Understanding non-communicable diseases (NCD) and the role of infection in Africa: building a partnership to generate big data
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
"Non-communicable diseases" (NCD) are increasing in Africa. They are a diverse group of conditions, not directly caused by infections and are most often long-term and lifestyle-related, such as diabetes, high blood pressure, cancers, asthma and kidney disease. The reasons for the increase in these diseases are complex but include increasing urbanisation, overweight/obesity and lifestyle risk factors, such as smoking tobacco, high alcohol intake and reduced physical activity. The increase in NCD, is occurring alongside a high level of infectious disease (such as HIV and tuberculosis) and under- or mal-nutrition, which often exacerbates these conditions and leads to very poor health outcomes and shortens lives. In Africa, deaths from NCD in adults now exceed deaths caused by infectious diseases. To truly understand the severity and extent of these diseases requires investigations using detailed information from a general population, referred to as population-based research. Population-based research (as opposed to hospital-based research) is particularly important in Africa as relatively few people use formal health services, especially in the early stages of illness. The unique and valuable data collected in repeated cycles of population-based research help us to determine the amount and causes of disease; the risk (or chance) of death from these conditions; how these diseases develop in individuals; and how the disease changes over time (for example, age and sex of people most commonly affected). To understand NCDs in Africa better, and to help inform African policy makers and researchers, we propose an African NCD Longitudinal Data Alliance (ANDLA). ANDLA will bring together population-based research data from multiple partners working in existing study sites across Africa to create large, harmonised datasets that are robust and powerful enough to address important research questions that individual study sites would struggle to answer on their own. ANDLA will provide a dynamic and sustainable platform of population-based data collected over time (longitudinal-data). The data will be standardised and made available in an easily usable form, and will focus on NCD and their risk factors. It will be a unique large-scale data resource for understanding NCD in Africa now and in future decades, to inform and shape effective policy in populations with limited resources and a large and growing amount of these disease.
Technical Summary
Global burden of disease estimates suggest NCD are overtaking infectious disease as the leading cause of adult mortality in Africa. Obesity, diabetes, hypertension and associated lifestyle risk factors are rising in urban and rural settings as populations age and urbanise. HIV-related cancers and those of infectious aetiology including liver and cervix, are highly prevalent, representing a higher fraction of total NCD burden in Africa than elsewhere. In future, cancers such as breast, lung and colon, will be increasingly important as countries undergo demographic transition. This is a critical time point to understand the epidemiology, phenotypes and determinants of NCD.
NCD data from LMIC are predominantly from small studies using differing methods. Evidence from adequately powered, "big" data platforms, of population-level data, is urgently needed to understand the burden, distribution and determinants of NCD and the intersection with HIV and other important infectious diseases. We propose to set up an African Non-communicable Disease Longitudinal data Alliance (ANDLA) to address this gap: working with policy makers and experienced research partners; bringing together partners with NCD data collected in demographic surveillance sites to address important questions relevant to our setting. This will enable a greater understanding of the current status of chronic NCD, provide evidence for future prevention and management strategies and build a platform for multi-site intervention development, monitoring and evaluation and health systems research. Longitudinal data are key to understanding disease progression, trends and contribution of risk factors to mortality.
We will analyse markers of cardio-metabolic mortality risk; develop and validate risk scores; and conduct analyses of HIV-related cancer mortality. Scientific advisory groups will inform future work which may include asthma, chronic kidney disease, disabilities, injuries, epilepsy and mental health.
NCD data from LMIC are predominantly from small studies using differing methods. Evidence from adequately powered, "big" data platforms, of population-level data, is urgently needed to understand the burden, distribution and determinants of NCD and the intersection with HIV and other important infectious diseases. We propose to set up an African Non-communicable Disease Longitudinal data Alliance (ANDLA) to address this gap: working with policy makers and experienced research partners; bringing together partners with NCD data collected in demographic surveillance sites to address important questions relevant to our setting. This will enable a greater understanding of the current status of chronic NCD, provide evidence for future prevention and management strategies and build a platform for multi-site intervention development, monitoring and evaluation and health systems research. Longitudinal data are key to understanding disease progression, trends and contribution of risk factors to mortality.
