Technology Enhanced Community Health Nursing to Reduce Recurrent STIs after PID

技术增强社区健康护理以减少 PID 后复发性传播感染

• 批准号: 9901560
• 负责人: MARIA E. TRENT
• 金额: $ 50.7万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9901560
• 关键词: Adherence; Adolescent; Adolescent and Young Adult; Affect; Alternative Therapies; Antibiotics; Azithromycin; Bacterial Vaginosis; Biological; Biological Markers; Care given by nurses; Centers for Disease Control and Prevention (U.S.); Clinical; Clinical Management; Communities; Community Health; Community Health Nursing; Control Groups; Data; Diagnosis; Diagnostic; Discipline of Nursing; Disease Management; Doxycycline; Ectopic Pregnancy; Enhancement Technology; Environment; Female genitalia; Fertility; Future; Genomics; Goals; HIV; HIV Infections; Health; Hydrogen Peroxide; Inflammation; Inflammatory; Inflammatory Response; Intervention; Knowledge; Laboratory Research; Lactic Acidosis; Lactobacillus; Macrolide-resistance; Macrolides; Measures; Metronidazole; Minority; Mycoplasma genitalium; Outcome; Outpatients; Participant; Patients; Pelvic Inflammatory Disease; Physicians; Precision Health; Process; Production; Property; Protocols documentation; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Recurrence; Reproductive Health; Research; Research Activity; Research Design; Resistance; Risk; STI prevention; Science; Self Care; Sexually Transmitted Diseases; Specimen; Syndrome; Testing; Text Messaging; Translating; Translations; Treatment Protocols; Trichomonas vaginalis; United States; Vagina; Visit; Woman; Youth; arm; base; care delivery; chronic infection; chronic pelvic pain; community based research; compare effectiveness; control trial; cost; cytokine; design; dysbiosis; effective therapy; follow-up; group intervention; health disparity; health related quality of life; improved; incremental cost-effectiveness; individualized medicine; novel; nursing intervention; pain reduction; personalized care; personalized health care; prevent; programs; racial and ethnic disparities; randomized trial; recurrent infection; reproductive system disorder; reproductive tract; response; treatment guidelines; treatment strategy; trial design; tubal infertility; vaginal infection; vaginal lactobacilli; vaginal microbiota; young woman

Abstract Pelvic Inflammatory Disease (PID) is a common, serious reproductive disorder that is associated with significant adverse reproductive health outcomes such as ectopic pregnancy, tubal infertility, chronic pelvic pain, and significant reductions in health related quality of life for affected patients. The Technology Enhanced Community Health (TECH) Nursing Study has further demonstrated that the biological milieu associated with PID is more complicated than the Centers for Disease Control and Prevention (CDC) treatment guidance indicates, leaving women without adequate treatment for Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV). The broad-spectrum antibiotics recommended by the CDC for syndromic PID management are suboptimal because: 1) MG is often resistant to doxycycline (standard therapy) and macrolides such as Azithromycin (alternative therapy) and 2) metronidazole (effective for TV) is an optional add-on to standard PID treatment that is inconsistently prescribed at diagnosis. Further MG was not officially considered in CDC STI treatment guidelines until release until 2015, testing is only available in large research laboratories, and the paucity of data from randomized trials limits the scope of the CDC's recommendations. Finally, while there are no public health control programs in the United States for MG and TV, recurrent and persistent infection with MG and TV is associated with ongoing inflammation in the female genital tract and increased risk for secondary STI and HIV infection due to unhealthy shifts in vagina microbiota. The goals of this competitive renewal application are to leverage novel STI diagnostics (new MG macrolide resistance testing and TV testing) with our demonstrated ability to reach vulnerable youth to treat adolescents and young adult women with mild-moderate PID with precision based on their actual diagnoses rather than suboptimal syndromic management. We will add genomic analysis of vaginal specimens to assess compositional changes in the five vaginal Lactobacilli community state types associated with optimal vaginal health and measure the vaginal cytokine response to determine if TECH-precision-nursing (TECH-PN) protocols for field treatment tailored to STI results reduces the inflammatory response observed with active vaginal infections. We hypothesize that by further repackaging our previous successful TECH-N intervention protocol and translating bench science into precision healthcare, we will further reduce the risk of recurrent infection, restore vaginal health for PID- affected patients, and add new knowledge that advances public health control of STIs and has the potential to reduce the observed STI disparities after PID in urban youth.

摘要 盆腔炎性疾病是一种常见的严重的生殖障碍，与 严重的不良生殖健康后果，如异位妊娠、输卵管性不孕、慢性盆腔 疼痛，以及受影响患者与健康相关的生活质量显著下降。增强的技术 社区健康(TECH)护理研究进一步证明， PID比疾病控制和预防中心(CDC)的治疗指导更复杂 指示，使妇女得不到适当的生殖支原体(MG)和滴虫治疗 阴道(电视)。美国疾病控制与预防中心推荐用于治疗综合征的广谱抗生素有 不太理想的原因是：1)MG通常对多西环素(标准疗法)和大环内酯类药物具有耐药性，如 阿奇霉素(替代疗法)和2)甲硝唑(对电视有效)是标准PID的可选附加组件 诊断时不一致地开出的治疗方法。此外，疾控中心并未正式考虑MG STI治疗指南发布到2015年，检测只在大型研究实验室可用，以及 缺乏来自随机试验的数据限制了疾控中心建议的范围。最后，虽然有 在美国没有针对MG和电视的公共卫生控制计划，反复和持续感染 镁和电视与女性生殖道持续的炎症有关，并增加了患上 由于阴道微生物区系的不健康转变而导致的继发性性传播感染和艾滋病毒感染。这场比赛的目标是 更新应用是利用新的STI诊断方法(新的MG大环内酯耐药性测试和电视 测试)，证明我们有能力帮助易受伤害的青年治疗青少年和年轻成年妇女 根据他们的实际诊断而不是次优症状来精确地使用轻度到中度的PID 管理层。我们将增加对阴道样本的基因组分析，以评估这五种病毒的成分变化 阴道乳杆菌群落类型与最佳阴道健康相关，并测量阴道 细胞因子反应决定现场治疗的技术精准护理(TECH-PN)方案是否适合 STI结果减少了活动性阴道感染所观察到的炎症反应。我们假设，通过 进一步重新包装我们之前成功的TECH-N干预方案，并将工作台科学转化为 精准医疗，我们将进一步降低反复感染的风险，恢复阴道健康，为PID- 并增加新的知识，促进对性传播感染的公共卫生控制，并有可能 减少城市青年产后观察到的性传播感染差距。