Improving effective contraceptive use among opioid-maintained women

描述(申请人提供)：阿片类药物依赖妇女的意外妊娠率极高：每10名怀孕的阿片类药物依赖妇女中，近9人报告当前怀孕是意外怀孕，这一比率是普通人群的2-3倍。尽管有这些可怕的统计数据，但关于避孕措施在这一人群中的使用缺乏科学知识。现有的有限研究表明，75%的阿片类药物维持(OM)妇女要么不使用避孕措施(45%)，要么使用效果较差的方法，如避孕套(30%)。在阿片类药物和其他药物依赖人群中增加避孕用具的干预措施的制定，主要是由减少艾滋病毒性传播而不是预防怀孕的努力推动的，重点是避孕套的使用。然而，现有干预措施产生的避孕套使用量略有增加，突显出迫切需要制定其他专门针对怀孕预防的办法，并促进使用更有效的避孕措施(例如避孕药、宫内节育器、植入物)。这一阶段应用行为和综合治疗发展计划的目的是开发和试行一种新的避孕管理计划，以增加OM妇女使用更有效的避孕措施。有意外怀孕风险的OM妇女(N=100)将被随机分配到为期6个月的避孕管理计划或常规护理中。避孕管理计划将由两部分组成：(1)世界卫生组织的避孕方案和(2)加强随访。在第一次访问时，被分配到避孕管理方案的参与者将完成世界卫生组织的避孕协议，其中包括帮助选择避孕方法，关于他们选择的方法的有组织的教育咨询，免费提供这种方法，以及在最初的避孕评估访问中立即启动他们选择的方法的选项。随后，避孕管理计划参与者将获得基于代金券的奖励，以加强对后续访问的出席，在后续访问中，他们将获得支持，以管理副作用和解决问题-遵从性问题，重新填充他们选择的方法，并在指示时帮助切换方法。分配到通常护理条件的参与者将获得有关避孕选择的一般信息，以及提供避孕服务的诊所和提供者的联系信息。所有参与者的避孕药使用情况将在试验后1个月、3个月和6个月后进行评估。拟议中的项目将是一项干预措施的开创性研究，以增加OM妇女更有效的避孕用具使用，并朝着开发有效的、以经验为基础的避孕管理计划的总体目标迈出第一步，该计划可以传播到全国各地的药物治疗机构。这项拟议的研究还具有影响总体公共健康的巨大潜力，因为开发有效的计划将有助于降低药物依赖和非药物依赖妇女因意外怀孕而产生的巨大经济和社会成本。

DESCRIPTION (provided by applicant): The rate of unintended pregnancy among opioid-dependent women is extremely high: nearly 9 of every 10 pregnant opioid-dependent women report that the current pregnancy was unintended, a rate 2-3 times that of the general population. Despite these dire statistics, there is a dearth of scientific knowledge about contraceptive use in this population. The limited research available indicates that 75% of opioid-maintained (OM) women either use no contraception (45%) or less effective methods like condoms (30%). Development of interventions to increase contraceptive use among opioid- and other drug-dependent populations, driven primarily by efforts to reduce sexual HIV transmission rather than pregnancy prevention, has focused on condom use. However, the modest increases in condom use produced by existing interventions underscore the urgent need to develop other approaches that specifically target pregnancy prevention and promote the use of more effective contraceptives (e.g., birth control pills, IUDs, implants). The aim of this Stage I Behavioral and Integrative Treatment Development Program application is to develop and pilot test a novel contraceptive management program to increase use of more effective contraceptives among OM women. OM women (N=100) at risk for unintended pregnancy will be randomly assigned to a 6-month contraceptive management program or to usual care. The contraceptive management program will consist of two components: (1) the World Health Organization's contraception protocol and (2) reinforced follow-up visits. At their first visit, participants assigned to the contraceptive management program will complete the WHO's contraception protocol, which consists of assistance choosing a contraceptive method, structured educational counseling about their chosen method, a free supply of this method, and the option of initiating their chosen method immediately at an initial contraceptive assessment visit. Subsequently, contraceptive management program participants will earn voucher-based incentives to reinforce attendance at follow-up visits where they will receive support to manage side effects and problem-solve compliance problems, refills of their chosen method, and assistance switching methods when indicated. Participants assigned to the usual care condition will be given general information about contraceptive options and contact information for clinics and providers that provide contraceptive services. Contraceptive use by all participants will be evaluated at assessments scheduled 1, 3, and 6 months after trial intake. The proposed project will be the seminal study of an intervention to increase more effective contraceptive use in OM women and the first step towards the overarching goal of developing an efficacious, empirically based contraceptive management program that can be disseminated to drug treatment facilities throughout the country. The proposed research also holds significant potential for impacting public health in general, as development of efficacious programs will help reduce the vast economic and societal costs associated with unintended pregnancy among drug-dependent and non-drug-dependent women alike.