About

Brief study summary

Phase I: Formative Research
Starting in December 2022, members of the White Mountain Apache Tribal community participated in a project called “The Staph Study”. This project helped researchers explore the community’s thoughts about Staph and the best ways to prevent it. 

Phase II: Clinical Trial, StapH Intervention for Effective Local Defense (SHIELD)
The results of Phase I were used to develop culturally-tailored education materials and a regimen to reduce carriage of Staph. These methods were assessed through a clinical trial called SHIELD (Staph Intervention for Effective Local Defense). The goal of this trial was to test the culturally-developed regimen to see if it was feasible and acceptable to the community and if it reduced Staph carriage. Analysis of study findings is underway. 

Background

  • Staphylococcus aureus or “Staph” is a bacterium (germ) that often lives in the nose of healthy people (called carriage).
  • Sometimes carriage can lead to infection. Infections can be mild (e.g., skin and soft tissue infections) or severe (e.g., sepsis, pneumonia, and flesh-eating disease).
  • Staph infections are especially common in people with specific risk factors including diabetes, obesity, and previous skin and soft tissue infections
  • Methicillin-resistant Staph (MRSA, “mer-suh”) is a type of Staph infection that is difficult to treat because of resistance to some antibiotics. 
  • The White Mountain Apache Tribal community has a high burden of Staph infections. Between 2016-2018, the rate of invasive MRSA infections was over seven times higher than the general US.  

What we are doing

Phase I: Formative research
Study activities for this phase were completed in May 2023. We conducted in-depth interviews (IDIs) and focus group discussions (FDGs) with community members and healthcare providers to understand their thoughts and perceptions about Staph infections, disease, and prevention. A total of 21 White Mountain Apache community members were enrolled in three FDGs and ten IDIs, and 17 healthcare providers were enrolled in IDIs. Results from this phase were used to develop culturally tailored education material and a feasible and acceptable regimen to reduce carriage of Staph

Phase II: SHIELD trial
Study activities for this phase were completed in October 2025. Adults were eligible for this study if they (1) were living in or around the White Mountain Apache Tribal lands, (2) had a risk factor such as obesity, diabetes, or a skin infection in the last three years, and (3) if they were carrying Staph in the nose or throat

  • The study enrolled 78 participants who provided consent and were randomized to one of two groups:
    • Intervention: 40 participants completed the culturally-tailored regimen over 4 months and received education and household supplies for reducing Staph
      • The culturally-tailored regimen included a nasal antibiotic ointment for 5 days, followed by a nasal sanitizer (Nozin®) and antiseptic body wash for 4 months
    • Control: 38 participants received educational and household supplies only
  • Both study groups completed the following study visits over 5 months:
    • Screening visit: assess potential participant eligibility
    • Baseline visit part 1: randomization (group assignment), educational materials given, and swabs collected from the nose, throat, and skin of upper thigh
    • Baseline visit part 2: household visit to collect swabs from household members, home surfaces, and indoor pets
    • 5 follow-up visits: at 2 weeks, 1 month, 2 months, 3 months, 4 months, which included questionnaires, swab collection, and payment

How this will help improve health in your community
We know from previous studies that the White Mountain Apache Community has high rates of Staph and MRSA infections compared to the general US. Through the results of this study, we hope to learn what the community knows about Staph infections, how Staph spreads in the community, and how we can effectively reduce infections in a culturally informed way. The results will help us provide specific recommendations about a disease that negatively impacts our community. 

We also hope to spread awareness about the risk of Staph infections through educational materials that participants are encouraged to share with household members 

Principal Investigator (PI) or Program Coordinator contact information:
Dr. Laura Hammitt, lhammitt@jhu.edu

Additional Information:

The results of the Phase 1 Formative research were published: Beekun SU, Pilewskie M, Sutcliffe CG, Sinquah FL, Littlepage SJ, Richards JR, Jones N, Hammitt LL. Understanding Community Perspectives on Staphylococcus aureus Disease and Prevention in the White Mountain Apache Tribal Community in Arizona. Int J Environ Res Public Health. 2026 Jun 27;23(7):845. doi: 10.3390/ijerph23070845.  The full text can be found here: https://pmc.ncbi.nlm.nih.gov/articles/PMC13410874/

Phase 2: Learn more about the study on clinicaltrials.gov (NCT06210594).