Pilot Testing of an HIV Medication Adherence Intervention in a Public Clinic in the Deep South

Summary to the article 

The article stipulates the need to adhere to HIV medications, which is a critical process in ensuring long-term disease control, while it also gives the adherence interventions which are possible in the health facility setting under the constraint of limited resources. The study examines the system of adherence to medical intervention under the guidance of the Information-Motivation-Behavioral Skills (IBM) as the basic model. Some of the intervention steps include HIV education, systems for peer video, systems of motivational guidance through interviewing and systems of behavioral change skills through effective communication with health service providers (Konkle‐Parker et al., 2012). The article takes into account the qualitative and quantitative study with dependent variables being comprised of 3-4 week adherence recall, prescription refill rates, alterations in the IBM sores within the subscale and the findings within HIV laboratory tests. It is also evident that the article analyzes 73 individuals who are either starting or restarting antiretroviral therapy, and who were enrolled. Among these individuals, 56 of them were randomized.

The significance of the study is to give the factors that underpin the complex issue of adherence to medications in the current age of completely suppressive antiretroviral therapy (ART), which is applicable to the HIV disease (Konkle‐Parker et al., 2012). The study reveals that there are patient related factors, which include the level of literacy, the level of substance abuse and the health benefits. On the other hand regimen related factors for adherence in HIV disease intervention include factors like the side effects, the complexity of treatment and the number of pills. On the other hand, the environmental related factors include the human beliefs of the significance of adherence and the economic factors. Consequently, providers related factors are given as the provider communication, the ability of the patient to ask questions and the accessibility to the providers.

The article gives emphasis to the Information-Motivational-behavioral skills model, which is applicable to the system of health promotion behavior. In the model, the adherence-related information and the motivation of the patients directly affect the behavior to adherence to the antiretroviral treatment (Konkle‐Parker et al., 2012). This implies that a change in the system of adherence behavior is in direct correlation with the health outcomes since the system of adherence behavior affects the control of HIV disease and the system of development of resistance to the ART. The major purpose of the pilot study was to establish how feasible it is with regards to intervention basing on the IBM model in the chosen population. In this regard, adherence is defined as the total percentage of the prescribed medication that is taken in the past 3-4 weeks basing on the rate of acquiring the refills for medications. 

The results of the study show that from 2005 to 2006, there were 73 participants who were enrolled to the study. From the fact that 17 participants did not come back for V-1, only 56 of the participants were randomized (Konkle‐Parker et al., 2012). On the other hand, the self reported adherence outcomes showed that there were minute although non-statistically significant improvements in the principal and derived result measures. Overly, improvements were observed in most outcomes resulting from less to moderate effect sizes despite the fact that the study was not energized to depict the statistical significance. Some of the threats to power included the above average attrition rate, which resulted from the loss to clinical care or long periods in gaps in the system of care. The study was significant in giving the implications for practice, where it proposes further study with improved attention on the retention of care as the major attribute to the documentation of empirical results and conclusions on the adherence to ART through behavioral factors that underpin the system of care in HIV patients. 

Major weaknesses and strengths of the article

The article has varied levels of strengths, which include the detailed assessment of the demographics and screening of patients for health literacy coupled with screening for dementia. It is also evident that the research was detailed and thus the results are reliable. This is from the fact that in its assessment, the study takes into account the data collection for variables that are depended, which are basically medication adherence, IBM, which occurred by use of the ACASI at V-1 coupled with the two clinic visits (Konkle‐Parker et al., 2012). It is also imperative to note that the results are reliable since collection of the dependable variable was carried out by a clinical assistant who was not blinded to the group assignment, which implies that the results were more of practical than theoretical. 

On the other hand, the study has weaknesses too. One of the weaknesses is that study may be biased as a result of the antagonistic changes in behavior of the participants under study. This implies that the study is pegged on a 3-4 weeks adherence to behavior on HIV antiretroviral response. It is evident that the behavior of adherence changes with the change in the social and economic factors under which the patient is constrained to (Konkle‐Parker et al., 2012). This also means that the study cannot be conclusive since the changes in behavior would only reflect the 3-4 weeks period during the study, while the behavior after and before the study might have changed among these patients. The other weakness of the study is that it gives the self reported adherence based on the refill rate. This implies that the participants give their own perception of the rate of adherence, where the results may be biased since some self reported results may be wrong. This implies that the study fails to give the practical rates of adherence, where a self reported result may be jeopardized by the responded or the responded might decide to give a wrong result as a result of stigmatization. 

Reference

Konkle‐Parker, D. J., Erlen, J. A., Dubbert, P. M., & May, W. (2012). Pilot testing of an HIV medication adherence intervention in a public clinic in the Deep South. Journal of the American Academy of Nurse Practitioners , 24 (8), 488-498.