A working group commissioned by the Office of AIDS Research of the NIH identified multi-morbidity, functioning, impacts of anti-retroviral therapy (ART), immune senescence, inflammation and a focus on women caregivers among the areas where critical needs for research exist. One of the major limitations identified by the working group, was the lack of appropriate comparison populations in existing studies, thereby limiting the inferences from data collected on older adults in "Western" populations due to different exposures and risk behavior. The need to leverage and build on existing cohorts was emphasized. The proposed study addresses many of these issues. The World Health Organization's Study on Global AGEing and Adult Health (SAGE), in its Well-Being of Older People Study (WOPS) sub-study, is currently collecting data on a cohort of about 1300 community dwelling respondents older adults in two low-income rural/periurban settings in sub-Saharan Africa (Uganda and South Africa) to understand the direct and indirect impact of HIV/AIDS on older adults. Half the respondents are HIV- positive and of these about half are currently on ART. The other half of the cohort is HIV- negative, but have been indirectly affected by HIV/AIDS in their families. A "control" cohort is included in Uganda, with older adults neither infected nor affected by HIV or AIDS. The cohort will already have been interviewed twice before the start of this proposal and with funding from this grant, will provide data for a seven year period over the full course of the study - the longet community dwelling cohort of older adults infected and/or affected by HIV, with a comparable cohort of older adults living in the same areas without HIV. Comprehensive measures of health and the inclusion of an array of biomarkers, including those of immune function and the ageing process, provide an unprecedented opportunity to study the complex nature of HV/AIDS in two non- clinical African populations (South Africa and Uganda). Data from the proposed study will have direct implications for understanding the health and well-being of similar older adult populations with HIV/AIDS in the US, especially those from lower socioeconomic classes and minority populations. Data from the study will use measures that are comparable to other international studies of aging, including SAGE and the US Health and Retirement family of studies. All anonymized microdata from the study will be archived according to international standards along with all metadata and made available to researchers.
In all countries, increasing proportions of older adults are living with HIV. The predominant reason is that HIV-infected persons are living longer as a result of access to antiretroviral treatment (ART), resulting in greatly improved survival rates. In sub- Saharan Africa, where HIV prevalence rates in the general population are still very high, this will become a major public health issue. Understanding the impacts of HIV/AIDS in older adults, and factors that influence this over time, will be key to maintaining health and minimizing health care costs in this population as it ages. The WHO Study on global AGEing and adult health (SAGE) - Well-being in Older Persons Study (WOPS) on HIV/AIDS, will provide needed data in two highly impacted countries, but which have different timing of implementation and levels of political support behind their approaches to deal with the epidemic. Insights obtained from such studies will help plan health care and social policy to provide the appropriate support required to support these populations and protect their productive roles in communities such as caregivers. These studies would also help to improve our understanding of the interrelationship between aging, non-communicable diseases, HIV/AIDS and ART. Important strategies to extend health care for HIV/AIDS and chronic diseases in an integrated manner can be identified to promote well-being and improve quality of life. Data collected as part of the proposed study have also been designed to be comparable to ageing and health studies in higher income countries.