Technology Enhanced Community Health Nursing to Reduce Recurrent STIs after PID

描述(由申请人提供)：盆腔炎(PID)仍然是一种严重的生殖健康疾病，在少数族裔青春期女孩和年轻成年妇女中，发病率仍然高得令人无法接受。这种上生殖道感染的每一次发作，通常由性传播感染(STI)引起，增加了包括输卵管性不孕症、宫外孕和慢性盆腔疼痛(CPP)在内的多重尖叫的风险。PID的护理已经从住院转移到门诊；然而，我们对全国数据的年龄分层分析表明，无论治疗策略如何，青少年重复性传播感染和CPP的比率仍然很高。我们当地的临床试验数据也显示，城市青少年对疾病控制和预防中心(CDC)推荐的3天临床随访的依从性较差，在90天的STI复查中存在STI的高风险，急性护理环境中的短暂干预对遵守自我管理行为有积极但温和的影响。与门诊治疗相比，住院治疗PID的费用很高，但疗效却没有增加，因此有必要制定门诊策略，以改善短期和长期的生殖健康结果，包括复发性性传播感染和PID。社区卫生护士(CHN)的干预措施已被证明可以增加获得适当资源的机会，提高卫生保健的利用率，并促进青少年的减少风险行为。最近的研究还表明，使用短消息服务(SMS)消息传递可以通过改善对就诊、用药依从性和与医疗团队的沟通的关注来增强临床护理。本项目的主要目的是使用随机试验设计比较技术增强型社区卫生护理干预(TECH-N)干预和优化护理对照组标准的有效性。我们假设，与标准护理相比，使用TECH-N重新包装推荐的CDC-PID后续访问将具有成本效益，并通过提高对PID治疗的依从性和减少无保护的性行为来降低短期重复感染率。我们已经证明，我们训练有素的社区卫生专业人员团队可以在社区跟踪患有PID的青春期女孩，并证明在PID后阶段利用CHNS优化治疗是可行的，并为城市社区的青少年和父母所接受。我们使用短信通信的试点还表明，城市青春期女孩可以使用手机技术，热切地接受短信作为一种沟通策略，并响应卫生服务提供者对性健康维持支持的询问。我们建议在巴尔的摩招募350名13-21岁的年轻女性，并随机接受TECH-N干预，其中包括使用单一的面对面临床评估的CHN临床支持，该评估结合了基于证据的STI预防课程和在诊断后30天内的短信沟通支持(干预组)或护理标准(控制组)。

DESCRIPTION (provided by applicant): Pelvic Inflammatory Disease (PID) remains a serious reproductive health disorder and disease rates remain unacceptably high among minority adolescent girls and young adult women. Each episode of this upper reproductive tract infection, usually caused by a sexually transmitted infection (STI), increases the risk for multiple squeal including tubal infertility, ectopic pregnancy, and chronic pelvic pain (CPP). Care for PID has shifted from the inpatient to the outpatient setting; however, our age-stratified analysis of national data shows that adolescents continued to have high rates of repeat STIs and CPP, regardless of treatment strategy. Our local clinical trial data has also shown that urban adolescents have poor adherence to the 3 day clinical follow- up visit recommended by the Centers for Disease Control and Prevention (CDC), are at high risk for STI at the 90-day STI re-screening visit, and that brief interventions in the acute care setting have positive, but modest effects on adherence to self-management behaviors. Inpatient treatment for PID is expensive without incremental increases in effectiveness when compared with outpatient treatment so developing outpatient strategies to improve short and long-term reproductive health outcomes, including recurrent STI and PID, are warranted. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources enhance health care utilization and promote risk-reducing behavior among adolescents. Recent research has also shown that use of short messaging service (SMS) messaging can enhance clinical care by improving attention to medical visits, medication adherence, and communication with the health care team. The primary aim of this project is to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N) intervention to an optimized standard of care control group using randomized trial design. We hypothesize that repackaging the recommended CDC-PID follow-up visit using the TECH-N will be cost-effective compared with standard of care and reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse. We have demonstrated that our team of trained community-oriented health professionals can follow adolescent girls with PID in the community and that utilizing CHNs to optimize treatment in the post-PID period is feasible and acceptable to adolescents and parents in urban communities. Our pilot using SMS communication also demonstrates that urban adolescent girls have access to cell phone technology, eagerly accept SMS as a communication strategy, and respond to health provider queries for sexual health maintenance support. We propose to enroll 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive the TECH-N intervention which includes CHN clinical support using a single post-PID face-to-face clinical evaluation that incorporates an evidence based STI prevention curriculum and SMS communication support during the 30-day period following diagnosis (intervention group) or the standard of care (control group).