Deaths from HIV/AIDS are falling worldwide, prompting healthcare providers to shift focus on controlling comorbid conditions. Johns Hopkins University School of Nursing assistant professor Jason Farley, PhD, MPH, NP is on the forefront of this research, leading several studies both here and abroad on how to protect these patients from additional disease.
Hospital-acquired MRSA – the bacteria that causes “staph infections” – is well known. But community-acquired MRSA (CA-MRSA), with a different genetic basis and is increasing prevalence in HIV/AIDS-affected individuals has been linked to substantial illness in death in this population.
According to Farley, the bacteria are present, or colonize, only 1 percent of the general population, but it’s significantly more common among HIV/AIDS-affected groups. For patients who develop infections, repeat doctor’s visits to treat the infection augments the patient’s risk for further hospital-acquired sickness, potentially complicating any HIV treatment.
“We wanted to look at how the bacteria evolved and whether patients had the same strain of the bacteria on different parts of the body,” Farley says. “It’s important to know if a patient is a carrier or has been colonized by the strain especially if they start to develop multiple skin and soft tissue infections.” Also, data is emerging the MRSA may be associated with sexual transmission. “We don’t know if patients and their sexual partner harbor the same bugs.”
A Johns Hopkins Clinical Research Scholars Award funded the study.
CA-MRSA is highly transmittable within households, he says, so it’s possible for patients to pass the infection back and forth with their partner. In addition, a CA-MRSA-positive household, with all its surfaces and furniture, provides a ready-made source for reinfection. Understanding CA-MRSA’s genetic make-up and transmission between partners can help create an intervention that prevents bacterial infection between persons or within households, Farley says.
Multiple Drug Resistant TB
South Africa has been more affected by HIV/AIDS than any other country. As of 2009, the nation had 5.6 million people living with the virus. In partnership with the Medical Research Council and the Department of Health in Pretoria, Farley is expanding on previous research with multidrug-resistant tuberculosis (MDR-TB) to see if nurse-led care improves outcomes. Currently, 35 percent of South Africa’s HIV-positive patients who contract MDR-TB die compared to 16 percent of those who aren’t HIV-positive if life saving HIV treatment is not available. These mortality rates far outpace adjoining countries, Farley says.
“Based on our previous research into MDR-TB, we wanted to know why we were seeing such dismal cure rates in South Africa when other countries do better,” Farley says. “Our research now is looking into whether the non-physician care models would benefit patients, specifically, would a nurse case manager or nurse practitioner model increase access to care or improve treatment outcomes.”
This change would be a paradigm shift in South Africa’s physician-centric healthcare system, but Farley’s preliminary research revealed doctors only capable of seeing each patient once every week. According to pilot evaluation of a nurse case management model, nurses more actively monitoring patients, find 25 percent more adverse drug reactions. This data will be presented at the Annual Conference of the Association of Nurse in AIDS Care, next week in Baltimore.
To determine the feasibility of this care model, Farley is collecting data about what job responsibilities South Africa’s nurses have, what care requirements exist for MDR-TB, what and where the care gaps exist, and upon what services the nurses can improve and or provide in collaboration with physicians.
“Our goal is to develop and evaluate a model to replicate throughout the country,” Farley says. “We’re hoping for good evidence that shows nurses can start these treatments in highly safe and effective ways, expanding the population’s access to care.”