Integrating Prenatal Care to Reduce HIV/STDs Among Teens: A Translational Study

整合产前护理以减少青少年艾滋病毒/性病：一项转化研究

• 批准号: 7671400
• 负责人: JEANNETTE R ICKOVICS
• 金额: $ 90.27万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-18 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7671400
• 关键词: AIDS prevention; Academic Medical Centers; Acquired Immunodeficiency Syndrome; Adolescent; Affect; Age; Alcohols; Area; Assertiveness; Behavior; Behavioral; Biological; Birth; Breast Feeding; Build-it; Caring; Characteristics; Child; Childbirth; Clinical; Clinical Research; Clinical Services; Clinics and Hospitals; Communication; Communities; Community Health Centers; Controlled Environment; Development; Ecosystem; Effectiveness; Effectiveness of Interventions; Elements; Evaluation; Evidence based program; Family; Family Relationship; First Pregnancy Trimester; Gestational Age; HIV; HIV Infections; Health; Health Personnel; High Risk Woman; Hypertension; Incidence; Individual; Institution; Intervention; Intervention Trial; Knowledge; Latina; Leadership; Learning; Low Birth Weight Infant; Measurement; Measures; Mediation; Mental disorders; Modeling; Motivation; National Institute of Mental Health; New York; New York City; Nurse Midwives; Outcome; Parenting behavior; Patients; Peer Group; Perinatal; Physician Assistants; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Labor; Prenatal care; Prevention Research; Prevention program; Preventive Intervention; Probability; Process; Program Effectiveness; Provider; Public Health; Randomized; Readiness; Reducing diet; Reimbursement Mechanisms; Relative (related person); Reporting; Reproductive Health; Research; Research Personnel; Resources; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Schedule; Services; Sexuality; Sexually Transmitted Diseases; Site; Social Environment; Structure; System; Systems Theory; Teenagers; Testing; Time; Tobacco; Training; Translating; Translations; United States; Universities; Woman; Work; aged; base; beneficiary; clinical practice; condoms; depression; design; disorder prevention; disorder risk; effective intervention; efficacy trial; flexibility; group intervention; health disparity; high risk; high risk sexual behavior; improved; innovation; meetings; member; metropolitan; peer; practice-based research network; pregnant teen; prenatal; prevent; programs; prospective; psychosocial; satisfaction; self esteem; sex risk; skills; standard of care; success; translational study; transmission process; uptake

DESCRIPTION (provided by applicant): The long-term objective of this study is to reduce risk for HIV and other sexually transmitted diseases (STDs) during and after pregnancy among adolescents and young women (aged 14-19) receiving prenatal care in 14 Community Health Centers (CHCs) serving predominantly Black and Latina communities in the New York City Metropolitan area. We will evaluate an innovative model of group prenatal care that integrates HIV prevention (CenteringPregnancy Plus, CP+) and has already yielded favorable biological and behavioral outcomes in a large NIMH-sponsored randomized controlled efficacy trial. Specific aims are to: (1) Translate an efficacious HIV prevention intervention to 14 CHCs; (2) Test the effectiveness of this intervention by (a) examining behavioral and biological outcomes via prospective measurement throughout the prenatal period and up to one year postpartum (N=1400), and (b) identifying potential mechanisms of the effects of group prenatal care, using Bronfenbrenner's Ecological Systems Theory as a guiding framework; and (3) Conduct a rigorous process evaluation to identify factors that influence the uptake, fidelity, and sustainability of this intervention. Using a clustered randomized controlled design, CHCs will be randomly assigned to group care or individual standard of care. We hypothesize that CP+ will be effectively translated to CHCs, and that it will result in significant reductions in HIV-related risk behaviors, significantly lower rates of STDs and repeat pregnancies, as well as improvements in perinatal outcomes. While extensive resources have been devoted to efficacy trials, fewer resources have been devoted to identify the effectiveness of programs implemented in "real world" settings, such as CHCs, where one in ten women - including many at highest risk for HIV/STDs -- receive prenatal care. The proposed research is responsive to the PA-01-123, seeking to support multi-site collaborative intervention trials. This represents an important advance in interdisciplinary HIV prevention research for adolescent women: integrating a theoretically-driven and empirically-validated program for HIV/STD prevention into prenatal care is a promising way to provide sustainable care and disease prevention in a culturally-tailored setting. These underserved patients and the clinicians who care for them represent the ideal beneficiaries of translating clinical research into clinical practice for the reduction of risk and transmission of HIV and other STDs, as well as the elimination of health disparities.

描述(由申请人提供)：这项研究的长期目标是降低在14个社区卫生中心接受产前护理的青少年和年轻妇女(14-19岁)在怀孕期间和之后感染艾滋病毒和其他性传播疾病的风险，这些社区卫生中心主要服务于纽约市大都市区的黑人和拉丁裔社区。我们将评估一种整合艾滋病毒预防的团体产前护理创新模式(CenteringPregnancy Plus，CP+)，并已在NIMH赞助的大型随机对照疗效试验中产生了良好的生物学和行为结果。具体目标是：(1)将有效的HIV预防干预措施转化为14个CHC；(2)通过(A)通过对整个产前和产后一年(N=1400)的前瞻性测量来检查行为和生物学结果，以及(B)以Bronfenbrenner的生态系统理论为指导框架，确定集体产前护理效果的潜在机制；以及(3)进行严格的过程评估，以确定影响这种干预措施的吸收、保真度和可持续性的因素。采用群集化随机对照设计，将儿童健康中心随机分配到集体护理或个人标准护理。我们假设CP+将被有效地转化为CHC，并将导致与艾滋病毒相关的危险行为显著减少，性传播疾病和重复妊娠的发生率显著降低，以及围产期结局的改善。虽然已投入大量资源用于疗效试验，但用于确定在“现实世界”环境中实施的方案的有效性的资源较少，例如社区保健中心，在那里，十分之一的妇女--包括许多艾滋病毒/性传播疾病风险最高的妇女--接受产前护理。拟议的研究是对PA-01-123的响应，寻求支持多地点协作性干预试验。这代表了针对青春期妇女的跨学科艾滋病毒预防研究的重要进展：将理论驱动和经验验证的艾滋病毒/性传播疾病预防方案整合到产前护理中，是在文化定制的环境中提供可持续护理和疾病预防的一种有希望的方式。这些服务不足的患者和护理他们的临床医生是将临床研究转化为临床实践，以减少艾滋病毒和其他性传播疾病的风险和传播，以及消除健康差距的理想受益者。