{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:59:42Z","timestamp":1792058382688,"version":"4.4.0"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T00:00:00Z","timestamp":1732924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T00:00:00Z","timestamp":1732924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Multidrug-resistant tuberculosis (MDR\/RR-TB) is a major global health challenge, disproportionately\u00a0affecting low- and lower-middle-income countries (LLMICs). The World Health Organization (WHO) generates\u00a0guidance to address the problem. Here, we explore the extent to which guidance and related knowledge are\u00a0generated by experts living in the most-affected countries and consider the results in the context of the movement\u00a0to decolonize global health.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We examined the composition of World Health Organization (WHO) MDR\/RR-TB treatment Guideline\u00a0Development Groups (GDGs) from 2016 to 2022. We classified GDG members according to the MDR\/RR-TB\u00a0burden and World Bank income level of the country of their institutional affiliation. We also searched PubMed to\u00a0identify peer-reviewed publications from 2016 to 2023 which emanated from individual-patient-data meta-analysis\u00a0like those done for Guideline review, and classified the publication authors according to the same indicators.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 33 high-burden MDR\/RR-TB countries during the time period. Of these, 72.1% were LLMICs\u00a0and none was high-income. In contrast, only 30.3% of WHO GDG members and 10.4% of peer-reviewed\u00a0publication authors were from LLMICs. Representatives from high-MDR\/RR-TB-burden countries comprised 34.3%\u00a0of WHO GDG members and 14.7% of authors of guideline-related publications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The important imbalance between the geographical distribution of lived experience with MDR\/RR-TB\u00a0and the distribution of individuals generating knowledge and guidance on treatment of MDR\/RR-TB can have\u00a0clinical and resource implications. Countries may reject or defer guideline adoption because of a mismatch\u00a0between that guidance and local disease epidemiology. Funding conditioned on compliance with guidelines can\u00a0exacerbate health inequalities. The movement to decolonize global health considers representation disparities as\u00a0epistemic injustice, that is unfair treatment in the process of generating, sharing, or receiving knowledge. Reform is\u00a0possible in many of the institutions involved in generation of global health knowledge, such as: meaningful\u00a0participation of LLMICs in projects as a requirement for research funding, improved attention to the epistemic and\u00a0geographical location of journal editorial staff, and broader inclusion in guidelines committees. Better alignment of\u00a0participation in knowledge generation with burden of disease holds potential for reducing inequality and improving\u00a0relevance of guidance for the lived experience with MDR\/RR-TB.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-024-11958-1","type":"journal-article","created":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T11:23:15Z","timestamp":1732965795000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Revealing disparities in representation in knowledge generation and guideline development"],"prefix":"10.1186","volume":"24","author":[{"given":"Carlos P. 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