The Khayelitsha Comorbidity Cohort: Establishing a multimorbidity cohort with integrated clinical, genomic and epidemiological data in South Africa.

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In the Western Cape Province of South Africa, there is a large burden of diseases including infectious diseases HIV and TB as well as chronic diseases like hypertension, diabetes and kidney disease. Often patients have more than one condition at the same time. The Provincial Health Data Centre (PHDC) at the Department of Health collects ongoing patient information about their visits to health facilities, medicines received and laboratory tests done, in order to provide health care. Where patients consent, these health data can be used for research to better understand health conditions. Genes and DNA are unique to each individual and can affect whether they will get some diseases, how ill they will get with those illnesses, and how they respond to treatment. By understanding this relationship between DNA and diseases, individual patients will be able to receive better health care tailored to their own DNA sequence. Most of the research done on DNA and diseases until now has been done on Caucasian populations, and African patients have been poorly represented in research. This means that most health care is not optimised for Africans, even though African populations have rich genetic diversity which can provide many insights into the mechanisms of disease through biomedical research. In addition, research about genetic effects on disease have generally been conducted from the perspective of looking at a single disease and doing the analysis on who has the disease or not without taking into consideration other health conditions that the participant might also be experiencing. Recently, the H3Africa Bioinformatics Network (H3ABioNet) developed the H3Africa Illumina genotyping chip, a tool that is specifically optimised for measuring DNA variation in Africans, across the whole human genome. With the consent of research participants, health data from the PHDC can be combined with genetic data generated using the H3Africa genotyping chip, making it possible to research the relationship between DNA and different diseases in African individuals. In the first instance, this project aims to collect 700 DNA samples from consenting participants and link their DNA data to their health data from the PHDC. In this first stage it will be possible to research the more common diseases - hypertension, diabetes and kidney disease; but as the number of research participants increases in the future it will also become possible to research the less common illnesses. Updated health information will be received from the PHDC twice a year, to document all health outcomes as they occur in participants going forward. An additional benefit to this research is that it will use a participant-based approach rather than a disease-based view, researching the whole health profile of the participant instead of only looking at whether they have a single disease or not. By working in collaboration with the Department of Health, a system will be set up to return useful findings from the research so that they can be used to provide better tailored health care by the Department of Health for individuals as well as the whole population. The information will also help to inform health care in other African countries, and well as providing research insights that can help improve our understanding of disease processes across the world.