We will analyse markers of cardio-metabolic mortality risk; develop and validate risk scores; and conduct analyses of HIV-related cancer mortality. Scientific advisory groups will inform future work which may include asthma, chronic kidney disease, disabilities, injuries, epilepsy and mental health.
Planned Impact
The aim of the African Non-communicable Disease Longitudinal data Alliance (ANDLA) is to provide policy relevant data and analyses to national, regional and international bodies. It is anticipated that our policy briefs on burden and risk factors of NCD conditions will be used by Ministries, and regional and national bodies such as the NCD Alliance and WHO. These groups are active in determining policy, creating guidelines for managing NCD in LIMC and lobbying internationally for an effective global response. Overall we expect that findings from ANDLA will have a substantive influence on the decisions made by stakeholders to address the health care priorities of these populations.
Each partner institution has close relationships with local policy makers, through National Research Institutes, Public Health Institutes, other Ministry of Health departments and other Ministries involved in the multi-sectoral response to NCD. These have the local remit to lobby parliamentarians and lawmakers to respond appropriately with legislation (and the political will to enforce this) in the areas most likely to have impact on future NCD. Our capacity to provide high quality research evidence to these bodies will facilitate the development of evidence-informed legislation in important areas including alcohol, tobacco, sugar and town-planning (to enable increased physical exercise in urban communities). It will support Ministries of Education and Nutrition to take the lead in mainstreaming NCD prevention messages into Personal Social and Health Education programmes in schools and colleges, and to the wider community.
As part of the foundation phase, ANDLA partners will engage with national stakeholders, to solicit input for the Alliance's research agenda and to ensure that policy-relevant questions are addressed. Stakeholders involved in co-ordinating the multi-sectoral approach to NCD prevention and scale-up of response will be particularly important in refining research questions. Host country stakeholders will be invited to the presentation days on each selected topic. Our findings will be communicated through dissemination in national meetings and policy briefings. We anticipate that the Alliance output will be highly influential in both the international and national fora where our high quality evidence will help direct the urgently-needed health care response.
Each partner institution has close relationships with local policy makers, through National Research Institutes, Public Health Institutes, other Ministry of Health departments and other Ministries involved in the multi-sectoral response to NCD. These have the local remit to lobby parliamentarians and lawmakers to respond appropriately with legislation (and the political will to enforce this) in the areas most likely to have impact on future NCD. Our capacity to provide high quality research evidence to these bodies will facilitate the development of evidence-informed legislation in important areas including alcohol, tobacco, sugar and town-planning (to enable increased physical exercise in urban communities). It will support Ministries of Education and Nutrition to take the lead in mainstreaming NCD prevention messages into Personal Social and Health Education programmes in schools and colleges, and to the wider community.
As part of the foundation phase, ANDLA partners will engage with national stakeholders, to solicit input for the Alliance's research agenda and to ensure that policy-relevant questions are addressed. Stakeholders involved in co-ordinating the multi-sectoral approach to NCD prevention and scale-up of response will be particularly important in refining research questions. Host country stakeholders will be invited to the presentation days on each selected topic. Our findings will be communicated through dissemination in national meetings and policy briefings. We anticipate that the Alliance output will be highly influential in both the international and national fora where our high quality evidence will help direct the urgently-needed health care response.
Organisations
- London School of Hygiene & Tropical Medicine (Lead Research Organisation)
- African Academy of Sciences (Collaboration)
- National Institute for Medical Research, Tanzania (Collaboration)
- African Population and Health Research Center (Collaboration)
- University of the Witwatersrand (Collaboration)
- Wellcome Trust (Collaboration)
- Ifakara Health Institute (Collaboration)
- Wits Health Consortium (Collaboration)
- Bill & Melinda Gates Foundation (Collaboration)
- Africa Health Research Institute (Collaboration)
- Medical Research Council (MRC) (Collaboration)
- National Institutes of Health (NIH) (Collaboration)
Publications
Asiki G
(2021)
Trends and risk factors for non-communicable diseases mortality in Nairobi slums (2008-2017).
in Global epidemiology
Chikumbu EF
(2022)
Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment.
in PLOS global public health
Price AJ
(2018)
Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi.
