FAS Prevention: A Trial of the IOM Model

描述：作为预防研究的目标，南非(SA)是世界上胎儿酒精综合征(FAS)发病率最高的国家。在第一波和第二波研究中，Fas的比率分别为46/1000和75/1000，第三波的初步比率为79。在SA的其他部分，Fas的患病率很高。预防研究对南澳、美国和发展中国家的项目具有广泛的影响。这是一项由医学研究所(IOM)定义的全面、公共卫生模式、社区范围的Fas预防计划的多点疗效试验。它利用比较社区和预防前/后设计，通过对儿童和婴儿的Fas进行严格诊断进行评估，并通过随机抽样饮酒做法调查的措施反映饮酒习惯的变化。严格的方案评估还将评估土著工人采用的特定的、选定的和普遍的预防技术。多层次干预措施包括：通过以下方式减少产妇风险的指示性预防：对高危个人进行病例管理、获得节育和加强营养；利用激励访谈和社区强化办法的原则进行简短干预；以及个人赋权/技能建设。有选择和普遍的预防使用：对酗酒进行筛查；有针对性地传递信息以改变规范和KABB；政策宣传；以及社区教育和对话。目前的试验已被修改，以开始解决艾滋病毒/艾滋病的共病状况，这种情况存在于相同的高危妇女中，并具有许多预测不良妊娠结果的相同病因。由于这项预防试验的设计是全面的和社区范围的，因此有多种机会收集数据、风险评估和评估孕产妇和胎儿干预措施对FASD和艾滋病毒/艾滋病高危母亲及其子女的疗效。 预防地点(城市和农村部分)与四个比较社区相匹配，这些社区将作为不同的实体进行综合分析，以评估混淆的影响。利用LOM推荐的以前在美国印第安人社区应用的研究和预防技术，这项研究将确定在SA中社区范围内预防Fas的有效性，以及哪些特定组成部分最可行。预防设计中的嵌套研究还涉及基础研究，以进一步明确Fas的流行病学和临床特征：Fas、成人饮酒和母亲Fas的危险因素。具体目标是：1.)评估国际移民组织、Fas预防计划的效果；通过改变特定年龄段的Fas比率，直接衡量流行病学“仅供研究”阶段的预防效果；衡量成人知识、态度、信念和饮酒行为(KABB)的变化，以及社区对变化的准备情况；通过过程评估将预防活动的参与程度与具体成果联系起来；5.进一步确定产妇患Fas的风险因素；和6.)通过嵌套研究探索风险和保护的基本问题；以及7)检查南非西开普省艾滋病毒/艾滋病的流行情况和特点，以及艾滋病毒/艾滋病的风险因素，包括疾病进展、艾滋病药物供应情况以及与艾滋病毒相关的胎儿结局。

DESCRIPTION: The highest rates of fetal alcohol syndrome (FAS) in the world have been found in South Africa (SA) in this town targeted for prevention research. Rates of FAS were 46 and 75 per 1,000 in waves I and II of research and a preliminary rate in Wave III is 79. A high prevalence of FAS exists in other parts of SA. Prevention research has broad implications for programs in SA, the US, and developing populations. This is a multi-site, efficacy trial of a comprehensive, public health model, community-wide, FAS prevention program defined by the Institute of Medicine (IOM). It utilizes both comparative community and pre/post prevention designs with assessment via rigorous diagnosis of FAS in children and infants and also change in drinking practices reflected in measures from a random sample drinking practices survey. Rigorous program evaluation will also assess specific indicated, selected, and universal prevention techniques applied by indigenous workers. Multilevel interventions include: indicated prevention where maternal risk is reduced via: case management of high risk individuals, access to birth control, and enhanced nutrition; brief interventions using principles of motivational interviewing and community reinforcement approach; and individual empowerment/skills building. Selective and universal prevention use: screening for alcohol abuse; targeted messages to change norms and KABB; policy advocacy; and community education and dialogue. The current trial has been modified to begin to address the comorbid condition of HIV/AIDS that is present in the same high-risk women and has many of the same etiological factors predicting adverse pregnancy outcomes. Because this prevention trial is designed as comprehensive and community-wide, there are multiple opportunities for data collection, risk assessment, and evaluation of efficacy of maternal and fetal interventions on both FASD and HIV/AIDS at-risk mothers and their children. The prevention site (urban and rural components) is matched with four comparison communities which will be analyzed in aggregate and as distinct entities to assess confounding influences. Utilizing lOM-recommended techniques of research and prevention applied previously in American Indian communities, this study will determine the efficacy of community-wide prevention of FAS in SA, and which specific components are most viable. Nested studies within the prevention design also address basic research for further specificity of epidemiologic and clinical characteristics of: FAS, adult drinking, and maternal risk factors for FAS. Specific aims are to: 1.) assess the efficacy of the IOM, FAS prevention program; 2.) directly measure the prevention efficacy of the epidemiology "research only" phase via change in age-specific FAS rates; 3.) measure change in adult knowledge, attitudes, beliefs, and drinking behavior (KABB) as well as community readiness for change; 4.) link the level of participation in prevention activities to specific outcomes through process evaluation; 5.) further define maternal risk factors for FAS; and 6.) explore basic issues of risk and protection via nested studies; and 7) examine the prevalence and characteristics of, and risk factors for HIV/AIDS in the Western Cape Province of South Africa including disease progression, AIDS medication availability, and HIV-related fetal outcomes.