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: 7163884
• 负责人: JEANNETTE R ICKOVICS
• 金额: $ 81.94万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-18 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7163884
• 关键词: African American; HIV infections; Hispanic Americans; adolescence (12-20); behavior therapy; behavioral /social science research tag; clinical research; clinical trials; community health services; condoms; disease /disorder prevention /control; disease /disorder proneness /risk; early /brief intervention /therapy; environmental exposure; family planning; female; group therapy; high risk behavior /lifestyle; human ecology; human subject; longitudinal human study; low birth weight infant human; mother /infant health care; patient oriented research; perinatal; premature infant human; prenatal care; safe sex /sex abstinence; sexually transmitted diseases; urban area; women' s health

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.

说明（由申请人提供）：本研究的长期目标是降低 14 个社区接受产前护理的青少年和年轻女性（14-19 岁）在怀孕期间和怀孕后感染艾滋病毒和其他性传播疾病 (STD) 的风险健康中心 (CHC) 主要为纽约市都会区的黑人和拉丁裔社区提供服务。我们将评估一种创新的团体产前护理模式，该模式整合了艾滋病毒预防（CenteringPregnancy Plus，CP+），并且已经在 NIMH 资助的大型随机对照疗效试验中产生了良好的生物学和行为结果。具体目标是： (1) 将有效的艾滋病毒预防干预措施推广到 14 个社区卫生中心； (2) 通过以下方式测试该干预措施的有效性：(a) 通过前瞻性测量来检查整个产前期间和产后一年 (N=1400) 的行为和生物学结果，以及 (b) 确定群体产前影响的潜在机制护理，使用布朗芬布伦纳的生态系统理论作为指导框架； (3) 进行严格的过程评估，以确定影响该干预措施的采用、保真度和可持续性的因素。使用集群随机对照设计，CHC 将被随机分配到团体护理或个人标准护理。我们假设 CP+ 将有效转化为 CHC，从而显着减少与 HIV 相关的危险行为，显着降低 STD 和重复妊娠的发生率，并改善围产期结局。虽然为功效试验投入了大量资源，但用于确定在“现实世界”环境中实施的计划的有效性的资源却较少，例如社区卫生中心，其中十分之一的妇女——其中包括许多感染艾滋病毒/性病的风险最高的妇女——接受产前护理。拟议的研究响应 PA-01-123，寻求支持多站点协作干预试验。这代表了针对青春期女性的跨学科艾滋病毒预防研究的重要进展：将理论驱动和实证验证的艾滋病毒/性病预防计划纳入产前护理是在文化定制环境中提供可持续护理和疾病预防的一种有前景的方法。这些服务不足的患者和照顾他们的临床医生是将临床研究转化为临床实践的理想受益者，以减少艾滋病毒和其他性传播疾病的风险和传播，并消除健康差距。