in The lancet. Diabetes & endocrinology
Description | Short Abstract In the era of ART, HIV-positive individuals remain at higher risk of mortality compared with their HIV-negative counterparts. Understanding the causes of this HIV attributable mortality is important for directing interventions to prevent such deaths. We use verbal autopsy data from three demographic surveillance sites in Eastern and Southern Africa, with cause of death assigned using the InSilicoVA model, to describe the association between HIV and mortality attributable to non-communicable diseases (NCDs) in three broad groupings: all NCDs, cancer and cardiovascular disease. Preliminary results from two East African study sites suggested that at least 10% of NCD mortality there was attributable to HIV. There was no evidence for an association between HIV and all NCD mortality in the South African study, but HIV was associated with a doubling in the rate of cancer mortality in this setting. We observe inconsistent results of the effect of HIV on cardiovascular disease mortality, likely due to the small number of deaths attributed to this cause and the difficulty in assigning such deaths using these tools. The apparent increase in the rate of NCD mortality with HIV infection in some settings highlights the importance of understanding other chronic conditions with HIV, including ART side-effects. Detailed analyses of mortality associated with individual conditions (hypertension, diabetes, obesity) and multimorbidity have been conducted and are being prepared for publication. Detailed comparative analyses of cardiovascular risk scores have been conducted and are being prepared for publication. |
Exploitation Route | Our cardiovascular risk score work will have direct policy and clinical relevance in subSaharan Africa. |
Sectors | Healthcare |
Description | Preliminary findings have been presented at policy meetings in Malawi and at meetings of the Collaboration for Evidence Based Health Care in Africa meetings. Findings have informed the Lancet Commission on NCDI and Poverty in Malawi, published 2021 |
First Year Of Impact | 2021 |
Sector | Healthcare |
Impact Types | Policy & public services |
Description | Cardiovascular disease in very low income sub-Saharan Africa: informing the response to an emerging epidemic |
Amount | £1,198,975 (GBP) |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 03/2022 |
End | 02/2025 |
Description | Cardiovascular disease in very low income sub-Saharan Africa: informing the response to an emerging epidemic |
Amount | £1,198,975 (GBP) |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 03/2022 |
End | 02/2025 |
Description | Healthy Lives - Malawi : Intergenerational Cohort of Chronic Conditions |
Amount | £4,420,517 (GBP) |
Funding ID | 217073/Z/19/Z |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 08/2019 |
End | 09/2024 |
Description | Improving outcomes for people with type 2 diabetes in Sub-Saharan Africa |
Amount | £298,768,644 (GBP) |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 03/2024 |
Description | Multimorbidity in Africa - Increasing Understanding of the Patient Experience and Epidemiology (MAfricaEE) |
Amount | £199,515 (GBP) |
Funding ID | MR/T037849/1 |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 03/2020 |
End | 09/2021 |
Description | Public Engagement Award - including schools activities |
Amount | £245,000 (GBP) |
Funding ID | 217073/Z/19/A |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 02/2021 |
End | 08/2024 |
Title | Extension of database to include socio-economic data and data from an additional two partners |
Description | As described before, now including multiple SES indices and data from Rakai Health Institute and Africa Health Research Institute |
Type Of Material | Database/Collection of data |
Year Produced | 2019 |
Provided To Others? | Yes |
Impact | Analyses in progress |
Title | Indepth interviews on lived experience of multimorbidity, Malawi and Tanzania |
Description | Collection of IDI from three settings Rural Uganda Rural Malawi Urban Malawi Lived experiences of multimorbidity, coded and analysed as a complete dataset for comparability |
Type Of Material | Database/Collection of data |
Year Produced | 2022 |
Provided To Others? | Yes |
Impact | Two publications todate Presentation to policy makers and service providers Agreement that should impact on clinical training in Malawi |
Title | Pooled data on long-term conditions from Malawi, Uganda and the Gambia |
Description | Individual level data Urban and Rural Malawi Rural Uganda Rural Gambia Long-term conditions, including HIV, Hypertension, Obesity, Diabetes |
Type Of Material | Database/Collection of data |
Year Produced | 2022 |
Provided To Others? | No |
Impact | Pooled analysis conducted, paper to be published second quarter 2023 |
Title | Pooled longitudinal data on non-communicable diseases from partners in sub-Saharan Africa |
