Improving effective contraceptive use among opioid-maintained women

阿片类药物依赖妇女的意外怀孕率极高：每10名怀孕的阿片类药物依赖妇女中有近9名报告当前怀孕是意外的，这一比率是一般人群的2-3倍。尽管有这些可怕的统计数据，但这一人群缺乏关于避孕药具使用的科学知识。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%）。制定干预措施以增加类阿片和其他药物依赖人群中避孕药具的使用，主要是为了减少艾滋病毒的性传播而不是预防怀孕，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专门针对预防怀孕和促进使用更有效的避孕药具的其他方法（例如，避孕药、宫内节育器、植入物）。第一阶段行为和综合治疗发展方案申请的目的是开发和试点测试一种新的避孕管理方案，以增加OM妇女使用更有效的避孕药具。将有意外妊娠风险的OM女性（N=100）随机分配至6个月的避孕管理计划或常规护理。避孕管理方案将包括两个组成部分：（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，分配到避孕管理计划的参与者将完成世界卫生组织的避孕协议，其中包括选择避孕方法的帮助，关于他们所选择的方法的结构化教育咨询，免费提供这种方法，以及在首次避孕评估访问时立即启动他们所选择的方法的选择。随后，避孕管理计划的参与者将获得基于代金券的激励措施，以加强随访的出勤率，在随访中，他们将获得支持，以管理副作用和解决问题的依从性问题，补充他们所选择的方法，并在指示时协助转换方法。将向分配到常规护理条件的参与者提供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。将在试验开始后1、3和6个月计划的评估中评价所有受试者的避孕措施使用情况。拟议的项目将是一项开创性的干预研究，以提高OM妇女更有效地使用避孕药具，并朝着制定一个有效的，以经验为基础的避孕管理计划，可以传播到全国各地的药物治疗设施的总体目标迈出了第一步。拟议的研究还具有影响公共卫生的巨大潜力，因为有效计划的制定将有助于减少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.