The Khayelitsha Comorbidity Cohort: Establishing a multimorbidity cohort with integrated clinical, genomic and epidemiological data in South Africa.
Medical Research Council
University of Cape Town
There is high multimorbidity in South Africa, consisting both infectious and non-communicable diseases. Elucidating diagnostic, therapeutic and prognostic genetic drivers of morbidities can help tailor preventative and therapeutic patient care at both population and individual levels, and requires research into associations between genetic factors, complex patient phenotypes, and how these factors work in concert to impact complex clinical phenotypes in African individuals. The Provincial Health Data Centre (PHDC) is a health information exchange collating routine health data on a daily basis from 6.6million health care clients in the Western Cape Province (South Africa), compiling a patient-centric longitudinal health profile for every individual, with daily updates available on an ongoing basis. This presents an opportunity to research complete, complex clinical phenotypes with prospective automated health data updates for consenting individuals. The H3Africa Bioinformatics Network has developed an African-specific 2.5million SNP genotyping chip including novel African variants, known disease markers and pharmacogenomic variants. With the appropriate informed consent from participants, individuals' genotypes generated with the H3Africa chip can be linked to complex, longitudinal clinical phenotypes from the PHDC to develop an infinitely-scalable comorbidity cohort. At the seed-stage of the project, nested case-control analyses and genetic epidemiology methods will be used to explore complex genotype-phenotype associations focusing on high prevalence morbidities - diabetes, hypertension and kidney disease - in conjunction with HIV and TB. As the cohort grows, going forward, other morbidities can be analysed. Clinical data will be updated from the PHDC biannually, growing the extent of the clinical profiles over time. Additionally, a framework will be developed for returning clinically actionable findings to the Western Cape government health service.
4.1 Discovery and preclinical testing of markers and technologies / P&Cs