Original StudyResults of a Randomized Controlled Trial of a Brief Behavioral Intervention for Pelvic Inflammatory Disease in Adolescents
Introduction
Although the current generation of screening programs for asymptomatic sexually transmitted infection (STI) has been successful in reducing the overall rates of pelvic inflammatory disease (PID) in women in the United States, PID rates remain unacceptably high among adolescent minority girls.1 In the past, one method of ensuring adherence and reducing the complications of PID in adolescent girls has been to hospitalize these patients for 48 to 72 hours of aggressive management with intravenous antibiotics followed by discharge and close follow-up during the remaining days of the 2- week antibiotic therapy.2
In recent years, clinical trials in adolescent and adult women have demonstrated that outpatient management alone for mild to moderate PID is equivalent to several days of inpatient management followed by an outpatient course of treatment.3 This has resulted in a shift to outpatient therapy for women of all ages, including adolescents. Unfortunately, several studies have demonstrated poor adherence to regimens by both adult women and adolescent girls when they are outpatients and have found that this may be the result of incorrect prescriptions and limited instructions for self-care at discharge.4, 5, 6 The objective of this research was to examine the effectiveness of a brief behavioral intervention at the time of PID diagnosis on subsequent patient adherence behaviors among urban adolescents from an STI-prevalent community.
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Patient Selection
Adolescents were recruited from five clinical sites in two institutions (a large academic medical center and a community hospital with close ties, for resident training, to the larger academic center). The five sites of recruitment included the pediatric and adult emergency departments at both centers and the combined general pediatrics and adolescent medicine clinic in the large academic center. Both institutions are located in a large urban center on the east coast of the United States that
Selected Demographics
We approached 162 patients about recruitment for participation in the study, and 131 were enrolled. Of those who were enrolled, 62% (N = 81) had 2-week follow-up visits with DISs. Data gathered from 126 participants were successfully transferred at enrollment, and the 2-week follow-up visits of these participants (N = 77) were used for the analysis (Figure 1).
The mean age of participants was 17.3 (SD 1.7). Participants had a mean age of sexual debut of 14.2 (SD 1.7) and a mean of 7.4 (SD 10.3)
Discussion
This study demonstrates that among adolescents with mild to moderate PID, randomization to a 6-minute video intervention at the time of discharge from an urgent or emergency care setting results in increased treatment of partners, a key form of secondary prevention of STIs. Despite this finding, we were not able to demonstrate differences in all PID-adherence behaviors. For example, almost one third of participants did not complete their medications despite the intervention.
Our baseline data
Acknowledgements
This project was supported by funding from the Robert Wood Johnson Generalist Faculty Scholars Program, the Centers for Disease Control and Prevention, the Thomas Wilson Foundation for the Children of Baltimore City, and the John and Mary McCarthy Foundation. We are also especially grateful to Dr. Iris Litt, the research assistants and disease intervention specialists who worked on this study, the health providers who referred patients to the study, and the many adolescent girls who
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2022, Disease-a-MonthCitation Excerpt :Table 1 lists various risk factors for the development of PID that include a young age, exposure to STD agents via coital behavior, immature immune system, failure to consistently use condoms and others1,2,34,60,73. A key factor to appreciate in understanding PID is the adolescent and young adult age group combined with coital behavior that may involve multiple sex partners1,2,27,74–96. Prevalence of Chlamydia trachomatis is noted to be highest in sexually active females who are 16 to 19 years of age and sexually active males who are 20 to 24 years of age73,86.
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2021, Journal of PediatricsCitation Excerpt :Completion of clinic referral was rare and was not different between groups. Efforts to improve adolescent follow-up for sexual and reproductive health have included approaches such as educational videos, text-messaging, and in-person counseling, but these efforts have largely fallen short.10,42-44 To have any real impact on health outcomes, substantive changes to where and how care is delivered are necessary to overcome the long-documented barriers to accessing care.2,3