In Press
Jennifer Manne-Goehler, Livia Montana, F. Xavier Gómez-Olivé, Julia Rohr, Guy Harling, Ryan G. Wagner, Alisha Wade, Chodziwadziwa Whiteson Kabudula, Pascal Geldsetzer, Kathleen Kahn, Stephen Tollman, Lisa F. Berkman, Till W. Bärnighausen, and Thomas A. Gaziano. In Press. “The ART advantage: healthcare utilization for diabetes and hypertension in rural South Africa..” JAIDS Journal of Acquired Immune Deficiency Syndromes, Publish Ahead of Print. Publisher's Version Abstract
Background: The prevalence of diabetes and hypertension has increased in HIV-positive populations but there is limited understanding of the role that ART programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of healthcare services for diabetes and hypertension.Methods: Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5,059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes and hypertension and self-reported data on healthcare utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index (BMI), education and household wealth quintile.
Harling G, JM Perkins, Gómez-Olivé FX, Morris KA, Wagner RG, Montana L, Kabudula C, Bärnighausen TW, Kahn K, and Lisa F Berkman. Forthcoming. “Interviewer-driven variability in social network reporting: results from Health and Aging in Africa: a Longitudinal Study of an INDEPTH community (HAALSI) in South Africa.” Field Method.
Thomas A Gaziano, Shafika Abrahams-Gessel, Xavier F Gomez-Olive, Alisha Wade, Nigel J Crowther, Sartaj Alam, Jennifer Manne-Goehler, Chodziwadziwa W Kabudula, Ryan Wagner, Julia Rohr, Livia Montana, Kathleen Kahn, Till W Bärnighausen, Lisa F Berkman, and Stephen Tollman. 2017. “Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study.” BMC Public Health, 1, 17: 206. Abstract
BACKGROUND: A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults. METHODS: We recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels. RESULTS: Five thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 ± 13.06 years. Waist-to-hip ratio was high for men and women (0.92 ± 0.08 vs. 0.89 ± 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV(-) persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV(+) persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV(+) persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk scores ranged from 7.7-9.7% for women and from 12.5-15.3% for men, depending on the risk score equations used. CONCLUSIONS: This cohort has high CMD risk based on both traditional risk factors and novel markers like hsCRP. Longitudinal follow-up of the cohort will allow us to determine the long-term impact of increased lifespan in a population with both high HIV infection and CMD risk.
Thiago Veiga Jardim, Sheridan Reiger, Shafika Abrahams-Gessel, Xavier F Gomez-Olive, Ryan G Wagner, Alisha Wade, Till W Bärnighausen, Joshua Salomon, Stephen Tollman, and Thomas A Gaziano. 2017. “Hypertension management in a population of older adults in rural South Africa.” J Hypertens, 6, 35: 1283-1289. Abstract
OBJECTIVE: Assess awareness, treatment, and control of hypertension, as an indication of its management, in rural South Africa, especially regarding modifiers of these variables. METHODS: A population-representative sample of adults aged at least 40 years residing in the rural Agincourt subdistrict (Mpumalanga Province) covered by a long-term health and sociodemographic surveillance system was recruited. In-person interviews, physical exams, and dried blood spots were collected. Hypertension awareness, treatment, and control rates were assessed. A regression model was built to identify predictors of those outcomes. RESULTS: The mean age of the 2884 hypertensive participants was 64.1 ± 12.7 years. Hypertension awareness rate was 64.4%, treatment among those aware was 89.3 and 45.8% of those treated were controlled. Considering aware and unaware hypertensives, treatment rate was 49.7% and control 22.8%. In the multivariable regression model, awareness was predicted by female sex, age at least 60 years, higher social economic status, prior cardiovascular disease (CVD), nonimmigrant status, literacy, and physical limitation. Improved control among those treated was predicted by age at least 60 years. Blood pressure control among all hypertensive study participants was predicted by female sex, being HIV-negative, age at least 60 years, nonimmigrant status, and prior CVD. CONCLUSION: High rates of awareness and treatment of hypertension as well as good levels of control were found in this population, probably explained by the long-term surveillance program conducted in the area. Considering the predictors of hypertension management, particular attention should be given to men, residents younger than 60 years, immigrants, and study participants without CVD as these characteristics were predictors of poor outcome.
Collin F Payne, Francesc Xavier Gómez-Olivé, Kathleen Kahn, and Lisa Berkman. 2017. “Physical Function in an Aging Population in Rural South Africa: Findings From HAALSI and Cross-National Comparisons With HRS Sister Studies.” J Gerontol B Psychol Sci Soc Sci. Abstract
Objectives: We use recently-collected data from the Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) cohort from Agincourt, South Africa, to describe physical functioning in this aging population, and place the overall level and age-trajectories of physical health in the context of other Health and Retirement Study (HRS) sister studies in low- and middle-income countries (LMICs). Method: We conduct multiple regression to estimate associations of physical functioning assessed from both self-report (activities of daily living [ADL] limitation, self-reported health) and performance (grip strength, gait speed) with socio-demographic and health characteristics in HAALSI, and use fully-interacted regression models to compare age-patterns of physical functioning outcomes cross-nationally. Results: Gender differences in self-reported health are minimal, and men had 30% higher odds of being ADL limited controlling for socio-demographic and health characteristics. Measured physical performance is closely tied with socioeconomic conditions, but self-reported measures have a much smaller or weaker socioeconomic gradient. In international age-adjusted comparisons, the HAALSI sample had lower physical performance outcomes than most comparison populations. Discussion: As the first HRS sister study undertaken in Africa, HAALSI adds vital information on population aging and health in the region. Continuing waves of HAALSI data will be a key resource for understanding differences in the complex processes of disability across LMIC contexts.
