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 VersionAbstract

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 VersionAbstract
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, 45, 4, Pp. 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, 43, 5, Pp. 1531-1541. Publisher's VersionAbstract
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.