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.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing and Related Clinical Sciences Study Section (NRCS)
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Hardy, Lynda R
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Johns Hopkins University
Schools of Medicine
United States
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Trent, Maria (2013) Status of adolescent pelvic inflammatory disease management in the United States. Curr Opin Obstet Gynecol 25:350-6
Trent, Maria (2013) Pelvic inflammatory disease. Pediatr Rev 34:163-72