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，少数民族少女和年轻成年妇女的发病率仍然高得不可接受。这种上生殖道感染通常由性传播感染（STI）引起，每次发作都会增加多次尖叫的风险，包括输卵管不孕，异位妊娠和慢性盆腔疼痛（CPP）。PID的护理已经从住院转向门诊;然而，我们对全国数据的年龄分层分析显示，无论治疗策略如何，青少年的重复性STI和CPP发生率仍然很高。我们的当地临床试验数据还表明，城市青少年对疾病控制和预防中心（CDC）建议的3天临床随访的依从性较差，在90天STI重新筛查访视时，STI风险较高，并且在急性护理环境中进行短暂干预对坚持自我管理行为具有积极但适度的影响。PID的住院治疗费用昂贵，与门诊治疗相比，有效性没有增加，因此有必要制定门诊战略，以改善短期和长期生殖健康结果，包括复发性性传播感染和PID。社区卫生护士（CHN）干预已被证明可以增加获得适当资源的机会，提高卫生保健利用率，并促进青少年降低风险的行为。最近的研究还表明，使用短消息服务（SMS）消息可以通过提高对医疗访问，药物依从性和与医疗保健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，比较技术增强的社区健康护理干预措施（OH-N）干预措施与优化的护理标准对照组的有效性。我们假设，与标准治疗相比，使用CDC-N重新包装推荐的CDC-PID随访访视将具有成本效益，并通过提高PID治疗的依从性和减少无保护性交来降低短期重复感染率。我们已经证明，我们的团队训练有素的面向社区的卫生专业人员可以在社区中跟踪患有PID的青春期女孩，并且利用CHN优化PID后时期的治疗是可行的，并且可以为城市社区的青少年和父母所接受。我们的试点使用短信通信也表明，城市青春期女孩有机会获得手机技术，热切地接受短信作为一种沟通策略，并回答卫生提供者的查询性健康维护支持。我们建议在巴尔的摩招募350名13- 21岁诊断为PID的年轻女性，并将其随机分配至接受CHN干预，其中包括在诊断后30天内（干预组）或标准护理（对照组）使用单一PID后面对面临床评价进行CHN临床支持，其中包括基于证据的STI预防课程和SMS通信支持。 公共卫生相关性：炎症性疾病（PID）是少数民族少女中严重的主要公共卫生问题，PID和其他性传播感染（STI）的每次发作都会增加长期问题的风险，如不孕症，输卵管妊娠和慢性盆腔疼痛。虽然社区保健护士干预措施增加了获得适当资源的机会，并促进青少年降低风险的行为;使用短信和基于证据的性传播感染预防协议可能会进一步提高护理的依从性，并减少PID后复发性传播感染。本申请中提出的研究活动有可能为门诊青少年PID患者的成本效益高、发育适当的临床管理提供指导。

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). PUBLIC HEALTH RELEVANCE: Inflammatory Disease (PID) is serious a major public health problem among minority adolescent girls and each episode of PID and other sexually transmitted infection (STI), increases the risk for long-term problems such as infertility, tubal pregnancy, and chronic pelvic pain. Although community health nurse interventions increase access to appropriate resources and promote risk-reducing behavior among adolescents; the use of text messaging and evidence based STI-prevention protocols may further improve adherence to care and reduce recurrent STIs after PID. The research activities proposed in this application have the potential to yield guidance for cost-effective, developmentally appropriate clinical management of adolescents with PID in the outpatient setting.