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

南非农村地区的内分泌和代谢疾病——确定负担并改进检测

• 批准号: 9904333
• 负责人: Alisha Nicole Wade
• 金额: $ 12.17万
• 依托单位: WITS HEALTH CONSORTIUM (PTY), LTD
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-22 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9904333
• 关键词: AIDS/HIV problem; Adult; Affect; Africa; African; Aging; Award; Biometry; Bone Density; Calcium; Cardiovascular Diseases; Cause of Death; Communities; Complement; Complex; Cost Effectiveness Analysis; Country; Data; Detection; Development; Diabetes Mellitus; Disease; Dyslipidemias; Early Diagnosis; Early treatment; Effectiveness of Interventions; Endocrine; Endocrine System Diseases; Endocrinologist; Endocrinology; Environmental Risk Factor; Epidemiology; Evaluation; Evolution; Functional disorder; Funding; Future; Genetic Risk; Genomics; Goals; HIV; Health; High Prevalence; Highly Active Antiretroviral Therapy; Income; Individual; Intervention; Life Expectancy; Longitudinal Studies; Longitudinal cohort; Mentors; Metabolic Bone Diseases; Metabolic Diseases; Micronutrients; Modeling; Morbidity - disease rate; National Human Genome Research Institute; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Obesity; Outcome; Participant; Pennsylvania; Population; Prevalence; Primary Health Care; Public Health; Randomized; Research; Research Institute; Resources; Risk; Risk Factors; Sampling; Scientist; South Africa; South African; Statistical Data Interpretation; Testing; Theory of Change; Thyroid Gland; Training; United States National Institutes of Health; Universities; Vitamin D Deficiency; Wit; Work; age related; aged; antiretroviral therapy; base; behavior change; cardiometabolism; career; career development; case finding; clinical risk; cost effective; cost effectiveness; economic evaluation; effective intervention; food insecurity; health economics; high risk; improved; interest; low and middle-income countries; mobile application; mobile computing; mortality; novel; nutrition; population based; prevent; primary care setting; programs; routine care; rural South Africa; rural area; screening; skills; socioeconomics; therapy development

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.

项目摘要/摘要：该奖项将支持 Alisha Wade 博士的职业发展和培训， 对内分泌和代谢疾病感兴趣的内分泌学家和临床科学家 艾滋病毒/艾滋病流行率较高的中等收入国家。内分泌和代谢紊乱 (EMD) 是 导致全世界发病率和死亡率的重要因素，但人们对其相对患病率知之甚少 南非农村地区，艾滋病毒/艾滋病、抗逆转录病毒治疗等多种独立危险因素日益增加 成年期的预期寿命和营养转变之间的相互作用可能会导致成年期的相对负担 EMD 与高收入国家不同。早期发现和治疗 EMD 将降低发病率 和死亡率，但在初级保健中进行广泛的人群筛查在资源匮乏的环境中是不切实际的。 将针对关键 EMD 风险最高人群的针对性病例发现纳入常规初级保健可能会证明 性价比高。这项工作的长期目标是确定南非面临最高风险的个人 关键的 EMD 及其后遗症，并为其长期制定具有成本效益的务实战略 识别和管理。该项目的具体目标是 (1) 确定相对患病率 1630 名 40 岁及以上黑人成年人样本中关键 EMD 的风险因素 HIV 和 HAART 使用率较高的南非人口，(2) 确定以下方案的可行性： 在初级保健中使用移动应用程序来支持常见病病例查找的整合 内分泌和代谢紊乱；(3) 确定整合病例发现的成本效益 确定 EMD 进入初级保健的方法。这些研究将嵌套在 NIA 资助的 HAALSI 中 项目和 NHGRI 资助的 AWI-Gen 项目。这项研究将使申请人能够发展以下方面的技能 先进的生物统计学和流行病学、复杂干预措施和健康的开发和评估 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，研究高风险背景下 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 博士在 宾夕法尼亚大学和威特沃特斯兰德大学的 Stephen Tollman 博士是该领域的专家 衰老的内分泌学和中低收入国家的衰老。她将得到学校设施的大力支持 金山大学，非洲领先的研究机构之一。该奖项将有利于 申请人转变为中低收入国家内分泌学领域领先的独立科学家。