The British HIV Association: How NICE accreditation adds credibility, quality and value

BHIVA is encouraging other guidance producers to achieve NICE accreditation because it believes from its own experience those guidance producers will be writing a more robust, more credible and more evidence-based guideline as a result.

Adrian Palfreeman and Martin Fisher from BHIVA explain:

"BHIVA acts as a national advisory body to professionals and other organisations and provides a national platform for HIV care. We publish a range of clinical guidelines covering the treatment and management of HIV infection and associated co-morbidities to help promote and monitor standards of care.

"We had set out to achieve NICE accreditation as we could see a number of challenges coming towards us in terms of the validity of our current guidelines. We realised being able to demonstrate that we produce guidelines according to rigorous processes recognised by NICE would be very useful when negotiating with commissioners and others. NICE accreditation would show that our guidelines are robust and evidence-based.

"In the current and future financial climate prescribing choices will be challenged, and quite rightly. Prescribing according to guidelines developed to a process with the NICE stamp of approval should help clinicians and BHIVA members avoid being challenged more than they should be.

"There is a relatively small number of physicians from a variety of different specialties who prescribe anti-retroviral therapy. We have one professional body, BHIVA, that the vast majority of those prescribers will belong to. So it seems entirely reasonable for that group of British experts to be writing the guidelines.

"We already had a reasonable guidance development process in place, but the NICE Accreditation Programme gave us a really good chance to look at what we were doing and make it substantially better. Throughout the application process the level of support provided by NICE was extremely helpful, adding value and quality. We were also grateful to other accredited organisations who shared some of their experience with us. Indeed, we were able to look at other guidance development manuals and processes - sometimes our processes were better and sometimes they weren't as strong. That allowed us to pick the better examples from different organisations to work to that would meet our needs.

"We took many lessons from the application process. What was of particular value was introducing training on information appraisal for the guideline development writing committee. They welcomed that, and it's added a further degree of credibility to the guidelines. Getting clinicians on board with the conflict of interest aspect of the document was also interesting and very useful.

"Achieving NICE accreditation actually gives you a more robust, more credible and a more evidence-based guideline. We're confident that the accredited process we've introduced in terms of the way we gather, appraise and assess the evidence is far more robust than some other guidelines out there and we can demonstrate that.

"A further benefit for us was that historically when publishing guidelines they would be sent out for external peer review, even in our own journal. This would sometimes require guidelines to be heavily amended or even rewritten based on the opinion of one individual - who might not even be practising in the UK. In the new process we've moved that external peer review into the guideline development process so once the writing committee has signed off the guidelines that is what will be published.

"Following accreditation our guidance has been better appreciated by our international colleagues - having seen the level of rigour with which they've been developed. And most importantly patient groups such as i-base and aidsmap have been impressed by the fact that they can see that the process is as rigorous as it can be. Indeed, Simon Collins, Treatment Advocate at HIV i-Base has said "BHIVA has for many years included community advocates on the writing groups for all guidelines. This involvement is essential. The move for BHIVA to use processes that have been accredited by NICE should both improve the transparency over the final recommendations and increase the clarity over the quality of the evidence on which they are based. This strengthens the quality of the final guidelines and ultimately it is patients who benefit."

"We now have a very clear implementation policy - which the NICE process encourages. We have developed patient friendly versions of the guidelines, we are developing a slide kit for clinicians, pharmacists and nurses to promote dissemination of the new guidelines and encourage implementation. We have also developed a 'best of 5 questions' on the BHIVA website, this can be used to gain Continuing Professional development (CPD) points - again, serving as a method of increasing dissemination and implementation. So there are a number of ways in which we can try to ensure the guidelines are implemented and that the patients get the most up-to-date care."

Read the article on The British HIV Association website: NICE accreditation adds credibility, quality, and value.

When I presented the British HIV Association (BHIVA) anti-retroviral guidelines at an American conference, our guidelines - which were produced following the NICE accredited process - were congratulated on the rigour of their development.

Martin Fisher

(Consultant Physician in HIV/GUM, Brighton and Sussex University Hospitals and Chair of BHIVA Guidelines Subcommittee)