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

项目摘要/摘要：该奖项将支持阿丽莎·韦德博士的职业发展和培训， 一位内分泌学家和临床科学家，对下丘脑内分泌和代谢疾病感兴趣， 艾滋病毒/艾滋病流行率高的中等收入国家。内分泌和代谢紊乱（EMD）是 这些疾病是世界范围内发病率和死亡率的重要因素，但对它们在 南非农村，那里有多种独立的风险因素，如艾滋病毒/艾滋病，抗逆转录病毒治疗， 成年期的预期寿命和营养过渡相互作用的方式，可能使相对负担 与高收入国家不同。早期发现和治疗EMD可降低发病率 和死亡率，但在初级保健中进行基础广泛的人口筛查在资源匮乏的情况下是不切实际的。 将有针对性的病例发现纳入常规初级保健中， 性价比这项工作的长期目标是确定南非最有可能发生艾滋病毒/艾滋病的人。 关键的EMD及其后遗症，并制定一个具有成本效益的，务实的战略， 识别和管理。该项目的具体目标是：（1）确定 在一个黑人社区，1630名40岁及以上的成年人为样本， 南非艾滋病毒和HAART使用率高的人群，（2）确定 在初级保健中使用移动的应用程序，以支持整合病例发现， 内分泌和代谢紊乱和（3）确定整合病例发现的成本效益 将EMD纳入初级保健的方法。这些研究将被嵌套在美国国家航空航天局资助的HAALSI中 NHGRI资助的AWI-Gen项目。这项研究将使申请人发展技能， 先进的生物统计学和流行病学，制定和评估复杂的干预措施和健康 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，在高风险的背景下研究EMD的演变。 艾滋病毒/艾滋病在低收入和中等收入国家的流行情况，并制定具有成本效益的干预措施， 他们的检测和管理。申请人将主要由Anne Cappola博士指导， 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LMIC中的衰老。她将得到良好的支持， 威特沃特斯兰德大学，非洲领先的研究机构之一。该奖项将促进 申请人转变为LMIC内分泌学领域领先的独立科学家。

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.