Using Innovation to Address Adolescent and Young Adult Health Disparities in Pelvic Inflammatory Disease: Design of the Technology Enhanced Community Health Precision Nursing (TECH-PN) Trial

Abstract

New approaches to pelvic inflammatory disease (PID) care among adolescents and young adults (AYAs) that optimize self-care and personalize treatment are warranted to address age and racial-ethnic PID-related health disparities. Here we describe the 13-month preliminary feasibility and acceptability outcomes of recruitment, retention, and intervention delivery for Technology Enhanced Community Health Precision Nursing (TECH-PN) randomized controlled trial. Urban AYAs 13-25 years assigned female sex at birth with acute mild-moderate PID provided baseline and follow-up interview data and vaginal specimens for sexually transmitted infection (STI), cytokine, and microbiota assessment. All participants received medications and text-messaging support. Participants were block randomized to either control or intervention. Control participants received 1 community nursing visit with self-management for interim care per national guidelines. Intervention participants received unlimited precision care services driven by interim STI and macrolide resistance testing results by an advanced practice provider. In the first 13 months, 75.2% patients were eligible, and 76.1% of eligible patients enrolled. Of the participants, 94% completed the intervention and 96%, 91%, and 89%, respectively, completed their 14-, 30-, and 90-day visits. Baseline laboratory results revealed infection rates that were highest for Mycoplasma genitalium (45%) followed by Chlamydia trachomatis (31%). Preliminary enrollment, STI, intervention delivery, and retention data demonstrate the feasibility and acceptability of the TECH-PN intervention and support rationale for precision care for PID among urban AYAs. ClinicalTrials.gov Identifier. NCT03828994.

Keywords: Chlamydia trachomatis; Mycoplasma genitalium; Neisseria gonorrhoeae; Trichomonas vaginalis; Pelvic Inflammatory Disease (PID); adolescents and young adults (AYAs); clinical trial; disparities; genomic; precision-nursing; sexually transmitted infections.

© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Conceptual framework of Technology Enhanced Community Health Precision Nursing (TECH-PN) trial. Dashed lines represent points of potential impact on the conceptual framework (solid lines) on the integrative model of behavior change. Abbreviations: PID, pelvic inflammatory disease; STI, sexually transmitted infection.

Figure 2.

Study Flow Diagram. Abbreviations: CHN, community health nurse; PID, pelvic inflammatory disease; SOC, standard of care; TECH-N, Technology Enhanced Community Health Nursing; TECH-PN, Technology Enhanced Community Health Precision Nursing.