Jessica Merlin came to UAB in 2011 with the goal of becoming one of the first researchers to study palliative care in patients with HIV.
"I was looking to be at a place that had strong programs in both HIV and palliative care," says Merlin, MD, MBA, who joined the UAB faculty as Assistant Professor in the Division of Infectious Diseases and the Division of Gerontology, Geriatrics, and Palliative Care. "UAB has exceptionally strong programs in both."
Merlin began her career in HIV research during her infectious diseases fellowship at the University of Pennsylvania, in 2008. Penn has a relationship with the African country of Botswana, and Merlin traveled there three times, first as a medical student, then as a resident, and finally as a fellow, where she attended on the wards. "Those experiences made a big impression on me, with regard to the importance of palliative care for HIV-infected patients," she says. She subsequently completed a palliative care fellowship at the Mount Sinai School of Medicine in New York.
Merlin learned about the opportunities in HIV and palliative care at UAB through interactions with Rodney Tucker, MD—who at the time ran the UAB HIV Palliative Care Clinic—at events for the American Academy of Hospice and Palliative Medicine (of which she is a member). During a weeklong visit to UAB just prior to her palliative care fellowship, Tucker introduced her to Michael Saag, MD, the head of UAB’s HIV program. During her interview at UAB, she met Edward Hook, MD, chief of Infectious Diseases, and Richard Allman, MD, chief of Geriatrics, Gerontology, and Palliative Care.
"I had very little research training—I thought of myself as a clinician educator—and I started talking to all of them about what a job would look like," she recalls. "Everyone kept saying, ‘You should really consider being a clinician-investigator.’"
Merlin says she wanted to work at a place that "strongly supported junior faculty in research. They saw in me what I hadn’t completely realized in myself, which was that I loved the research I had done, and I’m passionate about pursuing research in this area."
HIV and palliative care is, as Merlin explains, a truly niche area when it comes to research. "It hasn’t been done yet, and I decided I wanted to be the person to push that forward." As one of the first researchers trained in both infectious diseases and palliative care, she came to UAB for the research training and the mentorship, she explains. "I couldn’t have put together a better scenario than what I found here."
Today she runs the UAB HIV Palliative Care Clinic, where she and her colleagues have noticed that chronic pain complaints are common among patients. As treatments for HIV have improved and the drugs have become more tolerable, the focus in HIV research is shifting from treating the virus itself to managing the complications of aging with HIV, including non-AIDS comorbidities, such as liver and heart disease, Merlin says.
"Now the pendulum has swung back to quality of life, including pain management," she says.
At least one quarter of all HIV patients living with the disease report having pain, and as Merlin points out, "we don’t have great ways to screen for chronic pain," but says this is an important area of investigation.
Merlin found there seemed to be no scale to measure chronic pain, which, she says, "was very surprising." Working with Saag and other members of her mentor/collaborator team they began adapting existing instruments to create their own scale, in which chronic pain is defined as moderate to severe pain for three months or more.
Via word of mouth, Merlin learned about and applied for a CCTS pilot grant, with the purpose of investigating the impact of pain and age in the context of substance abuse and psychiatric issues in HIV-infected patients. She was awarded the pilot for 2012–2013. Recently, her manuscript on the topic of pain, mood, and substance abuse in HIV patients was accepted by the Journal of Acquired Immune Deficiency Syndromes.
Since beginning this work, Merlin applied for and received an Agency for Healthcare Research and Quality Patient-Centered Outcomes Research Institutional Award (K12) to further her research on the chronic pain scale. "My K12 has provided me with the protected time and resources I need to be able to do the work and take classes in psychometrics and qualitative research," she says. She credits the support she received from the CCTS pilot award, and the CCTS’ assistance with the grantsmanship process, for her getting the K award. "Just going through the grant process shouldn’t be underestimated," she says.
Merlin’s team is currently conducting qualitative interviews to test patients using a tool to see how pain affects outcomes, in an attempt to get the patient perspective to build a conceptual model. She plans to apply for a K23 award that will fund her research for up to five years.
"Over the next 10 years, my goal is to contribute substantially to understanding chronic pain in patients with HIV, while gaining the knowledge and experience necessary to become a successful independent investigator," Merlin says. "I plan to do this through mentorship, formal training in clinical epidemiologic research methods, and participating in the many diverse learning opportunities available on UAB’s campus. I hope that what we learn about chronic pain in HIV-infected patients will also be applicable to other medically and psychiatrically complex patient populations."