Soweto Syndemics: A Two-Phase Study of Surveillance and Co-Morbid Experiences

这项拟议中的研究将是第一次在弱势群体中测试合集理论。这个 与流行病概念相比，综合征概念提供了一种创新的理论和实践 一种结合了“协同效应”和“流行病”概念的方法，以调查社会、政治和生态 这些因素在人口层面促进疾病集聚，在个人层面影响疾病病理。 合并症的概念包含三个核心概念：1)两种或两种以上疾病聚集在一起 2)这些疾病相互作用，通常是生物上的；3)大规模的社会力量促成了这些疾病。 南非黑人中患有2型糖尿病(T2 DM)的联结性聚集性例证了联结性概念， 对这一现象的深入研究将提供重要的政策和临床前景。T2 DM是 低收入和中等收入国家的低收入人口不断增加，2型糖尿病影响到人们 年龄在60岁以下，并且经常没有确诊。共同发生的情况，包括抑郁症，是 居住在低资源环境中的妇女普遍而痛苦。拟议的研究将 招募5,000人参加既定的监控研究，以创建一个同步集群的平台。 第一个目标是通过评估产生共性的社会和经济因素来检验共性理论。 来自该监测的T2 DM合并高血压(HTN)、抑郁症、艾滋病毒和结核病(TB)的集群 站台。我们假设，共同发生条件的社会和经济决定因素将不同于 除了共性聚集性之外，滋生单一疾病的决定因素。第二个目标将采用混合模式 方法对150例老年精神分裂症患者的社会医疗经历及保健行为进行调查。 T2 DM和共生的HTN、HIV、TB或抑郁症，以检查哪些社会和生物学经历 描述这些共性星系团的特征。我们假设独特的社会、经济、心理和 个人经历将使人们经历一个与另一个相比较的联结群。这些数据将 在南非目前正在实施的新的初级保健系统的规划阶段， 我们预计，对综合初级保健的见解将是及时的、相关的和信息丰富的。公众 这项研究对健康的影响是：1)证明使用Syndemics框架比使用 评估复杂疾病事件的单一疾病框架，2)为社会政策提供信息，如新的 南非的含糖饮料税，以及3)为综合初级保健提供有针对性的信息 这可以为正在进行的南非卫生系统的重组提供信息。综合临床的设计 支持对综合征的进一步研究的干预措施以及初步研究将具有更广泛的意义 适用于美国和其他类似情况下的临床护理。

The proposed research will be the first to test the theory of syndemics among a vulnerable population. The syndemics concept, in contrast to the epidemics concept, provides an innovative theoretical and practical approach that combines concepts of “synergy” with “epidemic” to investigate how social, political, and ecological factors promote disease clustering at the population-level and impact disease pathologies at the individual-level. The notion of syndemic incorporates three core concepts: 1) two or more diseases cluster together within a population, 2) these diseases interact, often biologically, and 3) large-scale social forces precipitate them. Syndemic clusters with Type 2 diabetes (T2DM) among black South Africans exemplify the syndemics concept, and in-depth investigation of this phenomenon will provide important policy and clinical perspectives. T2DM is escalating among low-income populations in low- and middle-income countries, with T2DM affecting people younger than 60 years of age and often going undiagnosed. Co-occurring conditions, including depression, are common and afflict women disproportionately residing in low-resource settings. The proposed research will recruit 5,000 individuals enrolled in an established surveillance study to create a platform to syndemic clusters. The first aim will test syndemic theory by evaluating the social and economic factors that produce syndemic clusters of T2DM, with hypertension (HTN), depression, HIV, and tuberculosis (TB), from that surveillance platform. We hypothesize that social and economic determinants of co-occurring conditions will differ from those determinants that foster singular diseases apart from syndemic clusters. The second aim will employ mixed methods to investigate the social and medical experiences and health care behaviors among 150 people with T2DM and co-occurring HTN, HIV, TB, or depression to examine what social and biological experiences characterize these syndemic clusters. We hypothesize that unique social, economic, psychological, and personal experiences will afflict people experiencing one syndemic cluster compared to another. These data will be imperative during the planning stages of the new primary care system currently underway in South Africa, and we anticipate that insights into integrated primary care will be timely, relevant, and informative. The public health impact of this research is to 1) demonstrate that using a syndemics framework is more effective than a singular disease framework to evaluate complicated disease events, 2) inform social policy, such as the new sugar sweetened beverage tax in South Africa, and 3) provide targeted information for integrated primary care that can inform the restructuring of the South African health system underway. The design of integrated clinical interventions as well as the preliminary research to support further research on syndemics will have broader applicability to clinical care in the U.S. and other syndemic conditions.