Enhancing Delivery of Confidential Care and STI Screening in Urban Health Centers

描述(由申请人提供)：居住在贫困城市环境中的青少年有相当大的风险怀孕和性传播感染(STI)，包括艾滋病毒，但这些保健需求往往得不到满足。建议的预防服务的提供在不同的实践环境中是不一致的，性健康服务尤其多变。如果要满足青少年的保健关切，保密保健是必不可少的。尽管迫切需要保密护理，但许多年轻人报告说，他们没有与卫生保健提供者单独相处过，而且很少有人意识到保密护理的权利。为了准备一项更大规模的随机对照试验，我们的主要目标是开发、实施和评估一项以实践为基础的试点干预措施，通过改善城市初级保健环境中获得保密服务的机会，提高城市性行为活跃的青少年进行性传播感染筛查的比率和及时性。在第一阶段，我们将收集形成性数据，以完成试点干预的发展，方法是1)与社区咨询委员会举行会议，从目标社区获得意见，2)青春期男孩及其父母的重点群体(加强我们先前对青春期女孩及其父母的定性工作)，以及3)在访问青少年(男性和女性)之后完成的前瞻性卡片研究，然后深入访谈在城市初级保健中治疗青少年的提供者。在第二阶段，我们将在城市实践中实施干预措施，包括3个部分：1)提高青少年和父母对保密护理的必要性和可获得性的认识；2)培训医生定期和始终如一地提供保密护理和评估性健康，同时克服与决定不提供这项服务有关的障碍；以及3)在诊所一级改进预约、接待和计费程序，以创造更有利于保密护理的环境。我们将对干预措施的效果进行初步估计，以加强对机密护理的接触，进行更全面的风险评估(包括向卫生保健提供者披露青少年的性行为)，并改进对性活跃青年性传播感染的筛查。此外，我们将评估干预措施的可行性和在不同环境中采用的障碍，以及其对卫生保健提供者、工作人员、父母和青少年的接受程度。虽然我们的主要成果最终是性传播感染筛查，但我们预计，更多地接触保密护理将增加机会，不仅解决青少年的生殖健康问题，而且还解决青少年其他敏感的健康问题。居住在贫困城市环境中的青少年有相当大的怀孕和性传播感染(STI)的风险，包括艾滋病毒，但这些卫生保健需求往往得不到满足。该项目的总体目标是制定、实施和评估一项以实践为基础的干预措施，以改善城市青少年在城市初级保健环境中获得保密护理的机会。我们将初步估计干预措施对青少年风险评估(包括向卫生保健提供者披露性行为)和在性活跃的青少年中筛查性传播感染的影响。

DESCRIPTION (provided by applicant): Adolescents residing in impoverished urban environments are at considerable risk for pregnancy and sexually transmitted infections (STIs), including HIV, yet these health care needs are often not addressed. Delivery of recommended preventive services is inconsistent across practice settings, with sexual health services especially variable. Confidential health care is essential if adolescents' health care concerns are to be met. Despite the urgent need for confidential care, many youth report they have not spent time alone with health care providers, and few are aware of the right to confidential care. In preparation for a larger randomized controlled trial, our primary objective is to develop, implement and evaluate a practice-based pilot intervention to increase rates and timeliness of STI screening for sexually active urban adolescents by improved access to confidential services in urban primary care settings. In Phase I, we will gather formative data to complete development of the pilot intervention, through 1) meetings with a community advisory board to obtain input from the target community, 2) focus groups of adolescent boys and their parents (augmenting our previous qualitative work with adolescent girls and their parents), and 3) a prospective card study completed after visits with adolescents (male and female) followed by in-depth interviews of providers who treat adolescents in urban primary care. In Phase II, we will implement the intervention in urban practices, consisting of 3 components: 1) increasing adolescents' and parents' awareness of the need for and availability of confidential care; 2) training physicians to routinely and consistently provide confidential care and assess sexual health, while overcoming barriers associated with decisions to omit this service; and 3) implementing clinic level improvements in appointment, reception and billing procedures to create environments more conducive to confidential care. We will obtain preliminary estimates of the efficacy of the intervention to enhance exposure to confidential care, yield more thorough risk assessment (including adolescent disclosure of sexual activity to health care providers) and improve screening for STIs among sexually active youth. In addition, we will assess the feasibility of the intervention and barriers to adoption in different settings, as well as its acceptability to health care providers, staff, parents and adolescents. While our primary outcome is ultimately STI screening, we anticipate that increased exposure to confidential care will result in enhanced opportunities to address not only reproductive health but other sensitive health concerns of adolescents.Narrative Adolescents residing in impoverished urban environments are at considerable risk for pregnancy and sexually transmitted infections (STIs), including HIV, yet these health care needs are often not addressed. The overall goal of this project is to develop, implement and evaluate a practice-based intervention to improve urban adolescents' access to confidential care in urban primary care settings. We will obtain preliminary estimates of the effect of the intervention on adolescent risk assessment (including disclosure of sexual activity to health care providers) and screening for sexually transmitted infections among sexually active youth.