A technology-enhanced community health nursing (TECH-N) intervention was associated with a decrease in sexually transmitted infections (STI) of Neisseria gonorrhoeae and Chlamydia trachomatis among adolescents and young women with pelvic inflammatory disease (PID). According to the study published in JAMA Network Open, a TECH-N intervention also improved adherence to short-term clinical follow-up.
The investigators of this study sought to compare the efficacy of a TECH-N intervention vs standard of care to improve self-management of PID, as well as to improve N Gonorrhoeae and C trachomatis outcomes at 90 days.
The study included 286 female patients aged 13 to 25 years of age with mild to moderate PID who received outpatient care at a large urban academic medical center between September 2012 and December 2016. All participants completed an audio computer-assisted self-interview and were tested for N gonorrhoeae and C trachomatis infection at baseline and follow-up visits. Patients were randomly assigned to receive either the standard treatment for an STI (n=137) or the TECH-N intervention (n=149) in addition to STI treatment; the intervention group received support via text messages and were visited by a community health nurse within 5 days of enrollment. The primary outcome was the prevalence of N gonorrhoeae and C trachomatis infection, which was estimated through logistic regression analysis; the rate of positive infection results was evaluated through generalized estimating questions. A secondary outcome was adherence to self-care according to Centers for Disease Control and Prevention (CDC) recommendations.
Despite having similar demographic characteristics, the intervention group had a higher baseline rate of C trachomatis infection than the control group (32.4% vs 18.9%; P =.01). The intervention was effectively delivered to 89.6% of the participants in the intervention group and 90.9% of the total group were retained at 3 months. Participants in the intervention group were significantly more likely to receive the CDC-recommended short-term follow-up compared with participants in the control group (94.2% vs 16.3%; P <.001). At 90-day follow-up, the rate of recurrent N gonorrhoeae and C trachomatis infection did not differ significantly between the study groups (4.4% vs 10.4%; P =.07); however, the differential rate of decrease was significantly greater in the intervention group (34.4% to 4.4% vs 25.6% to 10.4%, respectively; P =.02).
Limitations to the study included the single-study design and a homogeneous sample of lower-income, black adolescents and young adults from the same community, preventing the generalizability of the study findings to other institutions or locations. Adherence variables in the control group were self-reported and collected by an outreach worker who was not blinded to group assignment information, and active outreach with all participants at days 14, 30, and 90 created potential for a positive influence on the controls.
Researchers of the study concluded that the TECH-N intervention should be considered as an add-on to standard care approaches for managing adolescents and young women with mild to moderate PID.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Trent M, Perin J, Gaydos CA, et al. 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. JAMA Netw Open. 2019;2(8):e198652.