Cohort Profile: The Vukuzazi (‘Wake Up and Know Yourself’ in isiZulu) population science programme

Gunda, Resign; Koole, Olivier; Gareta, Dickman; Olivier, Stephen; Surujdeen, Ashmika; Smit, Theresa; Dreyer, Jaco; Ording-Jespersen, Gregory; Munatsi, Day; Nxumalo, Siyabonga; Khoza, Thandeka; Mhlongo, Ngcebo; Baisley, Kathy; Seeley, Janet; Grant, Alison D.; Herbst, Kobus; Ndung’u, Thumbi; Hanekom, Willem A.; Siedner, Mark J.; Pillay, Deenan; Wong, Emily; Team, Vukuzazi

doi:10.1093/ije/dyab229

Cited by 19 publications

(41 citation statements)

References 16 publications

(25 reference statements)

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“…We analysed data from the Vukuzazi study, a cross-sectional health screening survey of individuals aged 15 or older in the uMkhanyakude district of KwaZulu-Natal, South Africa between 2018-2020, which collected information on HIV, DM and HPTN, described previously (12,23). The Vukuzazi study was embedded within an ongoing Africa Health Research Institute (AHRI) surveillance, the Population intervention Platform (PIP), which conducts multiple household, demographic, and health surveys annually on the surveillance population, and since 2017 has incorporated a clinic surveillance system (ClinicLink) that captures clinic attendance in the 11 primary health facilities in the PIP surveillance area (24).…”

Section: Study Setting and Populationmentioning

confidence: 99%

Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa

Singh

Olivier

Cuadros

et al. 2023

Preprint

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The convergence of infectious and non-communicable diseases (NCDs) in South Africa poses a challenge to health systems. Here we establish a framework to quantify met and unmet health needs for individuals living with infectious and NCDs. In this study, we screened adult residents >15 years of age within the uMkhanyakude district in KwaZulu- Natal, South Africa for HIV, hypertension (HPTN) and diabetes mellitus (DM). For each condition, individuals were defined as having no unmet health needs (absence of condition), met health need (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimization). We analyzed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution. We found that of 18,041 participants, 9,898 (55%) had at least one chronic condition. 4,942 (50%) of these individuals had at least one unmet health need (18% needed treatment optimization, 13% needed engagement in care, and 19% needed diagnosis). Unmet health needs varied by disease: 93% of people with DM, 58% of people with HPTN and 21% of people with HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed, unmet health needs had specific sites of concentration whilst the need for diagnosis for all three conditions was co-located. Whilst people living with HIV are predominantly well-controlled, there is a high burden of unmet health needs for people living with HPTN and DM. Adaptation of HIV models of care to integrate HIV and NCD services is of high priority.

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Section: Study Setting and Populationmentioning

confidence: 99%

Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa

Singh

Olivier

Cuadros

et al. 2023

Preprint

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“…We analyzed data from the Vukuzazi Study, a population-wide, cross-sectional study that enrolled residents in the uMkhanyakude District of KwaZulu-Natal, South Africa, as previously reported. [17] Briefly, all residents of the Africa Health Research Institute Demographic Health…”

Section: Study Population and Proceduresmentioning

confidence: 99%

Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Castle

Hoeppner²,

Magodoro³

et al. 2023

PLoS ONE

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Objective Tuberculosis (TB) may predispose individuals to the development of diabetes. Such a relationship could have an outsized impact in high-prevalence TB settings. However, few studies have explored this relationship in populations heavily burdened by diabetes and TB. Methods We analyzed data from a community-based population cohort that enrolled adults in rural South Africa. Individuals were considered to have prior TB if they self-reported a history of TB treatment. We fitted sex-specific logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between dysglycemia (HBA1c ≥6.5%) and prior TB. Propensity score-matched cohorts accounted for the differential age distributions between comparator groups. We examined the interactions between sex, prior TB, and HIV status. Results In the analytic cohort (n = 17,593), the prevalence of prior TB was 13.8% among men and 10.7% among women. Dysglycemia was found in 9.1% of the population, and HIV prevalence was 34.0%. We found no difference in dysglycemia prevalence by prior TB (men OR 0.96, 95% CI 0.60–1.56: women OR 1.05, 95% CI 0.79–1.39). However, there was a qualitative interaction by HIV serostatus, such that among men without HIV, those with a history of TB had a greater prevalence of dysglycemia than those without prior TB (10.1% vs. 4.6%, p = 0.0077). An inverse relationship was observed among men living with HIV (prior TB 3.3% vs. no TB 7.3%, p = 0.0073). Conclusions Treated TB disease was not associated with dysglycemia in an HIV-endemic, rural South African population. However, we found a significant interaction between prior TB and HIV status among men, suggesting distinct pathophysiological mechanisms between the two infections that may impact glucose metabolism. Longitudinal studies are needed to better establish a causal effect and underlying mechanisms related to resolved TB, HIV, and diabetes.

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“…Most of the uMkhanyakude area is poor and rural, with several informal periurban settlements and a single urban township [10]. Details of the Vukuzazi study were published previously [11]. In brief, study measurements included HIV testing with an immunoassay and HIV-1 RNA viral load (in people with a positive immunoassay).…”

Section: Study Participants and Settingmentioning

confidence: 99%

Tobacco smoking and prevalence of communicable and non-communicable diseases in rural South Africa: A cross-sectional study

Chidumwa

Olivier

Ngubane

et al. 2023

Preprint

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Background South Africa is facing a convergence of communicable diseases (CDs) and non-communicable diseases (NCDs). The contribution of tobacco use to the burden of these conditions is unknown. Methods We analyzed the associations between current tobacco smoking and four important CDs and NCDs in Vukuzazi, a cross-sectional study of individuals aged 15 years and older conducted between 2018–2020 in a demographic surveillance area in KwaZulu-Natal, South Africa. Data on HIV, active tuberculosis (TB), hypertension and diabetes mellitus were collected via direct measurement from participants. Results Of 18,024 participants (68% female, median age 37 years [interquartile rage 23–56 years]), 1,301 (7.2%) reported current smoking. Prevalence of HIV infection was similarly high among people who currently smoked (34.6%) and people who had never smoked (33.9%). However, among people living with HIV (PLWH), there was a higher prevalence of detectable viremia in people reporting current smoking compared to people who reported never smoking (28.8% vs. 16.6%; p-value < 0.001). Active TB was more prevalent in people who currently smoked than in people who never smoked (3.1% vs 1.3%, p < 0.001). In contrast, the prevalence of hypertension and diabetes mellitus were lower in people reporting current smoking than in people reporting never smoking (17.1% vs 26.0% (p < 0.001), and 2.5% vs 10.2% (p < 0.001), respectively). In sex-stratified multivariable analyses that were adjusted for potential confounding factors (including body mass index for the NCDs), the magnitude of differences in CD prevalence between people who currently smoked and people who never smoked decreased, whereas the lower prevalence of NCDs among people reporting current smoking persisted. Conclusions In rural South Africa, smoking is associated with higher rates of active TB, and people with HIV who smoke have worse disease control. In contrast, hypertension and diabetes mellitus are less common in those who smoke. Interventions to screen for TB among those who smoke and to address smoking among people with HIV may be particularly impactful.

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Cohort Profile: The Vukuzazi (‘Wake Up and Know Yourself’ in isiZulu) population science programme

Cited by 19 publications

References 16 publications

Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa

Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa

Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Tobacco smoking and prevalence of communicable and non-communicable diseases in rural South Africa: A cross-sectional study

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