STD PREVENTION FOR AT RISK AFRICAN-AMERICAN WOMEN

该研究的目的是测试一项为期12个月的多模式Well Woman干预的有效性，以防止有反复性病病史的年轻、低收入的非裔美国妇女感染新的性传播疾病。目标人群居住在芝加哥西区或附近，那里的女性受到全国最高的性病发病率的困扰。具体目的是确定随机对照重复测量试验对(a)中介结果（与性病相关的社会、心理和技能/行为因素）和(b)健康状况结果（实验室确认的新感染性病）的影响。干预由高级执业护士（apn）个案管理，并辅以社会工作者和同伴教育者。干预包括2个月的强化阶段和10个月的维持阶段，采用基于证据的标准化和个性化的性病预防策略：性病诊断、治疗、教学和apn的支持；由同伴教育者领导的性病预防课程；社工的社区转介及保留策略；还有伴侣课程，咨询和推荐。研究对象为670名年龄在18-29岁之间的女性，她们的病史中至少有一种性病。受试者招募将在西区4家公共支持的诊所进行，干预将在西区健康中心进行，这是该地区中心的一个新的库克县健康服务设施。基线测量后，考虑到静脉吸毒史、性伴侣数量、性暴力和艾滋病毒血清阳性，按照最小受试者分配程序将妇女随机分配到对照组或干预组。对照组将接受常规护理，性病尿液筛查，艾滋病毒检测（提供）和最低限度的教学经验，直到采取12个月的措施。然后，他们将接受集中干预。从经过测试的护理模型——考克斯客户健康行为互动模型——衍生出的性病预防框架将指导整体干预措施及其组成部分。分析方法包括变化评分、逻辑回归、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.