Molly S. Rosenberg, F. Xavier Gómez-Olivé, Julia K. Rohr, Brian C. Houle, Chodziwadziwa W. Kabudula, Ryan G. Wagner, Joshua A. Salomon, Kathleen Kahn, Lisa F. Berkman, Stephen M. Tollman, and Till W. Bärnighausen. 9/17/2016. “Sexual behaviors and HIV status: a population-based study among older adults in rural South Africa..” JAIDS Journal of Acquired Immune Deficiency Syndromes, Publish Ahead of Print. Publisher's Version Abstract

Objective: To identify whether older adults in rural South Africa have unmet needs for HIV prevention.Methods: We analyzed data from a population-based sample of 5059 men and women aged 40 and older from Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI) undertaken in the Agincourt sub-district of Mpumalanga Province, underpinned by the Agincourt health and socio-demographic surveillance system. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age-sex-standardization.

Glyn W. Humphreys, Mihaela D. Duta, Livia Montana, Nele Demeyere, Cathal McCrory, Julia Rohr, Kathleen Kahn, Stephen Tollman, and Lisa Berkman. 2016. “Cognitive Function in Low-Income and Low-Literacy Settings: Validation of the Tablet-Based Oxford Cognitive Screen in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI).” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. Publisher's Version Abstract
Objectives: 1. Assess validity of the Oxford Cognitive Screen (OCS-Plus), a domain-specific cognitive assessment designed for low-literacy settings, especially in low- and middle-income countries (LMIC); 2. Advance theoretical contributions in cognitive neuroscience in domain-specific cognitive function and cognitive reserve, especially related to dementia.Method: In a cross-sectional study of a sample of 1,402 men and women aged 40–79 in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we administered OCS-Plus along with health and sociodemographic assessments. HAALSI is a representative sample of older adults in Agincourt, South Africa contributing to normative understanding of cognition in LMIC. We report measure distributions, construct and external validity of the OCS-Plus.Results: OCS-Plus has excellent construct and external validity. Intra-class correlations between similar basic measures of orientation in OCS-Plus and in HAALSI assessments was 0.79, and groups of people performing well on the OCS-Plus verbal memory also showed superior performance on HAALSI verbal memory. The OCS-Plus scores showed consistent associations with age and education and domain-specific associations with alcohol and depression. Younger respondents and the more educated did better on all assessments.Discussion: The OCS-Plus represents a major methodological advance in dementia studies in LMICs, and enhances understanding of cognitive aging.
Stephen M Tollman, Shane A Norris, and Lisa F Berkman. 2016. “Commentary: The value of life course epidemiology in low- and middle-income countries: an ageing perspective.” International Journal of Epidemiology, 4, 45: 997-999. Publisher's Version
Jennifer Manne-Goehler, Livia Montana, Xavier Gomez-Olive, Julia Rohr, Ryan Wagner, Chodziwadziwa Kabudula, Alisha Wade, Kathleen Kahn, Stephen Tollman, Lisa Berkman, Till Barnighausen, and Thomas Gaziano. 2016. “Human Immunodeficiency Virus (HIV) Infection, Antiretroviral Therapy (ART) Use and Access to Care for Diabetes and Hypertension in Agincourt, South Africa.” Open Forum Infectious Diseases, 3. Publisher's Version
Xavier F Gómez-Olivé, Margaret Thorogood, Philippe Bocquier, Paul Mee, Kathleen Kahn, Lisa Berkman, and Stephen Tollman. 2014. “Social conditions and disability related to the mortality of older people in rural South Africa.” International Journal of Epidemiology, 5, 43: 1531-1541. Publisher's Version Abstract
Background: South Africa is experiencing a health and social transition including an ageing population and an HIV epidemic. We report mortality experience of an older rural South African population.Methods: Individual survey data and longer-term demographic data were used to describe factors associated with mortality. Individuals aged 50 years and over (n = 4085) answered a health and quality of life questionnaire in 2006 and were followed for 3 years thereafter. Additional vital events and socio-demographic data were extracted from the Agincourt Health and Demographic Surveillance System from 1993 to 2010, to provide longer-term trends in mortality. Cox regression analysis was used to determine factors related to survival.Results: In 10 967 person-years of follow-up between August 2006 and August 2009, 377 deaths occurred. Women had lower mortality {hazard ratio [HR] 0.35 [95% confidence interval (CI) 0.28–0.45]}. Higher mortality was associated with being single [HR 1.48 (95% CI 1.16–1.88)], having lower household assets score [HR 1.79 (95% CI 1.28–2.51)], reporting greater disability [HR 2.40 (95% CI 1.68–3.42)] and poorer quality of life [HR 1.59 (95% CI 1.09–2.31)]. There was higher mortality in those aged under 69 as compared with those 70 to 79 years old. Census data and cause specific regression models confirmed that this was due to deaths from HIV/TB in the younger age group.Conclusions: Mortality due to HIV/TB is increasing in men, and to some extent women, aged over 50. Policy makers and practitioners should consider the needs of this growing and often overlooked group.