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Evaluating the Conclusion


Evaluatingthe Conclusion

Medicalprofessionals look past a sick person’s immediate physicalchallenges to reflect on the manner medical treatments affects theirlife quality. When an individual survives for years with an illnesslike HIV/AIDS, life quality becomes a concern. Life quality regardsto a person’s outward, social and psychological health. Theemotional condition of patients is relevant because many are probableto suffer from depression. The study by Tsai et al (2013) suggeststhat depression, substance use disorders and pain are highlywidespread amid people with HIV/AIDS, amid the homeless andmarginally housed. The intent of this paper is to evaluate theconclusion of study.

Evaluatingthe Conclusion

Discussionof the study’s conclusion

Theresearchers conclude that in a populace of marginally housed andhomeless HIV positive grownups, adherence to medication and observingplanned appointments can be more convoluted by depression. Tsai et al(2013) demonstrate that pain, substance use disorders and depressionare pervasive amid HIV sick persons. This poses major predicamentsfor medical practitioners treating the patients. The research focuseson such a populace and depicts how directly observed fluoxetinetreatment might be an efficient treatment approach. It is expectedthat through the treatment of depression, more patients becomeadherent to HIV treatment. The researchers conclude that treatment ofdepression may be anticipated to enhance immunologic or virologicaleffects via enhanced adherence. Since the homeless and marginallyhoused face numerous psychological challenges to triumphantmedication adherence, and depression, the study uses a directlyobserved treatment approach, as the one employed for treating andmanaging of sick individuals with HIV and tuberculosis. The approachresulted in the conclusion that directly observed depressiontreatment through fluoxetine enhanced depression sign severity.However, it does not improve standard ART adherence or possibility ofviral control amid the marginally housed and homeless persons withcomorbid HIV, in addition to depression.

Thefindings are surprising because they demonstrate the effectiveness offluoxetine as a depression treatment approach for HIV positivemarginally housed and homeless grownups. The study employs apopulation that is highly susceptible with numerous impediments toadherence (Tsai et al, 2013). The study also informs on the treatmentproblems faced by clinicians, due to triple diagnosis of HIV,substance use and depression. It is expected that with the treatmentof depression, patients will be more adherent to HIV treatment. Thestudy intended at demonstrating this effectiveness. However, thoughthe anti depressant administered to the sick persons reducesdepression, it has minimal effect on the enhancement of average ARTadherence or possibility of viral repression amid the marginallyhoused and homeless individuals diagnosed with depression andcomorbid HIV.

Thefindings are not statistically significant. The intervention employedminimized depression sign severity and enhanced response, in additionto remission. The BDI-II results were the same. The researchers notethat there were no statistically relevant disparities in secondaryHIV outcomes. Based on the statistical analysis, there are manyassumptions and generalizations employed. To approximate the standardimpact of treatment on results over the whole study, the researchersfit generalized linear varied models to the information with the SASprocess GLIMMIX (Tsai et al, 2013). In addition, the researchersemploy an unstructured working covariance medium for all evaluations.For the continuous reliant variable, they presume a model linkingtreatment and time impacts linearly to the dependent variables.Notably, the randomized trial does not meet its enrolment objective.Close to two thirds of the selected participants failed in meetingthe DSM-IV measures for inclusion. There was no observedstatistically relevant enhancement in secondary HIV outcomes amidparticipants randomized to the intervention arm. Absence ofstatistical power possibly added to the lack of statisticallyrelevant approximated effect, due to inability to enroll the supposedfigure of participants.

Findingsin terms of the literature review on this health topic

TheUOPX library comprises of different studies that focus on the similarhealth topic as the one presented by the researchers. The field ofresearch in all studies is on enhancing HIV treatment observance bypatients. However, the studies differ in one aspect, but are similarin their focus. All the studies included in the literature review areintended at demonstrating how to enhance adherence to HIV treatment.The difference is apparent in that the selected study focuses onfactors like reducing depression to enhance HIV treatment adherence.Based on the different studies review, researchers avail informationon how sick persons can access, understand and employ HIV medicalinformation. There is an apparent correlation amid providinginformation to patients and adherence to individually scheduled HIVtreatment. In a different study, researchers inform on the impactpharmacists intervention has on HIV treatment adherence, amongpatients. The study further informs on the importance of adhering totreatment.

Theresearch is unique because it focuses on homeless and marginallyhoused HIV positive people. The populace is vulnerable, in additionto having numerous unmet medical needs. There is need for research onthe population to instruct practice and policy. Due to high levels ofsubstance use disorders amid the homeless, they have not beenincluded in measures intended at improving HIV treatment adherence.Another reason for the uniqueness is that the research adds to thelimited proof on the lasting treatment of depressed disposition.There are minimal studies that comprised randomized trials ofantidepressant medications, which is the focus of the study.

Thefindings add to the field of study on the topic. Key findings arethat treatment directly observed with fluoxetine enhanced depressionsign severity (Tsai et al, 2013). Another finding is the lack ofstatistically important impacts of the intervention on antiretroviraltherapy, which was the secondary result measure of the research (Tsaiet al, 2013). The field of study is on HIV treatment adherence amidHIV positive persons. More specifically is the concentration ofhomeless and marginally housed persons. The authors contributed onthe effect of depression in impeding effective treatment. It alsodemonstrates the need to treat illnesses arising from emotional,physical and psychological issues, like depression, if HIV treatmentadherence is to enhance.

Nextsteps with the findings

Theresearchers do not propose further research for extra information orclarification. As noted, the study is unique and focuses on apopulation that has previously had minimal research conducted about.The findings are conclusive in demonstrating the effectiveness offluoxetine in enhancing depression signs severity. However, theauthors note that in different areas of medicine, similar to the onein the research, randomized depression trial interventions have beenineffective in enhancing clinical outcomes like glycemic regulation.This hints that restrictions apart from depressed mood are impedingwith adherence. Thus, the suggestion that enhancing ART adherencemight need more than enhancements in mood. The researchers suggestmobilization of different types of social support as important inenhancing adherence.

Thestudy should be redone with a larger sample. One of the weaknessesapparent is that the targeted sample size was not attained (Tsai etal, 2013). This reduces the study’s ineffectiveness, especiallyfollowing the dropping of some participants due to death, droppingout or loss during follow up. A larger sample size enhances theresearch by ensuring more persons are targeted. Another weakness isthe lack of a placebo control group in the research. A larger sampleimplies inclusion of a placebo control group.

Thefindings can be employed to best practices. They inform on therelevance of ensuring that depression, pain and substance use arealso treated when providing treatment for HIV positive persons. Thestudy provides an effective antidepressant, in addition to informingon how the antidepressant may be employed. The findings areapplicable to public policy because they enhance the neglect towardsthe homeless, as well as marginally housed persons that are HIVpositive. It is a strategy towards enhancing ART adherence amid thepopulation. Last, the findings inform on how to avoid depression,which in turn improves the effectiveness of HIV treatment.


Thestudy is an important field of research on the topic of increasingHIV treatment adherence. It evaluates how directly observedfluoxetine treatment might be an efficient approach in minimizingdepression signs severity and enhance HIV treatment results. Theauthors employ a randomized trial to validate the effectiveness ofthe antidepressant. The research is important and unique in itstarget population. It enhances knowhow on the relevance of reducingdepression when controlling HIV. Thus, informing on theinterrelatedness between depression and HIV positive patients ARTadherence.


Tsai,A. C et al. (2013). Directly Observed Antidepressant MedicationTreatment and HIV Outcomes Among Homeless and Marginally HousedHIV-Positive Adults: A Randomized Controlled Trial. AmericanJournal of Public Health, 103(2),308-315.