Description | Our partnership aims to develop the capacity to share and harmonise data through partnerships, expertise and standardised data-specifications. We currently consist of six demographic surveillance sites in SSA (Ifakara, Tanzania; Kisesa Tanzania; Karonga, Malawi; APHRC, Kenya; Agincourt, South Africa; Masaka, Uganda) but are open to new partners with relevant longitudinal data. All of the existing partners currently work together on HIV-related pooled analyses through the ALPHA network (http://alpha.lshtm.ac.uk/) and a few of the partners work together on NCD related projects (for example, a multisite study of Chronic Kidney Disease and as part of the Regional Expert group on NCD). We are an enthusiastic and experienced group of predominantly Africa-based researchers. All partners listed already collect data on cardio-metabolic and cancer risk factors, HIV, anthropometry and verbal autopsy. ANDLA builds into the ALPHA network's existing framework of harmonised datasets for the analysis of longitudinal HIV data with the addition of a harmonised data specification on lifestyle factors (alcohol, tobacco), family health history, anthropometry (weight, height MUAC) and biological measures (lipids, blood glucose, blood pressure). Each of the partner sites has been working with ALPHA data scientists for many years harmonising data on residency episodes (entry (due to birth or entry to DSS), exit (due to death or departure from DSS), HIV test results (not all sites), ART use (not all sites), education, fertility and cause of death (from verbal autopsy and physician review (not all sites)). Overall, ANDLA aims to generate a large harmonised longitudinal NCD database (in many cases, linked to stored samples available for future screening for additional infections and biochemical abnormalities) to enable comparison of key risk factors and determinants of NCDs across different African populations and to investigate rarer risk factors and outcomes. Activities |
Type Of Material | Database/Collection of data |
Year Produced | 2018 |
Provided To Others? | No |
Impact | Pooled analyses on cancer deaths and attributable risk of HIV. Cardiovascular risk score developments underway. |
URL | http://www.andla.org |
Title | Publication of Malawi NCD survey data |
Description | N=30,000 Detailed survey and laboratory result data Cardiometabolic conditions Lifestyle factors Physical measurements |
Type Of Material | Database/Collection of data |
Year Produced | 2019 |
Provided To Others? | Yes |
Impact | Used in multiple high profile analyses |
Description | Partnership supported by award, as part of creation of ANDLA. |
Organisation | African Population and Health Research Center |
Country | Kenya |
Sector | Academic/University |
PI Contribution | Support in data management and analysis of longitudinal NCD data |
Collaborator Contribution | Staff time to develop research questions, attend workshops and participate in analyses. Contribution of large longitudinal datasets |
Impact | Analyses and publications in progress |
Start Year | 2017 |
Description | Partnership supported by award, as part of creation of ANDLA. |
Organisation | Ifakara Health Institute |
Country | Tanzania, United Republic of |
Sector | Charity/Non Profit |
PI Contribution | Support in data management and analysis of longitudinal NCD data |
Collaborator Contribution | Staff time to develop research questions, attend workshops and participate in analyses. Contribution of large longitudinal datasets |
Impact | Analyses and publications in progress |
Start Year | 2017 |
Description | Partnership supported by award, as part of creation of ANDLA. |
Organisation | Medical Research Council (MRC) |
Department | MRC/UVRI and LSHTM Research Unit Uganda |
Country | Uganda |
Sector | Academic/University |
PI Contribution | Support in data management and analysis of longitudinal NCD data |
Collaborator Contribution | Staff time to develop research questions, attend workshops and participate in analyses. Contribution of large longitudinal datasets |
Impact | Analyses and publications in progress |
Start Year | 2017 |
Description | Partnership supported by award, as part of creation of ANDLA. |
Organisation | National Institute for Medical Research, Tanzania |
Country | Tanzania, United Republic of |
Sector | Public |
PI Contribution | Support in data management and analysis of longitudinal NCD data |
Collaborator Contribution | Staff time to develop research questions, attend workshops and participate in analyses. Contribution of large longitudinal datasets |
Impact | Analyses and publications in progress |
Start Year | 2017 |
Description | Partnership supported by award, as part of creation of ANDLA. |
Organisation | Wits Health Consortium |
Country | South Africa |
Sector | Private |
PI Contribution | Support in data management and analysis of longitudinal NCD data |
