make sure that the reviews meet the needs of the people using them for national decision-making. Acknowledgment: Essential Drugs Programme, National Department of Health.