Focal Areas

Social & Economic Predictors of Physical & Cognitive Function

Principal Investigator: Lisa Berkman

Functional outcomes, such as disability and cognitive impairment, critically affect independence and productivity in old age, especially in low-income countries where medical assistance and access to adaptive equipment are limited. However, current surveillance data of disability are extremely limited, and evidence on determinants of functional outcomes in older Africans is heavily dependent on very few population-based cohorts.

The overall objective of this project is to introduce validated performance-based and self-reported assessments of physical and cognitive function into one INDEPTH cohort at the MRC/Wits Agincourt research site in South Africa, and use these data to test whether selected risk factors predict physical or cognitive impairments. Our long term goal is to enrich the INDEPTH cohort studies so they can be used to plan health and social services through the identification of specific, modifiable factors that promote physical and cognitive health of elderly.

Cardiometabolic Disease & Risk Factors 

Principal Investigator: Stephen Tollman & Thomas Gaziano

Cardiovascular disease (CVD) has become the leading cause of death globally as a result of epidemiologic, social, and economic transitions. These transitions are at a relatively early stage in Sub-Saharan Africa (SSA), but are advancing in rural South Africa where the population is rapidly aging. Reliable data on baseline levels of chronic cardiometabolic disease (CMD), such as CVD and diabetes, in older ages are extremely limited in rural SSA, but understanding the rate of change in CMD is critical for social and health policy planning.

Through surveys on health status, linkages to records of clinic and hospital services, evaluations of established biomarkers, and verbal autopsies, our aim is to develop a comprehensive understanding of the complex biologic, behavioral, demographic, and socioeconomic factors causing an increase in mortality and associated risk from cardiovascular and metabolic disorders. Our long term goal is to enrich the INDEPTH cohort studies systems in South Africa so they can be used to plan health and social services in diverse settings where infectious disease, including HIV/AIDS, is prominent by identifying high risk individuals who can benefit from simple interventions to reduce CMD morbidity and mortality.

Aging with HIV in Sub-Saharan Africa in the Era of Antiretroviral Treatment 

Principal Investigator: Till Bärnighausen

Conventionally, HIV infection in Sub-Saharan Africa (SSA) has been viewed as a disease that is irrelevant to older adults because it is typically acquired in youth and its consequences suffered in middle age. While global evidence strongly suggests that older adults continue to engage in risky sexual activity—a recent study in one rural community in SSA shows high HIV incidence in adults over 50 years of age—strong data on HIV prevalence, incidence, and risk factors in older adults in SSA are lacking. The economic and social needs and abilities specific to the HIV-infected elderly population receiving ART are largely unknown. In addition, we know very little about the consequences for older adults with family members living with HIV.

Our aim is to elucidate the factors leading to new HIV infection and HIV treatment access in older adults in SSA, and the effects of HIV infection and treatment on health, social, behavioral, and economic well-being outcomes. Our long-term goal is to understand how health policy can reduce older adults’ risk of acquiring HIV, and reduce the impact of the HIV epidemic on economic and social well-being in this growing age group in SSA.

Economic Well-Being & Productivity 

Principal Investigator: David Canning

Economic well-being can be profoundly impacted by ill health and functional limitations, just as health can be influenced by economic factors. Undertaking the study in this INDEPTH Demographic and Health Surveillance Site (DHSS) will allow us to combine our data with a substantial history of demographic, economic, and health measures for study participants. In addition, this study provides fundamentally essential data for the other three projects that make up the HAALSI project; the measures of income and economic well-being generated in this project will be used as factors that affect physical and cognitive functioning, cardiometabolic disorders, and HIV incidence and treatment.

Our aim is to measure the impact of ill health and functional limitations on economic circumstances and well-being within communities in Agincourt, South Africa. Our long-term goal is to introduce measures of household income and expenditure, and work them into a longitudinal survey of health and well-being, and to then use these measures to identify the effect of health and functioning on economic outcomes and well-being among the elderly.