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

项目摘要/摘要：该奖项将支持Alisha Wade博士的职业发展和培训， 一位内分泌学家和临床科学家，对低收入和低收入人群的内分泌和代谢性疾病感兴趣 艾滋病毒/艾滋病高流行率的中等收入国家。内分泌和代谢紊乱(EMDS)是 在世界范围内是发病率和死亡率的重要贡献者，但关于它们在 南非农村，艾滋病毒/艾滋病、抗逆转录病毒治疗等多种独立风险因素日益增多 成年期的预期寿命和营养转型的相互作用可能会使 EMDS不同于高收入国家。及早发现和治疗EMDS将减少发病率 但是，在资源匮乏的情况下，在初级保健中进行广泛的人口筛查是不切实际的。 将关键EMDS高危人群的目标病例发现整合到常规初级保健中可能证明 性价比高。这项工作的长期目标是确定南非那些面临最高风险的人 关键的EMDS及其后遗症，并为其长期制定具有成本效益的务实战略 识别和管理。该项目的具体目标是：(1)确定相对流行率 在以人群为基础的1630名40岁及以上的黑衣成年人样本中，关键的EMDS危险因素 南非艾滋病毒和HAART使用率高的人群，(2)确定 在初级保健中实施移动应用程序，以支持常见病例查找的集成 内分泌和代谢紊乱以及(3)确定整合病例发现的成本效益 确定初级保健中EMDS的方法。这些研究将嵌套在NIA资助的HAALSI中 项目和NHGRI资助的AWI-Gen项目。这项研究将使申请者在 高级生物统计和流行病学、复杂干预措施和健康的发展和评估 经济学，重点是成本效益分析，以支持她的长期职业目标 成为一名独立的临床科学家，在HIGH的背景下研究EMDS的演变 低收入和中等收入国家的艾滋病毒/艾滋病流行情况和制定成本效益高的干预措施 他们的检测和管理。申请者将主要由安妮·卡波拉博士在 宾夕法尼亚大学和威特沃特斯兰德大学的斯蒂芬·托尔曼博士， 衰老的内分泌学和LMICs中的衰老。她将得到学校设施的良好支持。 威特沃特斯兰德大学，非洲领先的研究机构之一。这一奖项将有助于 申请者转变为LMIC内分泌学领域的领先独立科学家。

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.