Can technology plus community nursing improve PID outcomes?

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Results of a randomized clinical trial suggest that an intervention that combines technology and community nurses may improve outcomes of treatment of pelvic inflammatory disease (PID) in young women. The findings, published in JAMA Network Open, suggest that the approach may have merit in cases of mild to moderate PID seen in urban communities.

Participants in the research were female patients aged 13 to 25 who had been diagnosed with mild to moderate PID and were being discharged to outpatient treatment between September 6, 2012 and December 8, 2016. They were all seen at clinics within a large urban academic medical center with a high prevalence of sexually transmitted infections. Nearly all the participants were African-American (93.7%) with a mean age of 18.8 years.

The 286 patients all completed an audio computer-assisted self-interview and provided specimens for Neisseria gonorrhoeae and Chlamydia trachomatis testing. They received a single intramuscular injection of 250 mg of ceftriaxone and 28 100-mg tablets of doxycycline and instructed to take one table orally twice a day for 14 days.

Participants randomized to the intervention group received daily reminders via automated text messages or 2 weeks and then weekly booster messages for 1 month sent through a personal mobile phone, or if they did not have a phone, via a prepaid, disposable mobile phone with text-messaging provided through the study. The messages focused on adherence to medication and provided information on how many schedule doses had been taken each day. They also were visited within 5 days of enrollment by a community health nurse who had been trained to deliver PID-specific, short-term clinical follow-up. The encounter included a complete clinical assessment with abdominal examination and 20 minutes of skills-based counseling on sexual risk reduction and condom negotiation. The intervention was termed “TECH-N.”    

The authors used logistic regression to estimate change in prevalence of N gonorrhoeae and C trachomatis and used generalized estimating equations to rate N gonorrhoeae and C trachomatis positivity rates over time. The primary outcome was prevalence of the two infections at 90-day follow-up. The investigators also looked at adherence to the Centers for Disease Control and Prevention (CDC) recommendations for self-care.

At 90-day follow-up, rates of N gonorrhoeae and C trachomatis positivity were not statistically different (6 of 135 [4.4%] vs 13 of 125 [10.4%], P = .07). However, the 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). Participants exposed to the technology plus nursing intervention were more likely to receive the CDC-recommended short-term follow-up visit than the control group (131 of 139 [94.2%] vs 20 of 123 [16.3%], P < .001).

The authors said that TECH-N “should be considered as a potential enhancement of standard of care approaches for female adolescents and young adults with mild to moderate PID in urban communities facing significant STI disparities.” They believe that a cost-effectiveness evaluation of community-level scale-up is warranted.