Research Overview

About the MRC/Wits-Agincourt Unit

The Agincourt Health and Socio-Demographic Surveillance System (HDSS), located in in rural northeast South Africa close to the Mozambique border, provides the foundation for the Rural Public Health and Health Transitions Research Unit of the Medical Research Council (MRC) and University of the Witwatersrand, South Africa (the MRC/Wits-Agincourt Unit). Its origins lie in the university’s ‘Health Systems Development Unit’ that in the early 1990s focused on district health systems development, sub-district health centre networks and referral systems and training of clinically oriented primary health care nurses. The Agincourt HDSS was a founding member of the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) (

Framework highlighting key research areas of the MRC/Wits-Agincourt Unit


COVID-19 Response

Health & Social Systems

The dynamics of health transition are reflected in the burdens affecting rural adults. Studies are occurring in epidemiology and treatment of epilepsy as well as the health and wellbeing of ageing populations.Theme Leader:
Steve Tollman

Adolescent Health & Development

In rural South Africa morbidity, mortality and growth failure associated with malnutrition exist alongside female obesity and emerging cardiovascular disease. By tackling proximal issues of infant growth and nutrition, and social and emotional development in children, we aim to impact more distal outcomes including cognitive development, educational attainment, and adult metabolic disease.Theme Leaders:
Kathy Kahn and Shane Norris

Research & Evaluation Platform – Trends and Transitions

This theme seeks to understand dynamics of demographic and epidemiological change in rural populations undergoing rapid and multiple transitions, and to identify the forces driving that change.Theme Leader:
Mark Collinson

Adult Health & Wellbeing

The Agincourt Unit is examining the immediate and longer term impacts of HIV/AIDS and antiretroviral therapy roll-out. This work will support provincial and national efforts and provide evidence on delivery models, coverage and individual and population impacts of ARTs, as well as efforts to improve chronic disease treatment.Theme Leaders:
Steve Tollman
F. Xavier Gómez-Olivé

Social & Environmental Determinants

Rural households remain under pressure. Sudden shocks, whether job loss or death of a breadwinner, can destabilise households; similarly, protracted stresses such as drought or chronic illness can undermine coping capacity and livelihoods. Key to understanding how to improve health and social development is to examine the strategies employed by households to gain livelihoods and cope with shocks and stresses.Theme Leaders:
Mark Collinson

Features of cohorts nested within the MRC/Wits-Agincourt Unit, 2018

  Cohort description Sample
Cohort name Aim Size Type Assessments to-date

Frequency of follow-up



Sampling unit



INDEPTH-SAGE (Survey on global AGEing and adult health)


To assess health status, wellbeing and health seeking behaviour of older persons 4509 Open Baseline in 2006

Follow-up in 2010

Repeated 2013

Repeat in 2018


Population 50 years and older

Permanent residents


(Health & Ageing in Africa: Longitudinal Study of an INDEPTH community)

Longitudinal follow-up of functional, physical and cognitive assessments, and biomarker measurement to identify biological, social, and economic predictors of mortality; incidence of disease and onset of new events; changes in physical and cognitive function.


5059 Open Baseline 2014-2015

Follow up 2018

Follow up 2021

Permanent residents in study site in 2013, both sexes, 40 years and older Individual

(Africa Wits-INDEPTH genomic studies of cardiovascular disease)

Expand genomic association studies; deepen understanding of genome architecture and population structure; strengthen genomic and bioinformatics research capacity; modify and develop tools to study African populations.

To develop community engagement strategies and approach to feedback results to communities.



1465 (40-60 years)

1021 (>60 years)

Open Baseline 2014-2015

Follow up 2018

Follow up 2021

Permanent residents in study site in 2013, both sexes, 40 – 60 years. Population >60 years integrated with HAALSI Individual

(Prospective Household  study of Influenza, Respiratory Syncytial virus and other respiratory pathogens community burden and Transmission dynamics)

To estimate the community burden of influenza and RSV, and to assess the transmission dynamics of influenza and RSV infections in the community 200 households to get sample of 1500 individuals per year Open First selection 2016

Second selection 2017

Third selection 2018

Randomly selected households residing in the communities for at least 1 year prior to start of study and planning to stay; all members of household consent to participate; households should have with at least 3 individuals; 50% of households with at least 1 child aged <5 Household (all individuals in the HH are selected)


(Migration & health follow-up study)


