The parent award was the first to test the theory of syndemics among a vulnerable population. The syndemics concept, in contrast to the epidemics concept, combines concepts of ?synergy? with ?epidemic? to investigate how 1) two or more diseases cluster together within a population, 2) these diseases interact, often biologically, and 3) large-scale social forces precipitate them. Syndemic clusters with Type 2 diabetes (T2DM) among black South Africans exemplify the syndemics concept, and in-depth investigation of this phenomenon provides important policy and clinical perspectives. The parent study established a cohort to evaluate syndemic clusters in Soweto, South Africa. The cohort study was organized around two phases: phase 1 focused on surveillance of co-occurring social and medical conditions in Soweto, and phase 2 explored people?s experiences living with co-occurring conditions. We completed 957 interviews for Phase 1, documenting prevalence and clustering of social and medical conditions in Soweto; although, we cut short recruitment for Phase 1 to safeguard against risk of transmission. We quickly transformed our methods to phone interviews with our existing cohort to focus on knowledge, perceptions, and experiences related to COVID-19 and depressive risk. Thus, from Phase 1, we have extensive data not only on COVID-19 but also on preexisting social stress, psychiatric morbidity, and comorbid medical conditions that will great advance our understanding of the novel coronavirus. Current COVID-19 data involves 1) perceptions of risk, morbidity, and transmissibility; 2) social, economic, and psychological predictors of COVID-19 through longitudinal design; and 3) effects of COVID-19 and comorbidities common in South Africa (e.g. HIV, diabetes, hypertension, depression). We also conducted 100 in depth qualitative interviews with people living with diabetes and comorbid infection (HIV and TB), hypertension, and depression. Once quarantine is lifted, we hope to complete 50 more in depth interviews, with an additional section on COVID-19. We also plan to conduct follow up phone interviews with each individual in the cohort to investigate how people are doing six months from now and to administer a brief mental health inventory. We will invite 250 participants into the research center to collect blood samples to evaluate stress and inflammation?which will take on even more significance if coronavirus eventually spreads throughout Soweto. These amendments have been approved by the Human Research Ethics Committee at the University of the Witwatersrand in Johannesburg, South Africa. Analysis: Now that we have completed baseline data collection we are beginning to analyze data from the parent study. The first hypothesis that social and economic determinants of co-occurring conditions will differ from those determinants that foster singular disease apart from syndemic clusters will be evaluated within the next month.
The second aim to investigate social and medical experiences and health care behaviors will be completed in part by late summer 2020; we have begun to code existing qualitative data but need more interviews to complete our analysis. We are actively coding the COVID data, as well, with nearly 300 interviews complete.

Public Health Relevance

We are currently interviewing people in our cohort residing Soweto about their perceptions and experiences with pandemic threat, social distancing, and quarantine. We have found that such experiences have already had significant effects on people's mental and physical health, despite the fact that there are to date no active COVID-19 cases in Soweto. This supplement will involve 1) follow up interviews in 6 months, 2) serology samples of immunity, & 3) in depth interviews of pandemic experience.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Exploratory/Developmental Grants (R21)
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Levintova, Marya
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Georgetown University
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