Improving effective contraceptive use among opioid-maintained women

改善使用阿片类药物的女性的有效避孕方法

• 批准号: 8190800
• 负责人: Sarah H Heil
• 金额: $ 30.2万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8190800
• 关键词: Address; Adverse effects; Area; Behavioral; Clinic; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Country; Development; Economics; General Population; Goals; HIV; Implant; Incentives; Intake; Intervention; Intervention Studies; Knowledge; Methods; Opioid; Oral Contraceptives; Participant; Pharmaceutical Preparations; Population; Pregnancy; Problem Solving; Protocols documentation; Provider; Public Health; Randomized; Recruitment Activity; Reporting; Research; Risk; Schedule; Seminal; Services; Staging; Structure; Testing; Time; Visit; Woman; World Health Organization; base; condoms; cost; follow-up; improved; non-drug; novel; pregnancy prevention; pregnant; programs; statistics; therapy development; transmission process; treatment as usual; unintended pregnancy; voucher

DESCRIPTION (provided by applicant): The rate of unintended pregnancy among opioid-dependent women is extremely high: nearly 9 of every 10 pregnant opioid-dependent women report that the current pregnancy was unintended, a rate 2-3 times that of the general population. Despite these dire statistics, there is a dearth of scientific knowledge about contraceptive use in this population. The limited research available indicates that 75% of opioid-maintained (OM) women either use no contraception (45%) or less effective methods like condoms (30%). Development of interventions to increase contraceptive use among opioid- and other drug-dependent populations, driven primarily by efforts to reduce sexual HIV transmission rather than pregnancy prevention, has focused on condom use. However, the modest increases in condom use produced by existing interventions underscore the urgent need to develop other approaches that specifically target pregnancy prevention and promote the use of more effective contraceptives (e.g., birth control pills, IUDs, implants). The aim of this Stage I Behavioral and Integrative Treatment Development Program application is to develop and pilot test a novel contraceptive management program to increase use of more effective contraceptives among OM women. OM women (N=100) at risk for unintended pregnancy will be randomly assigned to a 6-month contraceptive management program or to usual care. The contraceptive management program will consist of two components: (1) the World Health Organization's contraception protocol and (2) reinforced follow-up visits. At their first visit, participants assigned to the contraceptive management program will complete the WHO's contraception protocol, which consists of assistance choosing a contraceptive method, structured educational counseling about their chosen method, a free supply of this method, and the option of initiating their chosen method immediately at an initial contraceptive assessment visit. Subsequently, contraceptive management program participants will earn voucher-based incentives to reinforce attendance at follow-up visits where they will receive support to manage side effects and problem-solve compliance problems, refills of their chosen method, and assistance switching methods when indicated. Participants assigned to the usual care condition will be given general information about contraceptive options and contact information for clinics and providers that provide contraceptive services. Contraceptive use by all participants will be evaluated at assessments scheduled 1, 3, and 6 months after trial intake. The proposed project will be the seminal study of an intervention to increase more effective contraceptive use in OM women and the first step towards the overarching goal of developing an efficacious, empirically based contraceptive management program that can be disseminated to drug treatment facilities throughout the country. The proposed research also holds significant potential for impacting public health in general, as development of efficacious programs will help reduce the vast economic and societal costs associated with unintended pregnancy among drug-dependent and non-drug-dependent women alike. PUBLIC HEALTH RELEVANCE: Nearly 9 of every 10 pregnant opioid-dependent women report that the current pregnancy was unintended and the majority of non-pregnant, opioid-maintained women do not use contraception or use less effective methods like condoms. The primary aim of this application is to develop and test a novel contraceptive management program to increase use of more effective contraceptives among opioid-maintained women. The proposed research may reduce unintended pregnancy among opioid-dependent women and the knowledge gained will also have implications for addressing high rates of unintended pregnancy in the general population.

描述（由申请人提供）：阿片类药物依赖女性的意外怀孕率极高：每 10 名阿片类药物依赖孕妇中就有近 9 人报告当前怀孕是意外怀孕，这一比例是一般人群的 2-3 倍。尽管有这些可怕的统计数据，但仍缺乏有关该人群避孕药具使用的科学知识。有限的研究表明，75% 的阿片类药物维持 (OM) 女性要么不使用避孕措施 (45%)，要么使用避孕套等效果较差的方法 (30%)。为增加阿片类药物和其他药物依赖人群避孕药具的使用而制定的干预措施主要是为了减少艾滋病毒的性传播而不是预防怀孕，重点是使用安全套。然而，现有干预措施导致安全套使用量略有增加，这凸显了迫切需要开发其他专门针对怀孕预防的方法，并促进使用更有效的避孕药具（例如避孕药、宫内节育器、埋植剂）。第一阶段行为和综合治疗开发计划应用的目的是开发和试点测试一种新颖的避孕管理计划，以增加 OM 女性使用更有效的避孕药具。有意外怀孕风险的 OM 女性 (N=100) 将被随机分配至为期 6 个月的避孕管理计划或常规护理。避孕管理计划将由两个部分组成：(1) 世界卫生组织的避孕方案和 (2) 强化随访。在第一次访问时，分配到避孕管理计划的参与者将完成世界卫生组织的避孕方案，其中包括协助选择避孕方法、有关其所选方法的结构化教育咨询、免费提供该方法以及启动其选择的选项在初次避孕评估访视时立即采取该方法。随后，避孕管理计划参与者将获得基于代金券的奖励，以加强后续访问的参与度，他们将获得管理副作用和解决合规问题的支持，补充他们选择的方法，并在有需要时协助转换方法。分配到常规护理条件的参与者将获得有关避孕选择的一般信息以及提供避孕服务的诊所和提供者的联系信息。所有参与者的避孕措施使用情况将在试验后 1、3 和 6 个月的评估中进行评估。拟议的项目将是对提高 OM 妇女更有效避孕药具使用干预措施的开创性研究，也是实现制定有效的、基于经验的避孕管理计划的总体目标的第一步，该计划可以传播到全国各地的戒毒治​​疗机构。拟议的研究还具有影响整个公共健康的巨大潜力，因为制定有效的计划将有助于减少与药物依赖和非药物依赖女性意外怀孕相关的巨大经济和社会成本。 公共健康相关性：每 10 名阿片类药物依赖孕妇中有近 9 名报告称，当前怀孕是意外怀孕，大多数非怀孕、服用阿片类药物的女性不采取避孕措施或使用避孕套等效果较差的方法。该应用程序的主要目的是开发和测试一种新型避孕管理计划，以增加使用阿片类药物的女性使用更有效的避孕药具。拟议的研究可能会减少阿片类药物依赖妇女的意外怀孕，所获得的知识也将对解决普通人群意外怀孕的高发生率产生影响。