Endocrine and metabolic diseases in rural South Africa-establishing burden and improving detection

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Project summary/abstract: This award will support the career development and training of Dr Alisha Wade, an endocrinologist and clinician scientist with an interest in endocrine and metabolic diseases in lower and middle income countries with a high prevalence of HIV/AIDS. Endocrine and metabolic disorders (EMDs) are significant contributors to morbidity and mortality worldwide, but little is known about their relative prevalence in rural South Africa, where multiple independent risk factors such as HIV/AIDS, antiretroviral therapy, increasing life expectancy in adulthood and nutritional transitions interact in ways that likely make the relative burden of EMDs different from high income countries. Early detection and treatment of EMDs would reduce morbidity and mortality, but broad-based population screening in primary care is impractical in low resource settings. Integrating targeted case finding in those at highest risk for key EMDs into routine primary care may prove cost-effective. The long-term objective of this work to identify those individuals in South Africa at highest risk of key EMDs and their sequelae and to develop a cost-effective, pragmatic strategy for their long-term identification and management. The specific aims of the project are to (1) determine the relative prevalence and risk factors of key EMDs in a population based sample of 1630 adults aged 40 years and over in a Black South African population with high prevalence of HIV and HAART use, (2) determine the feasibility of implementing use of a mobile application in primary care to support integration of case-finding for common endocrine and metabolic disorders and (3) determine the cost effectiveness of integrating a case-finding approach to identifying EMDs into primary care. These studies will be nested within the NIA-funded HAALSI project and the NHGRI-funded AWI-Gen project. This research will allow the applicant to develop skills in advanced biostatistics and epidemiology, development and evaluation of complex interventions and health economics, with an emphasis on cost effectiveness analysis, to support her long term career objective of become an independent clinician scientist investigating the evolution of EMDs against the backdrop of high prevalence of HIV/AIDS in lower and middle income countries and developing cost-effective interventions for their detection and management. The applicant will be mentored primarily by Dr. Anne Cappola at the University of Pennsylvania and Dr. Stephen Tollman at the University of the Witwatersrand, experts in the endocrinology of aging and aging in LMICs respectively. She will be well supported by the facilities at the University of the Witwatersrand, one of the leading African research institutes. This award will facilitate the applicant's transition to a leading independent scientist in endocrinology in LMICs.