Technology Enhanced Community Health Nursing to Reduce Recurrent STIs after PID

技术增强社区健康护理以减少 PID 后复发性传播感染

• 批准号: 9901560
• 负责人: MARIA E. TRENT
• 金额: $ 50.7万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9901560
• 关键词: Adherence; Adolescent; Adolescent and Young Adult; Affect; Alternative Therapies; Antibiotics; Azithromycin; Bacterial Vaginosis; Biological; Biological Markers; Care given by nurses; Centers for Disease Control and Prevention (U.S.); Clinical; Clinical Management; Communities; Community Health; Community Health Nursing; Control Groups; Data; Diagnosis; Diagnostic; Discipline of Nursing; Disease Management; Doxycycline; Ectopic Pregnancy; Enhancement Technology; Environment; Female genitalia; Fertility; Future; Genomics; Goals; HIV; HIV Infections; Health; Hydrogen Peroxide; Inflammation; Inflammatory; Inflammatory Response; Intervention; Knowledge; Laboratory Research; Lactic Acidosis; Lactobacillus; Macrolide-resistance; Macrolides; Measures; Metronidazole; Minority; Mycoplasma genitalium; Outcome; Outpatients; Participant; Patients; Pelvic Inflammatory Disease; Physicians; Precision Health; Process; Production; Property; Protocols documentation; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Recurrence; Reproductive Health; Research; Research Activity; Research Design; Resistance; Risk; STI prevention; Science; Self Care; Sexually Transmitted Diseases; Specimen; Syndrome; Testing; Text Messaging; Translating; Translations; Treatment Protocols; Trichomonas vaginalis; United States; Vagina; Visit; Woman; Youth; arm; base; care delivery; chronic infection; chronic pelvic pain; community based research; compare effectiveness; control trial; cost; cytokine; design; dysbiosis; effective therapy; follow-up; group intervention; health disparity; health related quality of life; improved; incremental cost-effectiveness; individualized medicine; novel; nursing intervention; pain reduction; personalized care; personalized health care; prevent; programs; racial and ethnic disparities; randomized trial; recurrent infection; reproductive system disorder; reproductive tract; response; treatment guidelines; treatment strategy; trial design; tubal infertility; vaginal infection; vaginal lactobacilli; vaginal microbiota; young woman

Abstract Pelvic Inflammatory Disease (PID) is a common, serious reproductive disorder that is associated with significant adverse reproductive health outcomes such as ectopic pregnancy, tubal infertility, chronic pelvic pain, and significant reductions in health related quality of life for affected patients. The Technology Enhanced Community Health (TECH) Nursing Study has further demonstrated that the biological milieu associated with PID is more complicated than the Centers for Disease Control and Prevention (CDC) treatment guidance indicates, leaving women without adequate treatment for Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV). The broad-spectrum antibiotics recommended by the CDC for syndromic PID management are suboptimal because: 1) MG is often resistant to doxycycline (standard therapy) and macrolides such as Azithromycin (alternative therapy) and 2) metronidazole (effective for TV) is an optional add-on to standard PID treatment that is inconsistently prescribed at diagnosis. Further MG was not officially considered in CDC STI treatment guidelines until release until 2015, testing is only available in large research laboratories, and the paucity of data from randomized trials limits the scope of the CDC's recommendations. Finally, while there are no public health control programs in the United States for MG and TV, recurrent and persistent infection with MG and TV is associated with ongoing inflammation in the female genital tract and increased risk for secondary STI and HIV infection due to unhealthy shifts in vagina microbiota. The goals of this competitive renewal application are to leverage novel STI diagnostics (new MG macrolide resistance testing and TV testing) with our demonstrated ability to reach vulnerable youth to treat adolescents and young adult women with mild-moderate PID with precision based on their actual diagnoses rather than suboptimal syndromic management. We will add genomic analysis of vaginal specimens to assess compositional changes in the five vaginal Lactobacilli community state types associated with optimal vaginal health and measure the vaginal cytokine response to determine if TECH-precision-nursing (TECH-PN) protocols for field treatment tailored to STI results reduces the inflammatory response observed with active vaginal infections. We hypothesize that by further repackaging our previous successful TECH-N intervention protocol and translating bench science into precision healthcare, we will further reduce the risk of recurrent infection, restore vaginal health for PID- affected patients, and add new knowledge that advances public health control of STIs and has the potential to reduce the observed STI disparities after PID in urban youth.

抽象的 盆腔炎症性疾病（PID）是一种常见的严重生殖疾病，与 明显的不良生殖健康结果，例如异位妊娠，输卵管不育症，慢性骨盆 受影响患者的疼痛和健康相关生活质量的显着降低。该技术增强了 社区健康（技术）护理研究进一步证明了与 PID比疾病控制和预防中心（CDC）治疗指导更为复杂 指出，使女性对支原体生殖器（MG）和trichomonas没有足够的治疗 阴道（电视）。 CDC建议用于综合征PID管理的广谱抗生素是 次优的是因为：1）mg通常对强力霉素（标准疗法）和大环内酯类药物（例如 阿奇霉素（替代疗法）和2）甲硝唑（对电视有效）是标准PID的可选附件 诊断时不一致规定的治疗。疾病预防控制中心未正式考虑进一步的毫克 直到2015年发布的STI治疗指南，仅在大型研究实验室中进行测试， 来自随机试验的数据的贫困限制了CDC建议的范围。最后，有 美国没有公共卫生控制计划，用于MG和电视，反复和持续感染 MG和TV与女性生殖道持续的炎症有关，并增加 由于阴道微生物群的不健康转移而引起的继发性性传播感染和HIV感染。这个竞争性的目标 更新应用是要利用新型STI诊断（新的MACROIDE抗性测试和电视 测试）我们有能力吸引弱势青年来治疗青少年和年轻女性 基于其实际诊断而不是次优综合症，具有轻度中度PID具有精度 管理。我们将添加阴道标本的基因组分析，以评估五个的组成变化 阴道乳酸杆菌社区状态类型与最佳阴道健康相关并测量阴道 细胞因子的反应以确定针对现场治疗的技术培训（Tech-PN）方案是否量身定制 STI结果降低了活跃的阴道感染观察到的炎症反应。我们通过 进一步重新包装我们以前的成功技术-N干预协议，并将基准科学转化为 精确医疗保健，我们将进一步降低复发感染的风险，恢复阴道健康 受影响的患者，并添加新的知识，以提高性传播感染的公共卫生控制，并有可能 减少城市青年PID后观察到的性传播感染差异。