Epidemiology and Impact of the HIV, NCD, and Urbanization Syndemic in Africa

非洲是目前世界上艾滋病毒感染者的绝大多数（69%），有2 600万艾滋病毒感染者 （艾滋病毒感染者）。非洲抗逆转录病毒疗法的普及显著延长了艾滋病毒感染者的生命 艾滋病毒感染者的发病率和死亡率正在向非传染性疾病（NCD）转移，包括 高负荷心肺NCD（CP-NCD），如充血性心力衰竭、高血压、哮喘， 慢性阻塞性肺疾病此外，非洲正在经历快速城市化， 空气污染的增加以及生活方式和社会、结构和卫生服务环境的变化。 艾滋病毒、CP-NCD和城市化的这种显著趋同对未来的发展具有深远的影响。 全球健康。不幸的是，关于城市化和空气污染对CP的影响的数据很少， 非传染性疾病和艾滋病毒作为影响因素的潜在作用，例如艾滋病毒感染者可能更容易受到城市疾病的影响， 存在慢性炎症，尽管抑制了HIV病毒血症或过去结核病或其他 肺部感染此外，对艾滋病毒和CP-非传染性疾病的保健服务利用模式知之甚少， 人口迁移到城市环境以及如何更好地将艾滋病毒和慢性阻塞性肺疾病-非传染性疾病护理结合起来。最后，艾滋病毒和 非洲的预防性肺炎-非传染性疾病研究主要是跨部门的，而且往往没有艾滋病毒阴性比较 在理解因果因素和准确计算可归因分数方面的主要局限性 传统和非传统风险因素。需要采取纵向的、人口层面的方法， 未来的研究，计划和政策。Rakai社区队列研究（RCCS）成立于1994年， 在乌干达中南部的40个社区开展了一个开放的、以人口为基础的队列， 每隔约18个月（区域社区卫生服务中心普查人口约33 000名成人，艾滋病毒流行率约18%）。RCCs 社区是非城市的;然而，该队列经历了每轮约950名参与者的向外迁移 到两个大的城市中心（坎帕拉和马萨卡），在那里，区域协调中心设有卫星办事处。通过这项独特的研究 基础设施，RCCS提供了一个新的机会，进行纵向，以人口为基础的研究艾滋病毒， 综合健康决定因素框架内的慢性阻塞性肺疾病-非传染性疾病和城市化综合症。本研究 建议（i）描述心肺非传染性疾病的艾滋病毒相关和不相关风险因素 （二）描述空气污染的影响， 艾滋病毒对R2 U移民心肺结果的调节作用;（iii）评估艾滋病毒和CP- R2 U移民中的非传染性疾病卫生服务利用模式。据我们所知，这将是第一个 非洲艾滋病毒、慢性肺疾病-非传染性疾病和城市化综合征的基于人口的纵向队列研究。我们 独特的能力，利用农村到城市的队列，优秀的研究基础设施，和新的目标将 生成设计新的研究、干预措施和政策所需的重要数据，以对抗不断演变的艾滋病毒 和CP-NCDs的流行。

Africa bears the vast majority (69%) of the world’s current HIV infections with 26 million persons living with HIV (PLHIV). Increased access to antiretroviral therapy (ART) in Africa has markedly extended the lives of PLHIV and is shifting morbidity and mortality among PLHIV toward non-communicable diseases (NCDs), including high burden cardiopulmonary NCDs (CP-NCDs) such as congestive heart failure, hypertension, asthma, and chronic obstructive pulmonary disease. In addition, Africa is experiencing rapid urbanization with its associated increases in air pollution and changes in lifestyle and the social, structural, and health service environment. This remarkable convergence of HIV, CP-NCDs, and urbanization has profound implications for the future of global health. Unfortunately, there is a paucity of data on the impact of urbanization and air pollution on CP- NCDs and the potential role of HIV as an effect modifier, e.g. PLHIV may be more susceptible to urban ills due to existing chronic inflammation despite suppressed HIV viremia or from sequelae of past tuberculosis or other pulmonary infections. In addition, little is known about HIV and CP-NCDs health service utilization patterns as people migrate to urban settings and how HIV and CP-NCD care might be better integrated. Finally, HIV and CP-NCDs research in Africa has primarily been cross-sectional and often without HIV-negative comparison groups, major limitations in understanding causal factors and accurately calculating attributable fractions for traditional and non-traditional risk factors. Longitudinal, population-level approaches are needed to better guide future research, programs, and policies. The Rakai Community Cohort Study (RCCS), established in 1994, is an open, population-based cohort in 40 communities in south-central Uganda with survey rounds conducted over ~18 month intervals (RCCS census population ~33,000 adults, HIV prevalence ~18%). RCCS communities are non-urban; however, the cohort experiences an out-migration of ~950 participants per round to two large urban centers (Kampala and Masaka) where RCCS has satellite offices. With this unique research infrastructure, RCCS offers a novel opportunity to conduct longitudinal, population-based research on the HIV, CP-NCDs, and urbanization syndemic within a comprehensive health determinants framework. This study proposes to (i) Characterize HIV-related and -unrelated risk factors for cardiopulmonary non-communicable diseases in a novel Rural-to-Urban (R2U) African cohort; (ii) Characterize the impact of air pollution and moderating effects of HIV on cardiopulmonary outcomes among R2U migrants; and, (iii) Assess HIV and CP- NCDs health services utilization patterns among R2U migrants. To our knowledge, this would be the first population-based, longitudinal cohort study of the HIV, CP-NCDs, and urbanization syndemic in Africa. Our unique ability to leverage a rural-to-urban cohort, the excellent research infrastructure, and novel Aims will generate vital data needed for designing new research, interventions, and policies to combat the evolving HIV and CP-NCDs epidemic.