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

基本信息

批准号：
8309018
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
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2014-06-30
项目状态：
已结题

项目摘要

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.

描述（由申请人提供）：阿片类药物依赖性妇女的意外怀孕率极高：每10个怀孕的阿片类药物依赖性妇女中，近9个报告说，当前怀孕是意外的，这是普通人群的2-3倍。尽管有这些可怕的统计数据，但对该人群中避孕药的使用仍缺乏科学知识。可用的有限研究表明，有75％的阿片类药物维护（OM）妇女不使用避孕措施（45％）或诸如避孕套等有效方法（30％）。开发干预措施以增加阿片类药物和其他依赖药物依赖性种群的避孕措施，这主要是由减少性HIV传播而不是预防妊娠的努力驱动的。但是，现有干预措施产生的避孕套使用的适度增加突显了迫切需要开发其他针对预防妊娠的方法，并促进使用更有效的避孕药（例如，避孕药，iud，植入物）。此阶段I行为和综合治疗开发计划的应用的目的是开发和试点测试一种新型的避孕管理计划，以增加OM妇女中更有效的避孕药的使用。 OM妇女（n = 100）有意外怀孕的风险，将随机分配到6个月的避孕管理计划或通常的护理。避孕管理计划将由两个组成部分组成：（1）世界卫生组织的避孕方案和（2）加强后续访问。在第一次访问中，分配给避孕管理计划的参与者将完成WHO的避孕协议，该协议包括选择避孕方法，有关其选择方法的结构化教育咨询，免费提供此方法，以及在初始避孕评估访问中立即启动其所选方法的选择。随后，避孕管理计划参与者将获得基于优惠券的激励措施，以在后续访问中加强出勤率，在此期间，他们将获得支持，以管理副作用和解决问题的合规性问题，对所选方法的补充，并在指示时提供了辅助切换方法。分配给常规护理条件的参与者将获得有关避孕措施和提供避孕服务的诊所和提供者的联系信息的一般信息。所有参与者的避孕药具将在试验摄入量后1、3和6个月的评估中进行评估。拟议的项目将是对OM妇女中更有效的避孕药具的干预措施的开创性研究，也是朝着建立有效的，基于经验的避孕管理计划的总体目标的第一步，该计划可以将其传播到全国各地的药物治疗设施。拟议的研究还具有一般影响公共卫生的巨大潜力，因为有效计划的发展将有助于降低与依赖药物依赖和非药物依赖性妇女意外怀孕相关的巨大经济和社会成本。