A text message-based intervention to improve self-management of pelvic inflammatory disease, or PID, among teens and young adults significantly decreased rates of Neisseria gonorrhoeae and Chlamydia trachomatis infection compared with standard treatment, according to findings from a randomized clinical trial published in JAMA Network Open.
Maria Trent, MD, MPH, director of the adolescent medicine fellowship program and professor of pediatrics at Johns Hopkins Medicine, and colleagues said study findings have brought about a shift in the past 20 years from inpatient to outpatient management of PID among teens and young adults.
However, long-term follow-up of participants in the PEACH study suggested that more than 20% had a recurrent STI or PID diagnosis. In addition, chronic pelvic pain — a potential side effect of PID that can negatively affect health-related quality of life — was five times more common in participants aged 19 years and younger.
Trent and colleagues recruited females aged 13 to 25 years who received care for mild to moderate PID at a large academic medical center and were about to be discharged to outpatient treatment. All participants received care between Sept. 6, 2012, and Dec. 8, 2018.
The intervention, known as TECH-N, included daily text-message reminders for 2 weeks, followed by weekly messages for 1 month, focused on medication compliance. Participants randomly assigned to this intervention (n = 149) reported the number of scheduled doses taken, and they received affirming or encouraging messages about medication adherence.
Within 5 days of enrollment, a community health nurse provided short-term follow-up, which consisted of an abdominal examination and counseling on sexual risk reduction and condom negotiation. All other participants (n = 137) received standard care.
According to Trent and colleagues, participants in the TECH-N group had a higher rate of C. trachomatis infection (32.4% vs. 18.9%; P = .01). After 90 days, the differential rate of decrease in N. gonorrhoeae and C. trachomatis infection was significantly higher in TECH-N participants (34.4% to 4.4% vs. 25.6% to 10.4%; P = .02).
TECH-N also resulted in an increase in CDC-recommended short-term follow-up compared with standard treatment (94.2% vs. 16.3%; P < .001).
Trent and colleagues wrote that based on these findings, “a cost-effectiveness evaluation of such a community-level scale-up is warranted.” – by Katherine Bortz
Ness RB, et al. Am J Obstet Gynecol. 2002;doi:10.1067/mob.2002.121625.
Trent M, et al. JAMA Netw Open. 2019;doi:10.1001/jamanetworkopen.2019.8652.
Disclosures: Trent reports receiving grants and research supplies from Hologic Inc., research supplies from SpeeDx LLC and personal fees from Church and Dwight Inc. outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.