11/3/2011 - Newswise - Deaths from HIV/AIDS are falling worldwide, prompting healthcare providers to focus on
controlling the secondary infections that can be life-threatening for immunocompromised individuals. Johns Hopkins University
School of Nursing assistant professor Jason Farley, PhD, MPH, 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, is more dangerous to HIV/AIDS-affected individuals because it's easily
transmittable and more likely to recur.
According to Farley, the bacteria are present in only one percent of the general population, but it's more common among
HIV/AIDS-affected groups. The repeat doctor's visits needed to treat the infection augments the patient's risk for
further sickness, potentially complicating any HIV treatment.
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. In fact, based on a molecular-analysis comparison of swabs from seven body sites taken at
multiple times, Farley says 80 percent of patients treated for a CA-MRSA infection develop a second one within six months.
The biggest issue for HIV/AIDS-affected patients, Farley says, is the immune response a CA-MRSA infection prompts.
The viral load spikes when the body begins to fight CA-MRSA.
"We wanted to look at how the bacteria evolved and whether patients had it 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." Understanding CA-MRSA's genetic make-up can help create an intervention that
prevents bacterial infection between persons or within households, Farley says. A Johns Hopkins Clinical Research
Scholars Award funded the study.
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. Today, however, it's the hospital structure itself that increases the risk of death for these
individuals admitted with a secondary infection, Farley says. The problem is the high physician-to-patient ratio.
In partnership with the Medical Research Council and the Department of Health in Pretoria, Farley is expanding
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. 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 well," Farley says. "Our research now is looking into whether the physician-based
culture is responsible and if these patients would benefit from having a nurse manage their cases."
This change would be a paradigm shift in South Africa's physician-centric healthcare system, but Farley's
previous research revealed doctors only see each patient once every seven to 10 days. When nurses more actively monitor
patients, they catch 25 percent more adverse drug reactions than do physicians alone.
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.
Additionally, in response to mounting pressure on physician time, Farley, with support from the Medical Research
Council and South Africa's Department of Health, is testing another model in which nurses use the rapid MDR-TB diagnosis test
Gene Xpert PCR to initiate care in HIV-positive patients. The test truncates the diagnosis time from almost two months to
only a few hours, giving nurses a head start on treating the disease. The first nurse to test this model begins training
this month and will finish in January 2012.
"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."
The Johns Hopkins University School of Nursing is a global leader in nursing research, education, and scholarship. The
School and its baccalaureate, master's, PhD, and Doctor of Nursing Practice programs are recognized for excellence in educating
nurses who set the highest standards for patient care and become innovative national and international leaders. Among U.S.
nursing schools, the Hopkins Nursing graduate programs are ranked #1 by U.S. News & World Report. For more information,