The article “Electronic Monitoring-Based Counseling to Enhance Adherence Among HIV-Infected Patients: A Randomized Controlled Trial” focuses ways of enhancing the rate of adherence through AIMS adherence. It reveals that in 1996, after HAART (Highly Active Antiretroviral Therapy) concept was introduced, the prevalence of infection to HIV changed from a deadly illness to a chronic disease. The authors add that later discoveries concerning HAART’s capability to conquer the replication of viruses as well as continue being effective for many years, it was necessary to support high adherence levels among patients. Since a large number of patients showed adherence in a suboptimal manner, issues associated with disease advancement and treatment failure emerged. As such, a need emerged for emphasizing on the need to optimize the adherence of patients to HAART while treating HIV, which later emerged as a major objective in the delivery of health care (Bruin, et al., 2010). The article adds that to facilitate in providing professionals in the health care environment with operative tools that would show notable support to adherence, it is essential to develop a behavioral mechanism that would support HAART adherence as well as embark on investigations concerning the interventions’ effectiveness. Furthermore, it is vital to undertake systematic reviews revolving around meta-analysis to reveal that even though certain interventions portray promising influences, others demand significant attention mostly because of the issues that hinder the results from reflecting positive outcomes (Bruin, et al., 2010). As such, the design of the study is to focus on investigating the overall efficiency associated with AIMS (adherence intervention), which is developed to fit routine care processes that match HIV clinics. To realize the objective, the design process that the researchers emphasize on focuses on blocking randomization that facilitates in allocating patients to control groups of certain interventions. The study comprised of a starting point measurement of two months, the months for undertaking interventions, as well as four months for the follow-up process. In the study, the nurses handling HIV cases offer minimal intercession (adherence improvement) in the case of those patients with an adherence rate of less than 95 percent. In the case of the control group, they are accorded high-quality care in the normal way. The measures that are realized revolve around monitoring the rate of adherence and loading of viruses through electronic means (Bruin, et al., 2010). Around 133 patients participated in the study, including 66 for intervention and 67 for control. During the starting phase, 95 percent of the participants had an adherence rate of less than 95 percent, while 87 percent (116/133) went through the whole trial. When analyses concerning intent-to-treat were carried out, it revealed that the rate of adherence shows significant improvement in the case of the complete sample for intervention. Analyses of the subgroup portrayed that the effect resulted from the individuals having a score of less than 95 percent during the onset of the process. The effects did not change during the follow-up. However, the patients’ number having an undetectable load of the virus rose in the case of the intervention group unlike the case of the control group. The influences of treatments directed to a load of the virus were facilitated by improving the rates of adherence. The results of the study revealed that AIMS intervention showed effectiveness and is ideal for incorporation in offering routine clinical care for those patients infected with HIV. However, the article reveals that further research would be essential to facilitate in studying the cost-effectiveness of undertaking the process in the case of additional heterogeneous samples as well as in environments showing variability in care standards (Bruin, et al., 2010). Strengths and Weaknesses of the Study Strengths While performing the study, some forces became apparent. From the study, one of the major strengths was the adoption of the HAART strategy. The strategy made it possible for the study to focus on intervening with behavioral change to boost the rate of adherence among patients with HIV while using HAART. The strength of this technique was that it was possible to develop it in such a way that it would match with the procedures of standard care, thus making the treatment group to portray adherence improvements during the intervention process. In this case, the rise in the levels of adherence played a major role in supporting correct outcomes after undertaking an analysis among the patients. Moreover, the incorporation of the AIMS strategy was ideal in the study mostly because it dwells on behavioral theory, thus allowing it to show sufficient evidence concerning adherence determinants as well as effective strategies for intervention. The plan has also received widespread support among healthcare professionals while is also complying with the protocols for supporting the advancement of health promotion initiatives (Bruin, et al., 2010). Furthermore, the adoption of MEMs-reports during the intervention processes served as a major AIM element, as it gained notable appreciation by health care professionals and patients, rather than those patients utilizing their medication in social environments. These reports facilitated in identifying the areas that needed significant emphasis, thereby providing HIV nurses with opportunities for determining the ideal ways of targeting diverse groups of patients depending on their social standing (Bruin, et al., 2010). Weaknesses Concerning weaknesses, some limitations prevailed, thus hindering the overall effectiveness. For instance, using only 133 individuals for the study was limited in that the traits they portrayed would not adequately represent the overall population. Also, the study focused on individuals aged over 18 years, whereas the prevalence of HIV is also common among individuals below that age, hence an indication that the group of persons below 18 years was not represented. The study also focused on whites and Dutch-speaking individuals, thereby revealing that the situation of the non-whites was not shown. To add to that, there was a two-month delay in allocation from inclusion to randomization, thus posing challenges in allocating treatment until the overall assignment of the interventions (Bruin, et al., 2010). Additionally, the use of the MEMS cap to serve as a reliable instrument for measurement posed challenges mostly because of its potential to underestimate adherence concerning suboptimal use, especially pocket dosing. This situation became apparent mostly because a certain number of patients preferred carrying small bottles that could fit in their pockets particularly when it social situations. Here, the patients would encounter challenges associated with the treatment guidelines due to fear of stigmatization in their social environments. Moreover, the issue of gender inequality prevailed in the study, as males dominated the study. This resulted to discrepancies in the study due to inadequate representation of women (Bruin, et al., 2010). Moreover, a notable percentage of the patients declined because of the reduction in MEM's acceptance among patients who were HIV positive, thus an indication that the final study failed to represent the overall population in line with the non-white individuals who were not included adequately. The HIV nurses responsible for delivering interventions also served as the ones for offering standard care, thereby overburdening them to an extent that inaccurate results could emerge in the process (Bruin, et al., 2010). Reference Bruin, M., Hospers, H. J., Breukelen, G. J., Kok, G., Koevoets, W. M., & Prins, J. M. (2010). Electronic Monitoring-Based Counseling to Enhance Adherence Among HIV-Infected Patients: A Randomized Controlled Trial. Health Psychology, 29(4), 421-418.
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