Quantification of patterns of multimorbidity to develop effective and efficient models of HIV, TB and NCD co-care in rural South Africa

对多种发病模式进行量化，以在南非农村地区制定有效且高效的艾滋病毒、结核病和非传染性疾病共同护理模式

• 批准号: 10260533
• 负责人: Frank Courteney Tanser
• 金额: $ 16.64万
• 依托单位: KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10260533
• 关键词: AIDS prevention; Address; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Age-Years; Alcohol consumption; Area; Cardiovascular Diseases; Caring; Characteristics; Clinic; Communities; Complex; Data; Development; Diabetes Mellitus; Diagnosis; Disease; Enrollment; Ensure; Epidemic; Epidemiology; General Population; Geographic Distribution; Geography; Goals; HIV; HIV Infections; HIV/TB; Health; Household; Human immunodeficiency virus test; Hypertension; Individual; Infrastructure; Investigation; Life Expectancy; Light; Maps; Methodology; Modeling; Obesity; Obesity Epidemic; Pattern; Phenotype; Population; Population Sciences; Population Surveillance; Prevalence; Prevention; Research; Research Institute; Research Personnel; Risk; Risk Factors; Rural; Rural Community; Schools; Service delivery model; South Africa; South African; Spatial Distribution; Structure; Techniques; Testing; Tobacco use; Ursidae Family; aged; antiretroviral therapy; base; burden of illness; care delivery; cohort; comorbidity; design; disorder risk; epidemiological model; fast food; health care delivery; mHealth; multiple chronic conditions; multiple omics; population based; population health; rural South Africa; scale up; screening; screening services; theories; treatment services

PROJECT SUMMARY As HIV prevention and treatment efforts are successfully scaling up, life expectancies of individuals living with HIV are approaching to that in the general population. In rural KwaZulu-Natal, South Africa, where adult HIV prevalence exceeds 20%, a growing proportion of individuals living with HIV are aged over 50 years, putting them at the risk of developing age-associated co-morbidities. To ensure effective screening, diagnosis, and treatment efforts for HIV, TB and associated non-communicable diseases (NCDs), a comprehensive understanding of the disease drivers and distribution, as well as the interactive mechanisms of the co- epidemics among people living with HIV will be critical in sub-Saharan Africa (SSA). Our overarching goal in this project is to quantify the overlap in the infectious (HIV and TB) and non- communicable disease (hypertension, diabetes and obesity) epidemics and to determine their key individual, familial, household, and geospatial risk factors to ultimately design an effective and efficient care delivery model relevant to the overlapping epidemics in SSA. The project will take advantage of one of the largest ongoing population-based HIV cohorts in the world – the Africa Health Research Institute’s population cohort. Vukuzazi ("Wake up and know ourselves" in isiZulu), a multi-omics population science platform was established in 2018 to add comprehensive health phenotyping for multiple diseases, including HIV, TB, and diabetes, hypertension and diabetes to the ongoing longitudinal population surveillance platform. In light of the syndemic theory framework, the project will leverage the fully integrated data from both research platforms and utilize multilevel and spatial-temporal modelling to understand the interactive mechanisms and spatial distribution of the co-epidemics. The epidemiological and spatial understanding of the co-epidemics will also provide an opportunity to inform development of a co-care delivery model for integration of NCD care into HIV/TB co-delivery models in a HIV hyperendemic rural African setting. Building on one of the world’s largest ongoing population-based cohorts, the project will bring together a team of investigators with diverse and complementary areas of expertise to establish a multilevel analytical, methodological, and theoretical framework to address the emerging multimorbidity epidemic in South Africa and other similar settings in SSA. This framework will be co-developed by US, UK and South African investigators and trainees and will significantly enhance local capacity. Results from this study will be among the first to disentangle the complex associations between the individual, familial, household and community factors that impact HIV, TB and NCD risk in one of the world’s most severely affected populations. The results of the project will provide critical information for the design of an effective and efficient co-care delivery model for HIV and associated co-epidemics in rural SSA settings.

