# Soweto Syndemics: A Two-Phase Study of Surveillance and Co-Morbid Experiences

> **NIH NIH R21** · GEORGETOWN UNIVERSITY · 2020 · $31,500

## Abstract

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 socia...

## Key facts

- **NIH application ID:** 10151304
- **Project number:** 3R21TW010789-02S1
- **Recipient organization:** GEORGETOWN UNIVERSITY
- **Principal Investigator:** Emily A Mendenhall
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $31,500
- **Award type:** 3
- **Project period:** 2020-10-01 → 2021-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10151304

## Citation

> US National Institutes of Health, RePORTER application 10151304, Soweto Syndemics: A Two-Phase Study of Surveillance and Co-Morbid Experiences (3R21TW010789-02S1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10151304. Licensed CC0.

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