STD PREVENTION FOR AT RISK AFRICAN-AMERICAN WOMEN

这项研究的目的是测试为期12个月的多模式Well女性干预的有效性，以预防有反复性病史的年轻、低收入非裔美国女性新的性传播疾病(STDS)。目标群体居住在芝加哥西区或附近，那里的女性受到全国性病发病率最高的一些困扰。具体目的是确定随机对照重复措施试验对(A)中介结果--与性病相关的社会、心理和技能/行为因素，以及(B)健康状况结果--实验室确认的新感染的性病--的影响。干预由高级执业护士(APN)进行个案管理，并由一名社会工作者和同伴教育者补充。干预包括2个月的强化阶段和10个月的维持阶段，包括基于证据的标准化和个体化的性病预防策略：由APN进行的性病诊断、治疗、教学和支持；由同伴教育者领导的STD预防课程；由社会工作者进行的社区转介和保留策略；以及伙伴课程、咨询和转介。受试者将是670名年龄在18-29岁之间的女性，她们有性病指数，并且在她们的病史中至少有一种其他性病。受试者招募将在4家公共支持的西区诊所进行，干预将在西区卫生中心进行，这是库克县卫生服务中心的一个新设施。在基线措施后，妇女将被随机分配到对照组或干预组，采用最小限度的受试者分配程序，考虑静脉吸毒史、性伴侣数量、性暴力和艾滋病毒血清阳性。对照组将进行常规护理、性病尿检、艾滋病毒检测(提供)和最低限度的教学体验，直到采取12个月的措施。然后，他们将得到集中干预。从一个经过测试的护理模型--考克斯的客户健康行为交互模型--衍生出的性病预防框架将指导整体干预和组成部分。分析包括变化分数、Logistic回归、比例优势回归和随机回归分析。

The purpose of the study is to test the effectiveness of a 12-month multi-modal Well Woman intervention to prevent new sexually transmitted diseases (STDs) among young, low-income African American women with a history of repeated STDs. The target group lives on or near the Chicago Westside, where women are plagued with some of the highest STD rates in the nation. The Specific Aim is to determine the effects of the randomized, controlled repeated measures trial on (a) the mediating outcomes--STD related social, psychological, and skill/behavioral factors, and (b) the health status outcome-laboratory-confirmed newly contracted STDs. The intervention is case-managed by advanced practice nurses (APNs) and complemented by a social worker and peer educators. The intervention has a 2 month intensive phase and a 10-month maintenance phase with evidence- based standardized and individualized STD-prevention strategies: STD diagnosis, treatment, teaching, and support by APNs; STD prevention classes led by peer educators; community referrals and retention strategies by a social worker; and partner classes, counseling, and referrals. Subjects will be 670 women aged 18-29 years who have an index STD and at least 1 other STD in their histories. Subject recruitment will occur at 4 publicly supported West Side clinics, and the intervention will be in the West Side Health Center, a new Cook County Health Services facility in the center of the area. After baseline measures, the women will be randomly assigned to control or intervention groups with the minimization subject distribution procedure, taking into account the history of intravenous drug use, number of sexual partners, sexual violence, and HIV seropositivity. The control group will have usual care, STD urine screening, HIV testing (offered) and a minimal didactic experience until the 12-month measure is taken. Then they will be offered a concentrated intervention. A STD-Prevention Framework derived from a tested nursing model, Cox's Interaction Model of Client Health Behavior, will guide the overall intervention and the components. Analyses include change scores, logistic regression, proportional odds regression and random regression analysis.