To describe, at individual level, how a contemporary, complex pattern of migration and urbanization helps drive the health transition in low and middle income countries. To conduct a new observational study to understand how migrants acquire and manage chronic diseases and access long-term care







Baseline 2017-2018

Rounds 2 & 3 in 2019 and 2020 by phone call

Round 4 in person 2020

Round 5 2021 by phone


Residents in the study site in 2016, both sexes,18 – 49 years




CLINIC LINK Link HDSS members 18 years + with clinic records to measure chronic care utilization in the Primary Health Care system


All PHC clients Open Linkage started in 2014 Members of HDSS 18 years and older who attend any PHC service in the study site for HIV or chronic care



(Antibiotic access and use study)

Primary aim: to compare sociocultural determinants of appropriate access and use of antibiotics between 6 different LMICs.


600 Open Baseline in 2018 and follow up 6 months after the first visit. Households of the HDSS who consent to participate. Household

(African Research into Kidney disease)

Determine true prevalence of CKD in SA; develop and validate age- and gender-based prediction equation for estimating glomerular filtration rate in Africans; establish risk factors associated with CKD in South Africa


1800 Open Baseline 2017-2018

Follow up 2018-2019

Permanent residents in study site in 2016, both sexes, ≥ 18 years of age Individual
Ha Nakekela

(‘We care’)

Measure HIV and non-communicable disease prevalence and their risk factors 7428 Closed Baseline 2010/2011

Repeat planned in 2013

Men and women

15 years and older Permanent residents



(Study of the Epidemiology of Epilepsy)

To understand the burden of epilepsy, pattern of seizures, and excess mortality in  persons with epilepsy


310 Closed Nine rounds every 3 months completed in 2012 and 2013

Follow-up 2018

Tracking through HDSS


All ages diagnosed with epilepsy following screening in 2008 Individual
SUCSES (Sustainability in Communal Socio-Ecological Systems) To examine (i) household income, resource use, response to shocks, (ii) how livelihood capital, migration and use of natural resources shape household resilience and (iii) how poverty influences child nutrition 590 Closed Round 1 – 2010

Round 2 – 2011

Round 3 – 2012

Follow up – 2019

Sample stratified by gender and age

Four individuals selected per age/gender group in nine villages

Individual (households interviewed)

 Features of interventions and trial cohorts nested within the MRC/Wits-Agincourt Unit, 2017


  Cohort description Sample
Cohort name Aim Size Type Assessments to-date

Frequency of follow-up



Sampling unit
 Swa Koteka

(‘It is possible’


Conditional cash transfer trial)

To determine whether young women randomized to receive CCTs conditional on school attendance have lower incidence of HIV infection over time compared to young women not randomized to receive cash transfers 2537 Open Baseline 2011

First round 2012

Second round 2013

Third round 2014

Follow up 2015

Follow up 2017

Follow up 2018/19



Female; age 13-20; enrolled in grades 8-11; not married or pregnant; able to read; able to open bank accountt; parent/ guardian able to open bank account; residing in study area and intending to remain




To reduce population levels of uncontrolled hypertension, especially in those individuals at greatest risk, by supporting and strengthening the management of hypertension in primary care clinics 3770 in 2013

3015 in 2015

Closed Two cross sectional studies 2013 and 2015


Participants linked to clinics records

Adults over 18 years and residing in Agincourt sub-district.

All adults attending a clinic.

Individual for cross-sectional.

Clinics as clusters for trial


(‘Development’ -HIV self-testing)

To determine impact of HIV self-testing compared to HCT on testing uptake and frequency, referral and usage among peers/ partners, return for confirmatory testing and linking to care. To assess need for follow-up and linkage to care, as well as support materials for optimal and safe use of self-testing


400 Open Baseline 2017

Follow up after 3 and 6 months

Linked to HDSS

Young women 18-26 years from study site Individual
One Man Can Cluster randomised trial to assess impact of community mobilization intervention on gender norms


2400 Open Baseline 2012

Endline 2015

Young men 18-35 years Cluster

(‘Help each other’)


To evaluate theory-driven community-level interventions to improve uptake of testing, linkage to and retention in care for HIV positive individuals in high prevalence setting 7 control and 8 intervention villages Open Cross-sectional in 2015

Cross-sectional in 2018

Clinical records of all clinic attendees linked to HDSS

Lived in the study area for 12 months, 18-49 years, 1 individual per household Village clusters

Individual for cross-sectional studies