The challenge

The scale-up of antiretroviral treatment has dramatically improved survival, such that growing numbers of African women with chronic HIV are now reaching the menopause and living on into older age – a period of known increased fracture risk. Research has seldom focussed on African women at this stage of life.

The South African Health Minister's strategic plan has stressed the need to identify people at risk of noncommunicable diseases (NCDs) and use HIV clinics for screening and early intervention. Equally, the Zimbabwean Ministry of Health have expressed concern at disability caused by fractures. This emerging health challenge requires action. Osteoporosis medicines are cheap but not widely available. So far there has been little research to underpin a much-needed evidence-base to guide policy and practice.

What we're doing in partnership

We are working with a multi-disciplinary team from the Biomedical, Training and Research Institute in Harare and the MRC/Wits Developmental Pathways for Health Research Unit (DPHRU) in Johannesburg. Together we are working to understand mechanisms of bone loss in the context of HIV infection around the time of menopause. This new knowledge is intended to help inform interventions and guidelines in the region. We have analysed pre-collected longitudinal data from 450 women followed-up over six years in Soweto, collected new data from 400 women in Harare, and conducted one-to-one interviews with midlife women in Zimbabwe and South Africa. We are aiming to understand country-specific contexts and priorities, with initiatives embedded to train and build musculoskeletal research capability throughout this project, whilst expanding our SAMSON (The Sub-Saharan African MuSculOskeletal Network) collaborative.

How it helps

Findings from this project are informing clinicians, stakeholders, health policy, guidelines and future research/ trials.

This research is providing valuable new data to:

• raise public and clinical awareness of peri-menopausal osteoporosis risk in women living with HIV in Southern Africa
• inform guidelines concerning musculoskeletal side-effects of widely-used antiretroviral therapy regimes (e.g. so that fracture-risk assessment can be targeted appropriately by clinicians), which will
• inform policy changes (e.g. population-specific prescribing guidelines) and/or clinical trials of cheap anti-osteoporosis treatments in this growing menopausal population
• Inform the development of new country-specific information resources, translated into multiple languages, for both Zimbabwe and South Africa. These new resources have been endorsed by the Ministry of Health and Child Care in Zimbabwe and the South African Menopause Society.