Value and effectiveness of National Immunization Technical Advisory Groups in low- and middle-income countries: a qualitative study of global and national perspectives
Value and effectiveness of National Immunization Technical Advisory Groups in low- and middle-income countries: a qualitative study of global and national perspectives
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DOI：
10.1093/heapol/czz027
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发表时间：
2019-05-01
影响因子：
3.2
通讯作者：
Howard, Natasha
中科院分区：
文献类型：
--
作者：
Bell, Sadie;Blanchard, Laurence;Howard, Natasha
《全球疫苗行动计划》建议每个国家在2020年前建立或加入国家免疫技术咨询小组(NITAG)。NITAG的作用是产生结合当地情况的循证建议，指导国家免疫政策和实践。这项研究旨在探讨非国家技术援助小组在中低收入国家的价值和效力，查明非国际技术援助小组可能需要进一步支持的领域，以改进其功能和全球投资的潜在障碍。采用多方法研究设计，包括134个半结构化访谈和82个文献综述来源，包括38个国家。对能够深入了解NITAG有效性的53个全球/区域和81个国家一级的参与者进行了访谈，其中包括NITAG成员、国家免疫规划工作人员和全球机构代表(例如，世界卫生组织、比尔和梅林达·盖茨基金会、Gavi和疫苗联盟)。这项综述，包括关于LMIC中NITAG的已发表和未发表的来源，是为了补充和证实采访结果。对数据进行了主题分析。NITAG被描述为在促进循证的疫苗接种决策方面有价值，NITAG的参与提高了国家免疫规划的力度和可持续性。NITAG有效性面临的挑战包括：(1)资金不可靠；(2)成员专业知识不够多样化；(3)利益冲突管理程序不够充分；(4)获取和使用证据的能力不足；(5)缺乏透明度；(6)与国家决策程序的整合有限，减少了对NITAG建议的承认和纳入。LMIC NITAG在过去十年中有了显著的发展。运作良好的国家免疫援助方案是值得信赖的国家资源，可加强国家对免疫提供的所有权。然而，许多LMIC NITAG需要额外的技术和资金支持，以加强质量和效力，同时保持公正性，并确保与国家决策进程充分结合。需要消除阻碍可持续全球支持的障碍，使LMIC NITAG既能继续下去，又能进一步发展。
The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment. A multi-methods study design was used, comprising 134 semi-structured interviews and 82 literature review sources that included 38 countries. Interviews were conducted with 53 global/regional and 81 country-level participants able to provide insight into NITAG effectiveness, including NITAG members, national immunization programme staff, and global agency representatives (e.g. the World Health Organisation, the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance). The review, including published and unpublished sources on NITAGs in LMICs, was conducted to supplement and corroborate interview findings. Data were analysed thematically. NITAGs were described as valuable in promoting evidence-informed vaccination decision-making, with NITAG involvement enhancing national immunization programme strength and sustainability. Challenges to NITAG effectiveness included: (1) unreliable funding; (2) insufficient diversity of member expertise; (3) inadequate conflicts of interest management procedures; (4) insufficient capacity to access and use evidence; (5) lack of transparency; and (6) limited integration with national decision-making processes that reduced the recognition and incorporation of NITAG recommendations. LMIC NITAGs have developed significantly in the past decade. Well-functioning NITAGs were trusted national resources that enhanced country ownership of immunization provision. However, many LMIC NITAGs require additional technical and funding support to strengthen quality and effectiveness, while maintaining impartiality and ensuring sufficient integration with national decision-making processes. Barriers to sustainable global support need to be addressed for LMIC NITAGs to both continue and develop further.