Shlay Judith C, Mayhugh Barbara, Foster Mark, Maravi Moises E, Barón Anna E, Douglas John M
Department of Public Health, Denver Health and Hospital Authority, CO 80204, USA.
Am J Obstet Gynecol. 2003 Aug;189(2):473-81. doi: 10.1067/s0002-9378(03)00493-9.
Our purpose was to determine the effectiveness of sexually transmitted disease (STD) clinic-initiated contraceptive care.
Nonpregnant women (n=877) attending an urban STD clinic using either no contraception or only condoms were randomly assigned to either an intervention (n=437) or control group (n=440). Both groups received condoms with spermicide and a referral list of primary care providers (PCP) for ongoing reproductive health care, and the intervention group also received enhanced contraceptive counseling, initial provision of contraception, and facilitated referral to a PCP. Outcomes measured at 4-, 8-, and 12-month follow-up were transition to a PCP, effective contraceptive use (ECU), interval pregnancy, and STD.
The median time to PCP transition was 79 days for the intervention group versus 115 days for the control group (P=.007). Rates of ECU were higher for the intervention group than for control group at the 4-month visit (50% vs 22%, P<.0001) as well as the 8-month visit, although in the intervention group ECU diminished over the course of the study. During follow-up, pregnancy outcomes were documented for 229 women (26.1%), for an overall pregnancy rate of 38.2 per 100 person-years of follow-up. Of the 159 pregnancies defined by patient self-report, 153 (96.2%) were described as unintended and 32 (20%) resulted in a therapeutic abortion. The pregnancy rate was 15% lower in the intervention (105/437, 24.0%) than the control group (124/440, 28.2%) (P=.16), but this difference was not statistically significant.
The intervention helped women transition to a PCP and initiate ECU but did not significantly reduce the pregnancy rate. More intensive interventions are needed to prevent unintended pregnancy in this high-risk population.
我们的目的是确定性传播疾病（STD）诊所启动的避孕护理的有效性。
877名未怀孕的城市STD诊所就诊女性，她们要么未采取避孕措施，要么仅使用避孕套，被随机分为干预组（n = 437）或对照组（n = 440）。两组均收到含杀精剂的避孕套和初级保健提供者（PCP）的转诊名单以进行持续的生殖健康护理，干预组还接受了强化避孕咨询、初始避孕措施提供以及便利的PCP转诊。在4个月、8个月和12个月随访时测量的结果包括向PCP的转诊、有效避孕措施的使用（ECU）、间隔期妊娠和性传播疾病。
干预组向PCP转诊的中位时间为79天，而对照组为115天（P = 0.007）。干预组在4个月随访时的ECU率高于对照组（50%对22%，P < 0.0001），8个月随访时也是如此，但在干预组中，ECU在研究过程中有所下降。在随访期间，记录了229名女性（26.1%）的妊娠结局，总体妊娠率为每100人年随访38.2次。在159例由患者自我报告确定的妊娠中，153例（96.2%）被描述为意外妊娠，32例（20%）导致治疗性流产。干预组的妊娠率（105/437，24.0%）比对照组（124/440，28.2%）低15%（P = 0.16），但这种差异无统计学意义。
该干预措施有助于女性向PCP转诊并启动ECU，但未显著降低妊娠率。需要更强化的干预措施来预防这一高危人群的意外妊娠。