项目摘要 随着艾滋病毒预防和治疗工作的成功扩大， 艾滋病病毒正在接近普通人群的水平。在南非夸祖鲁-纳塔尔的农村， 流行率超过20%，越来越多的艾滋病毒感染者年龄超过50岁， 他们有发展与年龄相关的合并症的风险。确保有效的筛查、诊断和 艾滋病毒、结核病和相关非传染性疾病的治疗工作， 了解疾病的驱动因素和分布，以及共同疾病的相互作用机制， 在撒哈拉以南非洲，艾滋病毒感染者中的流行病将是至关重要的。 我们在这个项目中的首要目标是量化传染性（艾滋病毒和结核病）和非传染性疾病的重叠。 传染病（高血压、糖尿病和肥胖症）流行病，并确定其关键个人， 家庭、住户和地理空间风险因素，以最终设计有效和高效的护理服务 与SSA中重叠流行病相关的模型。该项目将利用世界上最大的 非洲卫生研究所的人口队列研究是世界上正在进行的基于人口的艾滋病毒队列研究。 Vukuzazi（isiZulu的“醒来并了解自己”）是一个多组学人口科学平台， 2018年成立，为多种疾病增加全面的健康表型，包括艾滋病毒，结核病， 糖尿病、高血压和糖尿病纳入正在进行的纵向人群监测平台。考虑到 该项目将充分利用来自两个研究平台的综合数据， 利用多层次和时空模型来理解互动机制和空间 共同流行病的分布。对共同流行病的流行病学和空间认识也将 提供一个机会，为将非传染性疾病护理纳入共同护理提供模式的发展提供信息， 艾滋病毒/结核病共同交付模式在艾滋病毒高流行的非洲农村环境。 该项目以世界上最大的正在进行的人口队列之一为基础，将汇集一个团队， 具有不同和互补的专业知识领域的调查人员，以建立一个多层次的分析， 方法和理论框架，以应对南非新出现的多重疟疾流行病 和其他类似的设置在SSA。该框架将由美国、英国和南非共同开发 这将大大提高当地的能力。这项研究的结果将成为 第一个解开个人、家庭、住户和社区之间复杂联系的 在世界上受影响最严重的人群之一，影响艾滋病毒，结核病和非传染性疾病风险的因素。结果 该项目将为设计有效和高效的共同护理提供模式提供关键信息 艾滋病毒和相关的共同流行病在农村的撒哈拉以南非洲环境。

项目成果

Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study.

• DOI: 10.2196/26073
• 发表时间: 2021-05-13
• 期刊: JMIR public health and surveillance
• 影响因子: 8.5
• 作者: Harling G;Gómez-Olivé FX;Tlouyamma J;Mutevedzi T;Kabudula CW;Mahlako R;Singh U;Ohene-Kwofie D;Buckland R;Ndagurwa P;Gareta D;Gunda R;Mngomezulu T;Nxumalo S;Wong EB;Kahn K;Siedner MJ;Maimela E;Tollman S;Collinson M;Herbst K
• 通讯作者: Herbst K

Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study.

• DOI: 10.1016/s2214-109x(21)00176-5
• 发表时间: 2021-07
• 期刊: The Lancet. Global health
• 作者: Wong EB;Olivier S;Gunda R;Koole O;Surujdeen A;Gareta D;Munatsi D;Modise TH;Dreyer J;Nxumalo S;Smit TK;Ording-Jespersen G;Mpofana IB;Khan K;Sikhosana ZEL;Moodley S;Shen YJ;Khoza T;Mhlongo N;Bucibo S;Nyamande K;Baisley KJ;Cuadros D;Tanser F;Grant AD;Herbst K;Seeley J;Hanekom WA;Ndung'u T;Siedner MJ;Pillay D;Vukuzazi Team
• 通讯作者: Vukuzazi Team

Computer-aided interpretation of chest radiography reveals the spectrum of tuberculosis in rural South Africa.

• DOI: 10.1038/s41746-021-00471-y
• 发表时间: 2021-07-02
• 期刊: NPJ digital medicine
• 影响因子: 15.2
• 作者: Fehr J;Konigorski S;Olivier S;Gunda R;Surujdeen A;Gareta D;Smit T;Baisley K;Moodley S;Moosa Y;Hanekom W;Koole O;Ndung'u T;Pillay D;Grant AD;Siedner MJ;Lippert C;Wong EB;Vukuzazi Team
• 通讯作者: Vukuzazi Team

Participant recall and understandings of information on biobanking and future genomic research: experiences from a multi-disease community-based health screening and biobank platform in rural South Africa.

• DOI: 10.1186/s12910-022-00782-z
• 发表时间: 2022-04-18
• 期刊: BMC MEDICAL ETHICS
• 影响因子: 2.7
• 作者: Luthuli, Manono;Ngwenya, Nothando;Gumede, Dumsani;Gunda, Resign;Gareta, Dickman;Koole, Olivier;Siedner, Mark J.;Wong, Emily B.;Seeley, Janet
• 通讯作者: Seeley, Janet