Collaborator Contribution | Staff time to develop research questions, attend workshops and participate in analyses. Contribution of large longitudinal datasets |
Impact | Analyses and publications in progress |
Start Year | 2017 |
Description | Planned creation of African Population Cohort Consortium 2020 |
Organisation | African Academy of Sciences |
Country | Kenya |
Sector | Charity/Non Profit |
PI Contribution | Through cohort work in Malawi and ANDLA network, invited to be part of Africa-wide consortium developing plans for region-wide initiative, supported by multiple funders and with multiple partners |
Collaborator Contribution | Experience in cohort establishment and data harmomonisation |
Impact | not yet |
Start Year | 2020 |
Description | Planned creation of African Population Cohort Consortium 2020 |
Organisation | Bill and Melinda Gates Foundation |
Country | United States |
Sector | Charity/Non Profit |
PI Contribution | Through cohort work in Malawi and ANDLA network, invited to be part of Africa-wide consortium developing plans for region-wide initiative, supported by multiple funders and with multiple partners |
Collaborator Contribution | Experience in cohort establishment and data harmomonisation |
Impact | not yet |
Start Year | 2020 |
Description | Planned creation of African Population Cohort Consortium 2020 |
Organisation | Medical Research Council (MRC) |
Country | United Kingdom |
Sector | Public |
PI Contribution | Through cohort work in Malawi and ANDLA network, invited to be part of Africa-wide consortium developing plans for region-wide initiative, supported by multiple funders and with multiple partners |
Collaborator Contribution | Experience in cohort establishment and data harmomonisation |
Impact | not yet |
Start Year | 2020 |
Description | Planned creation of African Population Cohort Consortium 2020 |
Organisation | National Institutes of Health (NIH) |
Country | United States |
Sector | Public |
PI Contribution | Through cohort work in Malawi and ANDLA network, invited to be part of Africa-wide consortium developing plans for region-wide initiative, supported by multiple funders and with multiple partners |
Collaborator Contribution | Experience in cohort establishment and data harmomonisation |
Impact | not yet |
Start Year | 2020 |
Description | Planned creation of African Population Cohort Consortium 2020 |
Organisation | Wellcome Trust |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | Through cohort work in Malawi and ANDLA network, invited to be part of Africa-wide consortium developing plans for region-wide initiative, supported by multiple funders and with multiple partners |
Collaborator Contribution | Experience in cohort establishment and data harmomonisation |
Impact | not yet |
Start Year | 2020 |
Description | Subsequent partnership and data sharing collaboration |
Organisation | Africa Health Research Institute |
Country | South Africa |
Sector | Charity/Non Profit |
PI Contribution | Development of analysis plans, support in analysis and publication of pooled and site-specific data |
Collaborator Contribution | Scientific engagements, attendance at analysis workshops, contribution of longitudinal NCD datasets |
Impact | In progress |
Start Year | 2018 |
Description | Subsequent partnership and datasharing collaboration |
Organisation | University of the Witwatersrand |
Country | South Africa |
Sector | Academic/University |
PI Contribution | We are exploring pooling of data between ANDLA and AWI-gen projects. |
Collaborator Contribution | We are exploring pooling of data between ANDLA and AWI-gen projects. |
Impact | No output yet |
Start Year | 2017 |
Description | Analysis workshop on Cardiovascular risk scores in sub Saharan Africa |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Partner sites are currently preparing their NCD specifications, according to a standardised template, for our first workshop in Lilongwe, March 2018 (19-23rd) on cardiovascular risk scores. Each of the partner sites is accustomed to participating in ALPHA analytical workshops, where sites have the opportunity to send an epidemiologist and analyst to explore their site specific data using programmes (in the form of Stata do files) prepared by ALPHA analysts prior to the workshop. ANDLA will follow the same model. Expected outcomes from the first ANDLA workshop n Lilongwe The focus of the first workshop is to: ? ?To undertake multisite analyses exploring the mortality associated with cardiometabolic risk factors and development of an Africa cardiometabolic risk assessment tools. ? ?Generate multi-site and site-specific publications ? ?Generate framework for next priority analyses Our workshop analyses will explore: ? ?The distribution of CVD risk in each site, comparing existing CVD risk scores that use blood measures to those that do not