Improving effective contraceptive use among opioid-maintained women

描述（由申请人提供）：阿片类药物依赖妇女的意外怀孕率非常高：每10名阿片类药物依赖妇女中有近9人报告目前的怀孕是意外怀孕，比率是一般人群的2-3倍。尽管有这些可怕的统计数据，但在这一人群中缺乏有关避孕措施使用的科学知识。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%），要么使用避孕套等效果较差的方法（30%）。在阿片类药物和其他药物依赖人群中增加避孕药具使用的干预措施的制定，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，现有的干预措施使避孕套的使用略有增加，这突出表明迫切需要制定其他专门针对预防怀孕和促进使用更有效避孕药具（如避孕药、宫内节育器、植入物）的办法。第一阶段行为和综合治疗发展计划的目的是开发和试点测试一种新的避孕管理计划，以增加OM妇女使用更有效的避孕药具。有意外怀孕风险的OM妇女（N=100）将被随机分配到6个月的避孕管理计划或常规护理组。避孕管理方案将由两个部分组成：(1)世界卫生组织的避孕方案；(2)加强随访。在第一次访问时，被分配到避孕管理规划的参与者将完成世卫组织的避孕方案，其中包括协助选择避孕方法，就其所选方法进行结构化的教育咨询，免费提供该方法，并可在首次避孕评估访问时立即启动所选方法。随后，避孕管理项目的参与者将获得基于代金券的奖励，以提高随访的出勤率，在随访中，他们将获得支持，以管理副作用和解决问题，解决合规问题，补充他们选择的方法，并在需要时帮助转换方法。分配到常规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。所有参与者的避孕使用情况将在试验开始后1、3和6个月进行评估。拟议的项目将是对一项干预措施的开创性研究，目的是增加OM妇女更有效地使用避孕药具，并朝着制定一项有效的、以经验为基础的避孕药具管理方案这一总体目标迈出第一步，该方案可向全国各地的药物治疗机构推广。拟议的研究还具有影响一般公共卫生的重大潜力，因为制定有效的方案将有助于减少与药物依赖和非药物依赖妇女意外怀孕相关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.