Improving Women's Sexual Health While in Drug Addiction Treatment

描述（由申请人提供）：接受阿片类药物依赖治疗的女性意外怀孕率（67%-86%）高于一般人群（49%）。鉴于阿片类药物依赖的妇女在激动剂治疗期间定期与卫生保健提供者接触，这种环境是整合意外怀孕干预措施的理想选择。目的：通过 R34提案的近期目标是发展和初步评估一种社会认知理论， 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坚持。SAFE包括四个60分钟的会议，将以两种形式之一提供：面对面的简短干预方法或新颖的基于互联网的计算机自适应平台。远端的目标是确定在何种程度上任一或两种安全的交付形式产生长期避孕措施的改善妇女的药物滥用治疗。设计：该研究有三个具体目标：目标1。对使用阿片类激动剂维持的育龄妇女的卫生服务提供者进行个别访谈，然后对使用阿片类激动剂维持的育龄妇女和使用阿片类激动剂维持的男性进行焦点小组和个别访谈，以制定SAFE干预措施的内容和结构。目标2.在随机分配到面对面或计算机自适应交付格式的女性样本（N=36）中迭代开发和预测试SAFE干预。SAFE的重点将是通过以下方式提高避孕药具的有效使用：（1）通过动机访谈技术解决避孕药具使用和怀孕的矛盾心理，这些技术将解决怀孕/生育动机和计划挑战;（2）通过使用男用和女用避孕套提高避孕能力（关于整形模特）、接受紧急避孕处方和关于克服有效使用避孕药具的障碍和避孕方法副作用的MI式讨论;（3）透过有效的伴侣沟通、安全性行为协商及身心安全技巧，减低人际暴力风险;及（4）立即将受害人送往卫生署接受评估，以决定其选择的避孕方法。目标3：进行一个小规模的三臂（面对面SAFE v.计算机自适应SAFE v.常规护理）随机试验（N=90），以估计效应量，并确定两种SAFE格式相对于彼此和常规护理的初始疗效，包括对（a）干预完成，（B）干预满意度，（c）避孕咨询预约出勤率，及（d）选择有效的避孕方法。次要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。总结：如果发现SAFE的任何一个版本都有效，它都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。提高妇女做出和坚持避孕选择的能力，更好地安排怀孕时间，同时减少可能导致艾滋病毒和其他性传播感染的危险性行为，增加了这种干预措施潜在的整体公共卫生影响的希望。

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.