MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt)

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Adult Health & Healthy Ageing

Health and Ageing in Africa: A Longitudinal Study in South Africa (HAALSI)
  • PI(s): Lisa Berkman, Co-PI(s): Thomas Gaziano, Stephen Tollman 
  • Project Manager: Nomsa Mahlalela
  • Funder: NIH, NIA (USA)
  • Collaborating Institutions: Harvard University, Brigham and Women's Hospital, Colombia University, Boston University, University of Pennsylvania, and the University of Southern California (USA), University of Cape Town, and SAMRC/SAPRIN (SA), Heidelberg University (Germany)

The HAALSI study is a decade-long research project that explores ageing in South Africa. In 2023 HAALSI investigators received funding from the NIH/NIA for additional waves of data collection and national expansion, with a special emphasis on cognitive health. Plans for the next 5-year phase of HAALSI include a 4th and 5th survey wave of a community-representative cohort in rural Agincourt, South Africa, and the launch of a nationally representative longitudinal HAALSI survey across South Africa, as well as a sub-study focused on dementia. Since 2013, the HAALSI study has examined the demographic and epidemiologic transition taking place in South Africa, one of many countries whose population has experienced a boost in life expectancy thanks to the successful scale up of antiretroviral therapy (ART) in response to the HIV epidemic, as well as general socioeconomic and health care improvements. These gains in life expectancy, however, have meant that the region has also experienced unprecedented levels of chronic, non-communicable diseases, such as cardiovascular and metabolic diseases and dementia, among its newly ageing population. Identification of social and economic factors shaping health inequities is central to HAALSI. By harmonizing specific data about the ageing process in South Africa with data from other global studies of ageing, such as the Health and Retirement Study in the United States (HRS) and sister studies in India, China, Brazil, the UK, and Europe, the HAALSI study provides an opportunity to compare the biological, social, and economic determinants of chronic diseases and their effects on functional and health outcomes in ageing populations on a global scale. 

Website: www.haalsi.org

KAYA

The Complexity of Informal Caregiving for Alzheimer's Disease and Related Dementias in Rural South Africa 

  • PI(s): Lenore Manderson, Guy Harling
  • Project Manager: Michelle Brear
  • Funder: NIH, USA
  • Collaborating Institutions: University College London (UK); Harvard T.H. Chan School of Public Health (USA)

As growing numbers of people age globally, many develop Alzheimer’s disease and related dementias (ADRD). The consequent care needs can be complicated, particularly in resource-constrained communities where formal care services are lacking. However, research on the impact of ADRD caregiving is largely limited to primary caregivers and high-income countries. Our long-term goal is to identify ways to mitigate the negative impacts of long-term caregiving for ADRD in such communities and to develop novel ways to support householders and other caregivers. Our objectives in this study are to analyze: (1) how extended households negotiate and provide care to people with ADRD; and (2) how the health and well-being of all caregivers are affected by care roles. Drawing from the Health and Ageing in Africa (HAALSI) cohort nested within the HDSS, we will recruit 100 index participants who have been clinically screened for dementia and confirmed to have cognitive impairment or ADRD. We will combine data from qualitative observation of household activities and in-depth interviews with quantitative surveys to determine patterns of care and health among residents, non-resident kin, and non-kin. The research will generate novel data on informal and formal caregiving, relevant to other resource-poor settings in both poorer and richer countries. 

ARK Variant Bio extension
  • PI(s): JuneFabian
  • Co-PI: Stephen Tollman
  • Project Manager: Nokthula Busisiwe Mayindi
  • Funder: Variant Bio (USA)
  • Collaborating Institutions: SBIMB of Wits University (SA)

The ARK Consortium includes researchers from South Africa, Malawi, Uganda, and the London School of Hygiene and Tropical Medicine. The aim of this collaboration is to better understand kidney disease in African populations. Our research collaboration with Variant Bio aims to identify genetic risk factors that cause kidney disease in South Africans and to improve the tools used to diagnose kidney disease. That way we can identify it earlier and delay progression to severe disease. In this study, Variant Bio is lending expertise in whole-genome sequencing, comparing the genomes of a group of people with poor kidney function to a group with good kidney health, and investigating whether there are differences between the groups that can be attributed to genetic susceptibility. In addition to the genomics analyses, we will analyze blood samples from a metabolomics perspective. In short, metabolomics is the study of very small compounds in a biological sample, such as blood or urine. The concentration of these small compounds can change depending on genetics, the environment, or whether someone has a disease. If we identify differences associated with certain genes or certain environmental risks, this provides us with clues as to how exactly genes and/or the environment are influencing kidney health. 

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