Direct and indirect impacts of HIV and ART among older people in community settin

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DESCRIPTION: A working group commissioned by the Office of AIDS Research of the NIH identified multi-morbidity, functioning, impacts of anti-retroviral therapy (ART), immune senescence, inflammation and a focus on women caregivers among the areas where critical needs for research exist. One of the major limitations identified by the working group, was the lack of appropriate comparison populations in existing studies, thereby limiting the inferences from data collected on older adults in "Western" populations due to different exposures and risk behavior. The need to leverage and build on existing cohorts was emphasized. The proposed study addresses many of these issues. The World Health Organization's Study on Global AGEing and Adult Health (SAGE), in its Well-Being of Older People Study (WOPS) sub-study, is currently collecting data on a cohort of about 1300 community dwelling respondents older adults in two low-income rural/periurban settings in sub-Saharan Africa (Uganda and South Africa) to understand the direct and indirect impact of HIV/AIDS on older adults. Half the respondents are HIV- positive and of these about half are currently on ART. The other half of the cohort is HIV- negative, but have been indirectly affected by HIV/AIDS in their families. A "control" cohort is included in Uganda, with older adults neither infected nor affected by HIV or AIDS. The cohort will already have been interviewed twice before the start of this proposal and with funding from this grant, will provide data for a seven year period over the full course of the study - the longet community dwelling cohort of older adults infected and/or affected by HIV, with a comparable cohort of older adults living in the same areas without HIV. Comprehensive measures of health and the inclusion of an array of biomarkers, including those of immune function and the ageing process, provide an unprecedented opportunity to study the complex nature of HV/AIDS in two non- clinical African populations (South Africa and Uganda). Data from the proposed study will have direct implications for understanding the health and well-being of similar older adult populations with HIV/AIDS in the US, especially those from lower socioeconomic classes and minority populations. Data from the study will use measures that are comparable to other international studies of aging, including SAGE and the US Health and Retirement family of studies. All anonymized microdata from the study will be archived according to international standards along with all metadata and made available to researchers.