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    Original Investigation
    Pediatrics
    August 7, 2019

    Efficacy of a Technology-Enhanced Community Health Nursing Intervention vs Standard of Care for Female Adolescents and Young Adults With Pelvic Inflammatory Disease: A Randomized Clinical Trial

    Author Affiliations
    • 1Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 2Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 3Johns Hopkins International STD Laboratory, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 4Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 5Department of Adult Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 6Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    JAMA Netw Open. 2019;2(8):e198652. doi:10.1001/jamanetworkopen.2019.8652
    Key Points español 中文 (chinese)

    Question  Is a technology-enhanced community health nursing intervention more efficacious than the standard of care for reducing recurrent and incident sexually transmitted infection with Neisseria gonorrhoeae and Chlamydia trachomatis and does it improve patient adherence to key self-care behaviors for outpatient management of mild to moderate pelvic inflammatory disease?

    Findings  In this randomized clinical trial of 286 female patients with mild to moderate pelvic inflammatory disease, patients in the intervention group experienced decreases in N gonorrhoeae and C trachomatis infection over time and were significantly more likely to receive short-term follow-up care according to Centers for Disease Control and Prevention standards compared with controls.

    Meaning  The technology-enhanced community health nursing intervention is an efficacious strategy for achieving decreases in N gonorrhoeae and C trachomatis infection during the 3 months after diagnosis and delivering short-term clinical follow-up after pelvic inflammatory disease.

    Abstract

    Importance  Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects female adolescents and young adults. Despite data indicating poor adherence and adverse outcomes among those who experience subsequent Neisseria gonorrhoeae and Chlamydia trachomatis infection, few trials have been designed to address this public health need.

    Objective  To examine the efficacy of a technology-enhanced community health nursing (TECH-N) intervention vs standard of care for improving PID self-management behaviors and 90-day longitudinal prevalence of N gonorrhoeae and C trachomatis infection.

    Design, Setting, and Participants  This randomized clinical trial of the TECH-N intervention was conducted among female patients 13 to 25 years of age diagnosed with mild to moderate PID who were being discharged to outpatient treatment from September 6, 2012, to December 8, 2016, at a large academic medical center. The final analysis of data was completed in November 2018. This study compared the efficacy of the intervention with that of the standard of care using an intention-to-treat analysis.

    Interventions  Enrolled participants completed an audio computer-assisted self-interview, provided specimens for N gonorrhoeae and C trachomatis testing, and were randomized to standard treatment (n = 137) or the TECH-N intervention (n = 149). Intervention participants received text-messaging support and a community health nurse visit within 5 days of diagnosis. Change in the prevalence of N gonorrhoeae and C trachomatis infection was estimated with logistic regression. The N gonorrhoeae and C trachomatis positivity rate over time was evaluated using generalized estimating equations.

    Main Outcomes and Measures  The primary outcome was the prevalence of N gonorrhoeae and C trachomatis infection at 90-day follow-up. The secondary outcome was adherence to the Centers for Disease Control and Prevention recommendations for self-care.

    Results  A total of 286 patients (mean [SD] age, 18.8 [2.5] years; 268 [93.7%] African American) participated in the study. Although the study groups were demographically similar, the intervention group had a higher baseline rate of C trachomatis infection (45 of 139 [32.4%] vs 25 of 132 [18.9%], P = .01). Although N gonorrhoeae and C trachomatis positivity was not statistically different between groups at 90-day follow-up (6 of 135 [4.4%] vs 13 of 125 [10.4%], P = .07), the differential rate of decrease was significantly higher in the intervention group (48 of 140 [34.4%] to 6 of 135 [4.4%] compared with 34 of 133 [25.6%] to 13 of 112 [10.4%], P = .02). Intervention participants were more likely to receive the Centers for Disease Control and Prevention–recommended short-term follow-up visit compared with the control group (131 of 139 [94.2%] vs 20 of 123 [16.3%], P < .001).

    Conclusions and Relevance  Adolescent and young adults with PID in the TECH-N intervention were more likely to experience decreases in N gonorrhoeae and C trachomatis positivity compared with the control group and to receive short-term clinical assessment. These findings suggest that the TECH-N intervention should be considered as a potential enhancement of standard of care approaches for management of female adolescents and young adults with mild to moderate PID in urban communities facing significant sexually transmitted infection disparities.

    Trial Registration  ClinicalTrials.gov identifier: NCT01640379

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