The science of improving health underpins the professional community’s ability to provide adequate care for those facing HIV/AIDS, tuberculosis, and many other infectious diseases. And every two years, the International AIDS Society (IAS) convenes a scientific conference to share and discuss research and findings within HIV/AIDS and other disease areas. In fact, the IAS meeting is the largest open science conference on HIV/AIDS-related issues for a variety of researchers and clinicians.
The focus of the conference is to move science into practice and policy – and as a newly minted PhD, I am excited to be attending the upcoming meeting in Paris, France to present part of my doctoral dissertation as an oral presentation.
My dissertation, which I completed at Duke University School of Nursing, focused on age-appropriate treatment for individuals with drug-resistant tuberculosis (DR-TB) in South Africa. Specifically, I examined the time from diagnosis to treatment initiation and the composition of medications used to treat DR-TB. South Africa has national guidelines to treat DR-TB, so as a pediatric nurse practitioner, I have always been interested to know how we do as clinicians at correctly prescribing for patients. A lot of research focuses on patient adherence (i.e. patients taking their pills as prescribed); however, much less research has focused on provider adherence. It is essential that healthcare professionals provide guideline based care, especially for drug resistant diseases, to prevent worsening diseases in patients and widespread community transmission.
Tuberculosis is both curable and preventable, yet in 2015 1.8 million people died from TB – more people die from TB each year than HIV and malaria (WHO, 2017). Thus, treatment is paramount for both individual cure and community transmission.
This study I am presenting in Paris, took place as part of a cluster-randomized trial in two South African provinces (KwaZulu-Natal and Eastern Cape) across ten sites. Using quantitative statistics and models, we examined the association between age and outcomes, adjusting for characteristics of individual patients and treatment sites. What we found was rather shocking – only one in six individuals with DR-TB received treatment per South African guidelines (treatment within five days of diagnosis), and the average time to treatment was eleven days. Strategies are needed to decrease treatment delays and meet the recommended guidelines.
Putting my research skills to use in TB management compliments my role as Director of Pediatric Nursing at Seed Global Health. I view TB as an exemplar of the strength of a health care system – 95% of TB deaths occur in low- and middle-income countries (WHO, 2017), while few high-income countries have high rates of TB. To tackle and overcome the burden of TB, a country needs to have public awareness of the disease, supply chains to deliver laboratory and diagnostic equipment and medications to individuals, and clinicians who can accurately diagnose and treat patients. In a healthcare system where access to treatment, is hindered by cost, geography, lack of knowledge, or political will, eradicating TB is very difficult.
Although conducting research studies is rarely as instantly gratifying as acutely treating a patient who walks into your clinic, the gains from potentially improving the health of a country is exciting. Sharing my results with the TB and HIV research community in Paris is an honor and I hope these results will have an impact on the individual patients and clinicians working on the front lines to end TB.