An innovative new Africa Health Research Institute (AHRI) programme is bringing cutting-edge health screening and scientific research to an area of northern KwaZulu-Natal with one of the highest HIV and tuberculosis prevalence rates in South Africa. Through the programme, AHRI hopes to get a better understanding of the ways in which the non-communicable and infectious disease epidemics are intersecting in South Africa.
The new research programme is called ‘Vukuzazi’, which means ‘wake up and know yourself’ in isiZulu. Vukuzazi builds on and enhances AHRI’s long-standing and pivotal demographic surveillance programme, which has been running since 2000. Vukuzazi will enable AHRI to develop a completely novel and integrated set of data and biosamples which scientists will use to gain insight into fundamental interactions between HIV, tuberculosis (TB), environmental exposures and non-communicable diseases.
Starting in mid-2018, residents living in AHRI’s health and demographic surveillance system site in uMkhanyakude District are being invited to participate in a comprehensive health screening at a Vukuzazi mobile camp. AHRI aims to reach 30 000 participants over the course of 18 months. The mobile camp will come within one kilometre of each participant’s home, making access easy. The camp has been set up to screen for diabetes, high blood pressure, nutritional status (obesity and malnutrition), tobacco and alcohol use as well as HIV and tuberculosis. This clinical information will be layered on to AHRI’s rich existing longitudinal population and clinical data from the Institute’s demographic surveillance programme. Through a sophisticated data system, which starts in the field at the Vukuzazi camp, AHRI’s clinical team will examine this information in real time, link it together and make referrals into the public health system for people as needed. This relies on AHRI’s long-standing and close partnership with the Department of Health.
“There are very few surveillance sites of the sort that we are building on,” said AHRI Deputy Director for Science, Professor Thumbi Ndung’u. “AHRI has been monitoring 120 000 individuals for the past 15 years. We are now building on to that a new level of clinical testing and diagnosis, together with biological sampling. There have been no studies to date in this setting which pull together this understanding of the socio -demographic and socio-economic environment and link those data with the kind of biological data that we are collecting.”
Tuberculosis is the leading cause of death in uMkhanyakude. At the Vukuzazi camp, participants will be offered TB screening with a chest X-ray. Those who report TB symptoms or have an abnormal X-ray will also have a sputum sample examined for evidence of TB. Capturing high-quality digital chest X-rays and using AHRI’s laboratories to analyse the circulating strains of TB will enhance scientists’ levels of understanding of TB transmission in the community. AHRI nurses will also collect a range of biological samples, which will be used for a wider programme of genetic and microbiome research at AHRI.
“One of the key aspects of Vukuzazi that will push this research agenda forward is understanding the genetic makeup of our population, but in particular what is it about those genetics which determines who is protected from disease, and who gets disease,” said AHRI Director, Professor Deenan Pillay. “There is a paucity of data from Africa, sub-Saharan Africa in particular, and we want to redress that balance. We want to ensure that the potential benefits that are being shown to populations in the West can also be provided to the population here.”