Improving Women's Sexual Health While in Drug Addiction Treatment

描述(申请人提供)：接受阿片类药物依赖治疗的妇女意外怀孕率(67%-86%)高于普通人群(49%)。考虑到阿片类药物依赖妇女在激动剂治疗期间经常与医疗保健提供者接触，这种环境对于整合意外怀孕干预是理想的。目标： R34提案的近期目标是开发和初步评估社会认知理论 驱动干预、性和女性赋权(SAFE)，旨在提高阿片类激动剂维持的育龄妇女对避孕做法的接受和遵守。外管局由四个60分钟的会议组成，将以两种形式之一进行演讲：面对面的短暂干预方法或新颖的、基于互联网的、计算机适应的平台。远端目标是确定一种或两种安全的提供形式在多大程度上为妇女在药物滥用治疗中长期改善避孕做法。设计：拟议研究有三个具体目标：目的1.对阿片类激动剂维持的育龄妇女的保健服务提供者进行个别访谈，然后对阿片类激动剂维持的育龄妇女和阿片激动剂维持的男性进行焦点小组和个别访谈，以制定安全干预的内容和结构。目的2.在随机分配到面对面或计算机自适应分娩方式的妇女样本(N=36)中，反复开发和预测安全干预措施。SAFE的重点将放在以下方面：(1)通过解决怀孕/生育动机和计划挑战的动机访谈(MI)技术，解决避孕用具使用和怀孕的矛盾心理；(2)通过(塑料模型上的)男性和女性避孕套实践、接受紧急避孕处方和MI风格的讨论，克服有效使用避孕措施的障碍和避孕方法的副作用，提高避孕能力；(3)通过实践有效的伴侣沟通、安全性行为谈判以及身体和情感安全技术，减少人际暴力风险；(4)立即运送和护送到卫生局，评估她所选择的避孕方法(S)。目的3.进行一项小规模三臂(面对面安全vs.计算机适应性安全vs.常规护理)随机试验(N=90)，以估计效果大小，并确定两种安全形式相对于彼此和常规护理对(A)干预完成率、(B)干预满意度、(C)避孕咨询预约次数和(D)有效避孕方法选择的相对影响。次级焦点包括生殖和避孕方法知识、避孕自我效能、有效避孕行为和危险性行为。摘要：只要SAFE的任何一个版本被发现是有效的，它就有可能减少意外怀孕的数量，从而减少对儿童保护服务的需求和费用。提高妇女作出和坚持避孕选择以及更好地安排怀孕时间的能力，同时还减少可能导致艾滋病毒和其他性传播感染(STI)的危险性行为，增加了这一干预措施潜在的整体公共卫生影响的前景。

DESCRIPTION (provided by applicant): Women treated for opioid dependence have a higher rate of unintended pregnancies (67%-86%) than the general population (49%). Given that opioid-dependent women have regular contact with health care providers during agonist-treatment, this setting is ideal for integrating unintended pregnancy interventions. Objective: The proximal goal of this R34 proposal is to develop and initially evaluate a social- cognitive, theory driven intervention, Sex and Female Empowerment (SAFE), designed to increase acceptance of and adherence to contraceptive practices among opioid-agonist- maintained women of childbearing age. SAFE comprises four 60-minute sessions that will be delivered in one of two formats: a face-to-face brief intervention approach or a novel, internet- based, computer-adaptive platform. The distal goal is to determine the extent to which either or both SAFE delivery formats yield long-term contraceptive practice improvements for women in substance abuse treatment. Design: The proposed study has three specific aims: Aim 1. To conduct individual interviews with providers of health services to opioid-agonist- maintained women of childbearing age, followed by focus groups and individual interviews with opioid-agonist-maintained women of childbearing age and opioid-agonist-maintained men in order to develop the content and structure of the SAFE intervention. Aim 2. To iteratively develop and pretest the SAFE intervention in a sample of women (N=36) assigned at random to either the face-to-face or computer-adaptive delivery format. SAFE's focus will be on increasing effective contraceptive use by (1) resolving ambivalence about contraceptive use and pregnancy through motivational interviewing (MI) techniques that will address pregnancy/childbearing motivation and planning challenges; (2) increasing contraceptive competence through male and female condom practice (on plastic models), receipt of emergency contraception prescription and MI style discussions about overcoming barriers to effective contraceptive use and contraceptive method side-effects; (3) reducing interpersonal violence risk through practicing effective partner communication, safer-sex negotiation, and physical and emotional safety techniques; and (4) immediate transport and escort to the Health Department for an evaluation for her contraceptive method(s) of choice. Aim 3. To conduct a small-scale, three-arm (face-to-face SAFE v. computer-adaptive SAFE v. usual care) randomized trial (N=90) to estimate effect sizes and determine the initial efficacy of both SAFE formats relative to each other and to usual care in terms of their relative impacts on (a) intervention completion, (b) intervention satisfaction, (c) contraceptive consultation appointment attendance, and (d) effective contraceptive method choice. Secondary foci include reproduction and contraceptive methods knowledge, contraceptive self-efficacy, effective contraceptive behavior, and risky sexual behavior. Summary: To the extent that either version of SAFE is found to be efficacious, it has the potential to reduce the number of unintended pregnancies and consequently decrease the need for and the costs of child protective services. Improving women's ability to make and adhere to contraceptive choices and better time their pregnancies while also decreasing risky sexual behavior that can lead to HIV and other sexually transmitted infections (STIs) adds to the promise of this interventions' potential overall public health impact.