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

项目总结 随着艾滋病毒预防和治疗工作的成功扩大，与艾滋病毒携带者的预期寿命 艾滋病毒正在接近普通人群的艾滋病毒水平。在南非夸祖鲁-纳塔尔农村，成年人艾滋病毒 流行率超过20%，越来越多的艾滋病毒携带者年龄超过50岁，这使得 他们面临着患上与年龄相关的共病的风险。以确保有效的筛查、诊断和 艾滋病毒、结核病和相关非传染性疾病的治疗努力，全面的 了解疾病的驱动因素和分布，以及共同感染的相互作用机制。 在撒哈拉以南非洲(SSA)，艾滋病毒携带者之间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疾病(艾滋病毒和结核病)和非传染性疾病之间的重叠 传染病(高血压、糖尿病和肥胖症)流行，并确定其关键个体， 家庭、家庭和地理空间风险因素，最终设计有效和高效的护理服务 与SSA重叠疫情相关的模型。该项目将利用世界上最大的 世界上正在进行的以人口为基础的艾滋病毒队列--非洲卫生研究所的人口队列。 一个多组学的人口科学平台Vukuzazi(IsiZulu中的“觉醒并了解自己”)被 成立于2018年，为多种疾病增加全面的健康表型，包括艾滋病毒、结核病和 将糖尿病、高血压和糖尿病纳入持续的人口纵向监测平台。鉴于 共性理论框架，该项目将利用来自两个研究平台和 利用多层次和时空模型来理解交互机制和空间 共流行疫情的分布。对共同流行病的流行病学和空间了解也将 提供机会，为发展共同护理提供模式提供信息，以便将非传染性疾病护理纳入 在艾滋病毒高度流行的非洲农村地区，艾滋病毒/结核病联合传播模式。 该项目建立在世界上最大的正在进行的基于人口的队列之一的基础上，将汇集一个团队 调查人员具有不同和互补的专业领域，以建立一个多层次的分析， 处理南非新出现的多发病流行病的方法和理论框架 以及SSA中的其他类似设置。这一框架将由美国、英国和南非共同开发 调查人员和受训人员，并将大大提高当地能力。这项研究的结果将包括 第一个解开个人、家庭、家庭和社区之间的复杂联系 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。结果是 将为设计有效和高效的共同护理提供模式提供关键信息 在农村SSA环境中预防艾滋病毒和相关的共同流行病。

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.