use blood measures ? ?Validation of existing CVD risk scores using mortality data with and without blood measures ? ?Determine the combination of risk factors which best predicts mortality over 1 year, 3 years, 5 years and longer (depending on availability of follow-up across the sites) ? ?In sites with HIV data, explore the extent to which CVD risk score performance differs by HIV status List of participants for the March 2018 Workshop Name of Participant Partner site and country/institution and country Xavier Gomez-Olive Agincourt South Africa Chodziwadziwa Kabudula Agincourt South Africa Gershim Asiki APHRC Kenya Marylene Wamukoya APHRC Kenya James Beard Kisesa Tanzania Coleman Kishamawe Kisesa Tanzania Ramadhan Abdul Ifakara Tanzania Grace Kyule Ifakara Tanzania Eveline Geubbels Ifakara Tanzania Innocent Erone Masaka Uganda Robert Newton Masaka Uganda Mia Crampin Karonga Malawi Albert Dube Karonga Malawi Estelle Mclean Karonga Malawi Wisdom Nakanga Karonga Malawi Alison Price Karonga Malawi Joise Prynn Karonga Malawi Pablo Perel WHO Geneva Clara Calvert LSHTM London David Prieto LSHTM London Keith Tomlin LSHTM London Kufre Okop CEPHA+ South Africa |
Year(s) Of Engagement Activity | 2018 |
Description | Kick off meeting for ANDLA, with ALPHA network. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Kick off ANDLA meeting with parter representatives - clinicians, scientists, data managers, analyst, Nairobi March 2017 - Planning of workshops, analyses, sharing of ideas and resources |
Year(s) Of Engagement Activity | 2017 |
URL | https://andla.org |
Description | Multimorbidity Workshop, Lilongwe Malawi |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | Policymakers and researchers in the field of NCD were invited to a workshop to review the findings from the studies, and other findings related to multimorbidity from the Malawi Epidemiology and Intervention Research Unit and the Multilink Project. There were discussions on the context and utility of the findings and an invitation from the Malawi Ministry of Health (the lead of the NCDI&MH Dept) to prepare a policy brief to support the work of the dept in lobbying for support for integration of services for long-term conditions. |
Year(s) Of Engagement Activity | 2022 |
Description | Presentation on ANDLA network to INDEPTH Network |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | Presentation on ANDLA aims, objectives and outputs to |
Year(s) Of Engagement Activity | 2017 |
URL | http://www.indepth-network.org/news-events/events/newsindepth-agm-2017-dubai-uae |
Description | Presentation on Cancer and HIV |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation at IUSSP Cape Town November 2017Short Abstract In the era of ART, HIV-positive individuals remain at higher risk of mortality compared with their HIV-negative counterparts. Understanding the causes of this HIV attributable mortality is important for directing interventions to prevent such deaths. We use verbal autopsy data from three demographic surveillance sites in Eastern and Southern Africa, with cause of death assigned using the InSilicoVA model, to describe the association between HIV and mortality attributable to non-communicable diseases (NCDs) in three broad groupings: all NCDs, cancer and cardiovascular disease. Preliminary results from two East African study sites suggested that at least 10% of NCD mortality there was attributable to HIV. There was no evidence for an association between HIV and all NCD mortality in the South African study, but HIV was associated with a doubling in the rate of cancer mortality in this setting. We observe inconsistent results of the effect of HIV on cardiovascular disease mortality, likely due to the small number of deaths attributed to this cause and the difficulty in assigning such deaths using these tools. The apparent increase in the rate of NCD mortality with HIV infection in some settings highlights the importance of understanding other chronic conditions with HIV, including ART side-effects. |
Year(s) Of Engagement Activity | 2017 |
URL | https://iussp.confex.com/iussp/ipc2017/meetingapp.cgi/Paper/4246 |
Description | Public Engagement - Schools activity on NCD and adolescents role in their community and own future health |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | As part of public engagement work supported through a direct grant from Wellcome, we are building on the relationships with primary schools and education authorities and established during the N2N Trial and the evidence that the school & communities respond to engagement around NCD, to deliver a programme where school children access simplified data from all our NCD work including the N2N trial to draw their own conclusions and to express their understanding of their own role in their future health and that of their communities. |
Year(s) Of Engagement Activity | 2023 |