162 - Repackaging the TECH-N Intervention for Precision: A Randomized Controlled Trial for Adolescents and Young Adults with Pelvic Inflammatory Disease

Publication Number: 162.6196

Maria E. Trent, Johns Hopkins University School of Medicine, Batlimore, MD, United States; Jamie Perin, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Betty A. johnson, Johns Hopkins University School of Medicine, Essex, MD, United States; Ashle Barfield, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Steven Huettner, Johns hopkins, Baltimore, MD, United States; Jacquelyn Toppins, JHU, Baltimore, MD, United States; K. Davina Frick, Johns Hopkins Carey Business School, Baltimore, MD, United States; Jennifer F. Anders, Johns Hopkins Children's Center, BALTIMORE, MD, United States; Richard Rothman, The Johns Hopkins University, Baltimore, MD, United States; Pamela A. Matson, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Charlotte A. Gaydos, Johns Hopkins University, Baltimore, MD, Gettysburg, PA, United States

Background: The Technology Enhanced Community Health Nursing (TECH-N) Intervention has been proven efficacious for treating adolescents and young adults (AYA) with mild-moderate pelvic inflammatory disease, demonstrating cost-savings due to the 86-fold increase in short-term follow-up and 28% reduction in 90-day sexually transmitted infections (STIs). However, gaps remain in delivering precision care that optimizes the use of laboratory data.

Objective: This study aims to determine if the TECH-Precision Nursing intervention (TECH-PN), which incorporates community-based care delivered by advanced practice assistants with a greater scope of practice, including independent prescribing and partner evaluation and treatment, achieves greater reductions in 90-day STI outcomes.

Design/Methods: AYA 13-25 years with mild-moderate PID were recruited during acute, ambulatory visits to participate in the human subjects' approved TECH-PN trial ((NCT#03828994). Participants completed audio-computerized self-interviews (ACASI), provided vaginal specimens for STI testing, and were randomized to intervention versus control groups. While all participants received medications, text-messaging support, and a community-based nursing visit per the TECH-N protocol, intervention participants received ongoing precision care by an advanced practice nurse or physician assistant driven by interim STI results and macrolide resistance testing during the 3-month follow-up period. The change over time in the prevalence of four STIs (NG, CT, TV, MG) was estimated with generalized estimating equations. The difference in the rate of change of prevalence for each STI was estimated with an interaction between time from enrollment and the study arm.

Results: The analytic sample includes 125 mostly black/African American (94%) participants with a mean age of 19.2 (SD 2.5). Compared with baseline, there were STI reductions across both groups over the 90-day treatment window. There was not a significant decrease in CT (odds ratio 1.39, 95% confidence interval 0.57 – 3.35, p=0.471), NG (0.61, 0.22 -1.73, p = 0.355), MG (0.78, 0.48 – 1.28, p = 0.328), or TV (1.29, 0.77 – 2.18, p = 0.338) for the participants receiving TECH-PN relative to those in the control arm (TECH-N).

Conclusion(s): While AYA in both TECH-N and TECH-PN saw improvements in STI rates over time, there is no statistically significant improvement in STI outcomes using the advanced practice provider intervention compared with the standard TECH-N intervention. Implementing the existing cost-saving intervention as a new standard of care in high STI-prevalent communities is warranted.

Figure 1: Study Design


Table 1. Baseline demographics by intervention group and for 120 study participants with completed audio-computerized self-interviews at baseline.


Figure 2 (a-d.) Prevalence of 2) Chlamydia trachomatis, 3) Neisseria gonorrhoeae, 3=4) Mycoplasma genitalium, and 5) Trichomonas vaginalis over time as estimated using generalized estimated equations (N=125 participant samples)