Integrating Prenatal Care to Reduce HIV/STDs Among Teens: A Translational Study

整合产前护理以减少青少年艾滋病毒/性病：一项转化研究

• 批准号: 7277807
• 负责人: Jonathan N. Tobin
• 金额: $ 61.1万
• 依托单位: CLINICAL DIRECTORS NETWORK, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-17 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7277807
• 关键词: AIDS prevention; Academic Medical Centers; Acquired Immunodeficiency Syndrome; Adolescent; Affect; Age; Alcohols; Area; Assertiveness; Behavior; Behavioral; Biological; Birth; Breast Feeding; Build-it; Caring; Characteristics; Child; Childbirth; Cities; Clinical; Clinical Research; Clinical Services; Clinics and Hospitals; Communication; Communities; Community Health Centers; Community Relations; Condition; Controlled Environment; Development; Effectiveness; Effectiveness of Interventions; Elements; Evaluation; Evidence based program; Family; Family Relationship; First Pregnancy Trimester; Gestational Age; HIV; HIV Infections; Health; Health Personnel; High Risk Woman; Hypertension; Incidence; Individual; Institution; Intervention; Intervention Trial; Knowledge; Latina; Leadership; Learning; Low Birth Weight Infant; Measurement; Measures; Mediation; Mental Depression; Mental disorders; Modeling; Motivation; National Institute of Mental Health; New York; New York City; Nurse Midwives; Outcome; Parenting behavior; Patients; Peer Group; Perinatal; Physician Assistants; Pliability; Postpartum Period; Practice based research; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Labor; Prenatal care; Prevention Research; Prevention intervention; Prevention program; Probability; Process; Program Effectiveness; Provider; Public Health; Randomized; Rate; Readiness; Reducing diet; Reimbursement Mechanisms; Relative (related person); Reporting; Reproductive Health; Research; Research Personnel; Resources; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Schedule; Services; Sex Behavior; Sexuality; Sexually Transmitted Diseases; Site; Social Environment; Standards of Weights and Measures; Structure; System; Systems Theory; Teenagers; Testing; Time; Tobacco; Training; Translating; Translations; United States; Universities; Week; Woman; Work; aged; base; beneficiary; condoms; design; disorder prevention; disorder risk; efficacy trial; health disparity; high risk sexual behavior; improved; innovation; member; metropolitan; peer; pregnant teen; prenatal; prevent; programs; prospective; psychosocial; satisfaction; self esteem; skills; success; translational study; transmission process; uptake

DESCRIPTION (provided by applicant): The long-term objective of this study is to reduce risk for HIV and other sexually transmitted diseases (STDs) during and after pregnancy among adolescents and young women (aged 14-19) receiving prenatal care in 14 Community Health Centers (CHCs) serving predominantly Black and Latina communities in the New York City Metropolitan area. We will evaluate an innovative model of group prenatal care that integrates HIV prevention (CenteringPregnancy Plus, CP+) and has already yielded favorable biological and behavioral outcomes in a large NIMH-sponsored randomized controlled efficacy trial. Specific aims are to: (1) Translate an efficacious HIV prevention intervention to 14 CHCs; (2) Test the effectiveness of this intervention by (a) examining behavioral and biological outcomes via prospective measurement throughout the prenatal period and up to one year postpartum (N=1400), and (b) identifying potential mechanisms of the effects of group prenatal care, using Bronfenbrenner's Ecological Systems Theory as a guiding framework; and (3) Conduct a rigorous process evaluation to identify factors that influence the uptake, fidelity, and sustainability of this intervention. Using a clustered randomized controlled design, CHCs will be randomly assigned to group care or individual standard of care. We hypothesize that CP+ will be effectively translated to CHCs, and that it will result in significant reductions in HIV-related risk behaviors, significantly lower rates of STDs and repeat pregnancies, as well as improvements in perinatal outcomes. While extensive resources have been devoted to efficacy trials, fewer resources have been devoted to identify the effectiveness of programs implemented in "real world" settings, such as CHCs, where one in ten women - including many at highest risk for HIV/STDs -- receive prenatal care. The proposed research is responsive to the PA-01-123, seeking to support multi-site collaborative intervention trials. This represents an important advance in interdisciplinary HIV prevention research for adolescent women: integrating a theoretically-driven and empirically-validated program for HIV/STD prevention into prenatal care is a promising way to provide sustainable care and disease prevention in a culturally-tailored setting. These underserved patients and the clinicians who care for them represent the ideal beneficiaries of translating clinical research into clinical practice for the reduction of risk and transmission of HIV and other STDs, as well as the elimination of health disparities.

描述（由申请人提供）：这项研究的长期目标是减少青少年和年轻妇女怀孕期间和年轻妇女（14-19岁）在14个社区卫生中心（CHCS）接受产前护理的青少年和年轻妇女（CHCS）中的艾滋病毒和其他性传播疾病（STD）的风险。我们将评估一种创新的群体产前护理模型，该模型整合了HIV预防（CenteringPregnancy Plus，CP+），并且在一项大型NIMH赞助的随机控制功效试验中已经产生了有利的生物学和行为结果。具体目的是：（1）将有效的HIV预防干预转化为14个CHC； （2）通过（a）在整个产前期间和产后一年（n = 1400）和（b）使用Bronfenbrenner的生态系统理论作为引导框架作为指导框架来测试（a）通过（a）通过前瞻性测量和产后一年（n = 1400）检查行为和生物学结果的有效性； （3）进行严格的过程评估，以确定影响这种干预措施的吸收，忠诚度和可持续性的因素。使用聚类的随机控制设计，CHC将随机分配给组护理或单个护理标准。我们假设CP+将有效地转化为CHC，并且将大大降低与HIV相关的风险行为，显着降低性病和重复妊娠的率显着降低，并改善周围结果。尽管大量资源已致力于效力试验，但较少的资源投入到确定“现实世界”环境中实施的计划的有效性，例如CHC，其中十分之一的妇女（包括许多处于HIV/STD的风险最高的女性）获得产前护理。拟议的研究对PA-01-123有反应，寻求支持多站点的协作干预试验。这代表了青春期妇女跨学科的艾滋病毒预防研究的重要进步：将艾滋病毒/性病预防的理论驱动和经验性验证的计划整合到产前护理中是一种有前途的方式，可在文化卫生环境中提供可持续的护理和预防疾病。这些服务不足的患者和照顾他们的临床医生代表了将临床研究转化为临床实践的理想受益者，以降低HIV和其他性病的风险和传播以及消除健康差异。