Joshi, Keya

Arts & Sciences


South Africa

South Africa - MDR-TB/HIV Co-Infection South Africa: Expanding Access to Care through Nurse Initiation

TB remains a leading cause of death globally and is the leading cause of death in South Africa. The South African Department of Health is collaborating with Johns Hopkins University School of Nursing on a national roll out of MDR-TB/HIV treatment expansion utilizing nurse practitioner (primary healthcare nurses). Dr. Farley developed this program over the last several years to increase access and reduce wait list for patients newly diagnosed with MDR-TB. While the program is identified as a practice placement, there are clear research questions that will be addressed throughout the project. The student will have opportunity to work with both program implementation and research evaluation during this experience.

           Throughout my college experience I have learned a lot about various facets of public health; from disaster preparedness to biostatistics, the knowledge I have accumulated has given me a solid grounding of what public health work is.  This summer, I was able to put all of the theory I learned into practice by participating in the Global Health Established Field Placements. For me, this was one of the most life changing experiences I have had and completely solidified my interest in infectious disease epidemiology.

            For my experience, I worked with Louise Walshe, Rachel Kidanne, and Dr. Jason Farley on a project entitled, “MDR-TB/HIV Co-Infection South Africa: Expanding Access to Care through Nurse Initiation.” Before this project I had never worked or lived in a third world country. Prior to arriving I was quite nervous about what to expect. In my previous travels to India I had seen poverty first hand, but visiting family is completely different than immersing oneself in another country’s culture for almost two months. I was especially anxious to see how treatment facilities were in South Africa and if patients received adequate care and support from healthcare workers.

            Dr. Farley developed a program to expand the role of nurse practitioners during MDR-TB treatment, including MDR-TB treatment initiation. The goal of the program was to reduce wait time for treatment for patients newly diagnosed with MDR-TB. For the project, I worked in Port Shepstone, South Africa where I traveled to Murchison Hospital. In order to expand the role of nurse initiators, it was important to establish that nurses could indeed initiate patients into MDR-TB treatment and sustain positive results. During my time I looked at patient treatment outcomes from 2012 and 2013 to see if nurses (compared to doctors) had successful treatment outcomes. The unique thing about Dr. Farley’s initiative was the task-sharing concept. There would not be two parallel sets of patients; one working with the doctor and the other set working with the nurse, instead, there would be a joint effort so patients would be receiving continuous care and treatment. In addition, I was able to attend the 4th annual South African TB conference. During this weeklong program I was able to listen to speakers from around the world and see how, globally, researchers were tackling the growing problem of drug resistant tuberculosis.   

            The field placement showed me how much I enjoyed fieldwork. Actually seeing how health systems worked in another country was fascinating. After this experience I am committed to pursuing a degree in infectious disease epidemiology in the future. I hope to specifically focus on outbreak predictions and dynamics to see how epidemics start and spread in a population and how this spread changes based on various geographic areas. It was interesting to think that South Africa provided the perfect environment for MDR-TB to thrive and pose such a problem to the local population due to high rates of poverty, lack of access to healthcare facilities, and how individuals travel from point A to point B. In the US, while there are cases of regular tuberculosis, MDR-TB could never devastate the country due to the drastically different healthcare system and population structure.

            In the future I hope to return to South Africa and continue to work with MDR-TB. This was a fantastic opportunity to work on an emerging global health problem and understand how MDR-TB treatment is not a quick fix but will require cooperation from many different parties across the world. 

Photo Captions:

1. Murchison Hospital
2. Patient charts
3. TB conference


October 2020




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