Evaluating the Implementation Success of an Intensity-Adapted Guideline for Pediatric Acute Myeloid Leukemia in Malawi: An Observational-Implementation Study Protocol.

Acute myeloid leukemia (AML) is most often incurable in low-resource settings. To address this challenge, the International Society of Paediatric Oncology (SIOP) developed an intensity-adapted AML practice guideline in 2019. Here, we present the protocol of an observational-implementation study evaluating the SIOP guideline in Malawi. The purpose of this manuscript is to present a novel application of hybrid effectiveness-implementation designs adaptable to a wide spectrum of pediatric hematology-oncology diseases and contexts. Here, we propose hybrid designs as an option for teams in low-resource settings to evaluate current practice and generate much-needed evidence to inform adoption decisions regarding adapted treatment strategies.