Dear Colleague: February 11, 2022

February 11, 2022

Dear Colleague,

The Centers for Disease Control and Prevention (CDC) is continuously working to improve patient care and health outcomes by ensuring that the latest evidence-based guidelines are made accessible to patients and providers, easily and quickly. Through initiatives such as the Adapting Clinical Guidelines for the Digital Age (ACG) initiative, CDC is modernizing its approach to clinical guidelines to reduce the time it takes to apply guidance to patient care and ensure that clinicians and patients can make informed decisions guided by the best available evidence to achieve optimal health outcomes.

The first step toward guideline modernization is to ensure that out-of-date guidelines are archived (by clearly labeling them as such). CDC guidelines may be archived for a number of reasons: the availability of new technologies, approved medications, or scientific breakthroughs may change prevention, care, or treatment approaches; a review of the scientific literature may yield evidence that supports an update to current guidelines; and, in some cases, out-of-date guideline documents may be archived although certain content within those guidelines still reflect current guidance. The latter is the case with CDC’s perinatal HIV transmission guideline, originally published in 1985, that includes recommendations about breastfeeding.

This guideline contains language and recommendations that are now considered obsolete; therefore, the original document has been archived. However, the recommendation that individuals in the U.S. with HIV should be advised not to breastfeed remains consistent with the most up-to-date scientific literature and is considered best practice for preventing HIV transmission. When guidelines are archived, the recommendations that remain relevant are published on CDC’s website or are incorporated into other public-facing guidance or policy documents. When resources exist that provide supplemental information related to the topic of the archived guideline, CDC may refer readers to other organizations. For example, the HHS Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission and the American Academy of Pediatrics have each more recently published recommendations on perinatal HIV prevention that are consistent with CDC’s recommendation, but offer additional information for care providers of individuals with HIV who wish to breastfeed. CDC continues to routinely assess the evidence supporting its guidelines and standalone recommendations and to publish updates and referrals to additional resources when appropriate.

As an initial step in the guideline modernization process, CDC is archiving a number of out-of-date HIV-focused guidelines. Please see Appendix A for a list of the HIV-related guidelines that have been archived and labeled.

Once out-of-date guidelines have been archived and updated where appropriate, the next step toward modernization is to ensure the rapid translation of critical evidence-based information into digital approaches and products. As a part of its guideline optimization process, CDC is exploring digitized as well as “living guideline” approaches to allow dynamic updating of individual recommendations as soon as new relevant evidence becomes available.

CDC’s modernization efforts aim to make public health guidelines actionable at a faster pace than ever before; facilitate the streamlined dissemination and translation of the latest guidance; and enhance connection with patient care by reducing the time a clinician must spend reviewing and interpreting new guidelines. CDC is committed to keeping partners, clinicians, and the public informed of its ongoing efforts to modernize public health information and improve patient care and health outcomes by ensuring that evidence-based guidelines are easily accessible and based on the latest science. For more information on guideline modernization, please visit CDC’s ACG web page.

Sincerely,

/Demetre Daskalakis/

Demetre C. Daskalakis, MD, MPH
Director
Division of HIV Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv