Research Article Critique: HIV in Pregnancy - Coursework Example

Research Article Critique This paper seeks to academically critique an article written by Siegfried, van der Merwe, Brocklehurst, and Sint (2011) titled: Antiretroviral used for reducing risks for mother-to-child transmission. It will also critically evaluate a research article titled, The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 — A Meta-Analysis of 15 Prospective Cohort Studies.” by The International Perinatal HIV Group (PLAATJIE, 2009). The authors’ research study was to determine whether antiretroviral therapies decrease mother-to-child transmission of HIV. It also sought to determine to what extent the therapies are clinically useful in decreasing transmission risk. The effects of these interventions on infant and maternal mortality and morbidity rates were also examined. My examination focuses systematically on specific areas of the research study article. It will focus on these aspects in terms of the process, validity of the research methods and results. This study is vital in the sense that it helps in indentifying the right combination therapy in suppressing HIV replication. This helps in improving the clinical status and the immune system of children and adults living with HIV/AIDS (Faden, & Kass, 1996). The second article determines the relationship between vertical transmission of human immunodeficiency virus type 1 (HIV-1) and elective cesarean section. But not all findings in the study are properly done to comprehensively validate the study results. Therefore, there is a need to critically put forth the worth of each study and the evidence provided by the researchers, thus appraising these studies. The title of study define clearly what the study is all about, that is, to investigate whether antiretroviral therapies decrease the risk of mother-to-child HIV transmission in the first article and to evaluate the relationship between HIV-1 vertical transmission and elective caesarean section in the second article. The study population, a brief description of the methodology and the key outcomes being investigated are all included in the title of the second study: The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 — A Meta-Analysis of 15 Prospective Cohort Studies. This is does not apply to the first article: Antiretroviral drugs for reducing risks of mother-to-child HIV infection and transmission. The study populations in the study is Pregnant women infected with HIV or/and infants born to mothers infected with HIV in both cases. Their age ranges or their previous pregnancies histories have not been stated in either of the study. This is a drawback on the applicability of the findings to the general population. The key outcomes in both studies were both primary and secondary. The methodology applied in this study was inclusion exclusion criterion where HIV positive pregnant mothers were included with their newborns. They were selected in a randomized fashion. This has only been stated, however, the reasons for using it have not been elaborated. The second study utilizes the cohort fashion; the number of follow ups is clearly stated. However, the merits and demerits have not been outlined. The study provides a summary that quickly provides the urgent and necessary information concerning the research activity clearly. In this study, the abstract is divided into sections: aim, background, methods, results, conclusions and implications of ART to HIV positive mothers and their babies, as opposed to the second study on caesarean section and vertical transmission of HIV. This section is particularly valuable especially for the busy reviewers with limited time allotted for going over the proposal. The abstract is exhaustive and comprehensive covering the main sections of study at a glance. Research Problem In their research, Siegfried N et al. (2011) focus specifically on answering a particular research question clearly outlined in the research topic; as the use of antiretroviral therapies to reduce mother-to-child transmission of HIV (MTCT). They offer their problem as an interrogative rather as a statement. This is also the same case in the research by The International Perinatal HIV Group (1999). This is a score to the researchers. Of particular importance, the authors recognize the menace of HIV in both articles to the study populations. Their main aim is to reduce the transmission of the HIV from the infected mothers to their babies by various interventions. The risks of HIV Other transmission have also been included in the research problem as being: sexually transmitted diseases, breastfeeding, prolonged rupture of membranes, chorioamnionitis, low CD4 count, vaginal mode of delivery, obstetric events increasing bleeding, advanced maternal HIV disease, young maternal age, and history of stillbirth (Dunn, 1992). The review also notes that combined antiretroviral cabs the development of resistance. They note that, prolonged use of NVP as monotherapy causes a rapid development of viral resistance thus limits its usefulness in treating HIV infection in the long term. (Musoke, 1999). As recommendation guidelines from WHO (2006) that persons with CD4 counts less than 200/mm3 would start and continue with ART. It is clear from the study women who were infected with HIV were put on ART without considering their CD4 count to benefit their own health and be the best prophylaxis against MTCT. Selection of Subjects The population of study this research is explicitly clear and identified by the authors in both of the articles. They were randomized controlled on any antiretroviral regime that decreases mother-to-child transmission of HIV infection and at least 100 mother–child pairs in the second research. The subjects age ranges and pregnancy histories were not stated in both of the studies thus generalizability of study could not be such possible. The follow ups in the cohort did not explicitly state out the withdrawals, side effects and the deaths encountered. Instrumentation All experimental, as well as the quasi-experimental research, should include some tools and methods to be used in evaluating effects of the independent variables upon the dependent variables or else the  need to conduct the study would not be there. In consideration of the methods for evaluation as applied in these two studies, the authors in both of the studies developed different tools for evaluation. For the case of the association between the mode of delivery and vertical risk of transmission of HIV type 1, the authors came up with an international collaborative effort as a method that lead to a meta-analysis of data to individual patients in a prospective cohort in helping evaluate the association between delivery mode and the risk of the vertical transmission of the HIV-1 (Brunswick, 2005). For the case of the association between the efficacy of the antiretroviral drugs and the reduction of mother-child transmission of HIV reduction of HIV, the authors developed a style of observation tool employed six times for at least each experimental group, as well as on each placebo. The style of observation was meant to observe the HIV outcome after birth, after 4-8 weeks, after 3-4 months, after six months, twelve months, and finally after 18 months. All this was spread to cover the death toll, and the HIV survival in this period range. As the instruments were designed just for the sake of measuring these groups, they all fall in the category of the non-metric testing. Such a statement can be verified on a basis that using survey as a research method leads to a non-parametric data. Additionally, it can also be verified by the fact that making the groups equal before subjecting them to any sort of treatment was tested using one way analysis of the variance for the independent group which is an ordinal ranking test. More often than not, ordinal scales lead to non-parametric data. This is statistically significant since just like many other elements of these two studies it leads to problems of the external validity because non-parametric tests often do not make assumptions concerning how normal, regular or even the distributions of scores would be. In both articles, the internal validity of the test appears to be quite positive. Indeed, the researchers in both the articles seem to take extraordinary pains in ensuring that and they are keen in explicitly outlining their efforts in the developing of their observation tool, especially as regard to the use of low and the high inference observations. In both articles, the observation tools were developed such that they were inclusive of the two sections with the low inference sections consisting of a check-list scored at intervals. The list indicates the activities that were taking place at every interval. Although they are useful especially when dealing with quantitative data, they failed to provide room for the qualitative observation. On the contrary, the second section for the observation tool for both articles was made of high inference evaluation in the likeness of Likert Scale. The application of this scale can result into introducing a problem of internal validity in which case the observers might never wish to indicate their extremes but be limited to sticking on the mid-range of the scale. It might be making sense since the indication of the extreme value placed on a ranking scale is binary in nature. The advantage of such an evaluation approaching it from its internal validity appears to be that the subjects do not fill up the survey but rather he/she is observed by the third party. The additional significance that is quite clear is that the observers in both the articles are just that they are not the real researchers. This implies that the chance of an observation bias or any attempt to doctor the results is quite reduced. However, while this is the case, in both the articles the extent of the training of the observer is not indicated. Design The designs of these two studies can explicitly be outlined as being experimental for the case of the study that brings out the association between the efficacy of the antiretroviral drugs and the reduction of mother-child transmission of HIV reduction of HIV with a randomized sample and quasi-experimental for the case of the study that brings out the association between the mode of delivery and vertical risk of transmission of HIV type 1with post-test and pre-test control group design. In both articles, the independent variables are all clearly manipulated, in which case the in the servicing of control groups were methodologically undertaken. Moreover, in both the studies, the treatments were done independently of the others. When considering the study that brings out the association between the efficacy of the antiretroviral drugs and the reduction of mother-child transmission of HIV, while both the treatments and the placebo were aimed at achieving a reduction of mother-child transmission of HIV, each of them were developed to achieve the results using different methods. The placebo did not receive any treatment, and was not at all influenced by the research beyond the level that, in a period of eighteen months, each HIV infected mother alongside her infant were observed keenly. In the study, that brings out the association between the mode of delivery and vertical risk of transmission of HIV type 1, both the cesarean mode of birth and other modes had a different method of achieving the expected returns. While this is the case, we have wealthy variable thought of as confounding factors that were not taken into account in both of the studies. First, in constructing the association between cesarean and HIV type I transmission, the issue of the doctors’ level of neglect cannot be denied as being of statistical significance. Concerning the study that build up an association between the efficacy of the antiretroviral drugs and the reduction of mother-child transmission of HIV, the differences in the setting implies that the groups were given different treatments, and this has serious repercussions as far as the valid of the research findings are concerned. It would have been somewhat more valid should the sample groups be all located in the same region rather than different countries like it was the case with this experiment. As it stands, one cannot be certain that differing efficacy of the drugs resulted in the resistance of the participants bearing in mind that they were in differing localities. Discussion and Conclusion It is true that the conclusion of the two articles takes the ideas that are presented in the Results section to make value statements that are based upon them. Certainly, the interpretation of the results has been reserved for this section. What is also similar in the two articles is the results section. Generally, the results are discussed in relation to previous research studies, but more emphasis is put on the current literature. In the first article, which is meant to highlight the association between the efficacy of the antiretroviral drugs, and the reduction of mother-child transmission of HIV. Considering how successful the two articles were, it is perhaps somewhat useful to reiterate the research questions for the two articles. The authors of these articles indicate that the two yet different projects were a success. This implies that it is true to as far as article 2 is concerned that caesarean mode of delivery reduces chances of mother-child transmission of HIV type 1. Countries are, therefore, advised to impress this association and use it to their advantage in reducing the ever increasing child mortality rates. This clearly shows that both results for the research conducted by the authors are consistent with the findings of the lab based experiments. While this is the case, it is indicated that the scores of both the experimental groups failed to differ significantly from the control. This shows that researchers, while with the notion of success, seem to acknowledge the fact that the collected results are not as such conclusive and themselves. The researchers’ recommend some amendments to the research methods that were employed throughout their study Personal Analytic Statement As a whole, personally, I found the two articles to be having merit in terms of quality and validity. It is quite fascinating to see how caesarean mode of delivery can ultimately lead to reduction in transmission of HIV type 1. Other modes of delivery can cause a reduction in HIV type 1 infections; however, they are known to be relatively superfluous. The sample groups for both studies were well selected and represent the immediate populations. As such, the findings of each research are more limited to the individuals studied. The samples might be taken as possibly a representative of other individuals, thus the call for replication of the research. Going beyond this, many at the time the results themselves can fail to be conclusive as there exist no real general, significant difference between the controls and the samples. The issue that is of particular interest was the fact that on, one hand, the authors for the two articles seem to have a converging idea about the drug that is most suitable for reducing on the mother-child infection. It will also critically evaluate a research article titled, The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 — A Meta-Analysis of 15 Prospective Cohort Studies.” by The International Perinatal HIV Group (1999). This article The authors’ research study was to determine whether antiretroviral therapies decrease the risk of mother-to-child HIV transmission. It also sought to determine to what extent the therapies are clinically useful in decreasing transmission risk. The effects of these interventions on infant and maternal mortality and morbidity rates were also examined. My examination focuses systematically on specific areas of the research study article. It will focus on these aspects in terms of the process, validity of the research methods and results. This study is vital in the sense that it helps in indentifying the right combination therapy in suppressing HIV replication. This helps in improving the clinical status and the immune system of children and adults living with HIV/AIDS (Volberding, 2010). The second article determines the relationship between vertical transmission of human immunodeficiency virus type 1 (HIV-1) and elective cesarean section. But not all findings in the study are properly done to comprehensively validate the study results. Therefore, there is a need to critically put forth the worth of each study and the evidence provided by the researchers, thus appraising these studies. The title of study define clearly what the study is all about, that is, to investigate whether antiretroviral therapies decrease the risk of mother-to-child HIV transmission in the first article and to evaluate the relationship between HIV-1 vertical transmission and elective caesarean section in the second article. The study population, a brief description of the methodology and the key outcomes being investigated are all included in the title of the second study: The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 — A Meta-Analysis of 15 Prospective Cohort Studies (Beckerman, 1998). This is not the case in the first article: Antiretroviral for the reduction of risks of mother-to-child HIV transmission. The study populations in the study is Pregnant women infected with HIV or/and infants born to mothers infected with HIV in both cases. Their age ranges or their previous pregnancies histories have not been stated in either of the study. This is a drawback on the applicability of the findings to the general population. The key outcomes in both studies were both primary and secondary. The methodology applied in this study was inclusion exclusion criterion where HIV positive pregnant mothers were included with their newborns. They were selected in a randomized fashion. This has only been stated, but the reasons for its use have not been elaborated. The second study utilizes the cohort fashion; the number of follow ups is clearly stated. However, the merits and demerits have not been outlined. The study provides a summary that quickly provides the vital and necessary information concerning the research activity clearly. In this study, the abstract is divided into sections: aim, background, methods, results, conclusions and implications of ART to HIV positive mothers and, their babies, as opposed to the second study on caesarean section and vertical transmission of HIV. This section is particularly beneficial especially for the busy reviewers with limited time allotted for going over the proposal. The abstract is exhaustive and comprehensive covering the main sections of study at a glance. Personal Analytic Statement As a whole, personally, I found the two articles to be having merit in terms of quality and validity. It is quite fascinating to see how caesarean mode of delivery can ultimately lead to reduction in transmission of HIV type 1. Other modes of delivery can cause a reduction in HIV type 1 infections; however, they are known to be relatively superfluous. The sample groups for both studies were well selected and represent the immediate populations. As such, the findings of each research are more limited to the individuals studied. The samples might be taken as possibly a representative of other individuals, thus the call for replication of the research. Going beyond this, many at time, the results themselves can fail to be conclusive as there exist no real general, significant difference that exist between the control experiment and the sample. The issue that is of particular interest was the fact that on, one hand, the authors for the two articles seem to have a converging idea about the drug that is most suitable for reducing on the mother-child infection. References Beckerman, K. (1998). Control of maternal HIV-1 disease during pregnancy. Ney York. University press. Bosek, M. S. D. & SAVAGE, T. A. (2007). The ethical component of nursing education: integrating ethics into clinical experience. Philadephia, Lippincott Williams and Wilkins Gallant, J. (2009). 100 Questions & Answers About Hiv and Aids. Sudbury, Mass: Jones and Bartlett Publishers Print Brunswick, N.J. ( 2005). New Jersey Women and AIDS Network (NJWAN) Duliege, A, (1995). Birth order, delivery route, and concordance in the transmission of human immunodeficiency virus type 1 from mother to twins. J. Pediatr; 126; 624-32. Dunn, D, Newell M-L, Ades A, Peckham, C. (2009) Risk of human immunodeficiency virus type 1 transmission through breast-feeding. 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