Effectiveness of Integrating Prenatal Care in Reducing HIV/STDs Among Young Pregnant Women

It is estimated that each year 1 out of 4 teenagers becomes infected with a sexually
transmitted disease (STD), which may include chlamydia, herpes, human papillomavirus, or
HIV. Teenagers are especially vulnerable to STD infections because of a lack of education
about proper condom use and consequences of sexual risk behaviors, including pregnancy. In
addition to the high prevalence of STD infection, teen pregnancy remains a health concern
for young women, with 31% of young women in the United States becoming pregnant before the
age of 20. Transmission of STDs from a pregnant woman to her baby is possible before,
during, and after birth, making it particularly important to inform young pregnant women
about STDs. A group prenatal care treatment program that incorporates HIV/STD prevention
education, called CenteringPregnancy Plus (CP+), has shown success in reducing sexual risk
behaviors in an academic setting, but its effectiveness at Community Health Centers (CHCs)
serving women at high risk of these behaviors is unknown. This study will evaluate the
effectiveness of CP+ in reducing transmission of STDs and rapid repeat pregnancies in
pregnant teens seeking care at participating CHCs in the New York metropolitan area.

This study will involve participants receiving prenatal care at 14 participating CHCs that
predominantly serve black and Latina communities in the New York metropolitan area. The CHCs
will be assigned randomly to deliver immediate CP+ or waitlist CP+ to women seeking care at
the clinics.

A subset of participants at CHCs assigned to hold CP+ treatment groups will first have an
individual medical exam. Groups will then be formed based on participants' estimated
delivery months and will be led by a trained independent practitioner. There will be ten
2-hour group sessions between Weeks 16 and 40 of pregnancy. At each session, participants
will first weigh themselves and take their blood pressure to chart their own progress.
Individual prenatal assessments lasting approximately 30 minutes will be conducted by the
practitioner. Participants will then have time to complete handouts and self-assessments and
engage in discussion with other group members. Discussions will be educational in nature and
will focus on building prenatal, childbirth, and parenting skills. Additionally, sessions
will include an HIV/STD risk reduction component, which will consist of interactive
discussion, exercises, and skill-building activities targeted toward reducing HIV/STD risk
behaviors. Participants at CHCs assigned to the waitlist condition will receive standard
individual prenatal care and will not initially participate in group sessions. These CHCs
will start offering CP+ after the end of the waitlist period.

All participants will complete four 40-minute interviews, occurring when they are 14 weeks
pregnant, during their 3rd trimester of pregnancy, and when their babies are 6 and 12 months
old. During interviews, participants will listen to questions through headphones delivered
on a handheld computer. The questions will concern participants' thoughts, feelings, health,
and health care. During the final interview, participants will provide a urine sample for
STD testing for chlamydia and gonorrhea and will be referred to treatment if necessary. The
results of participants who test positive for either of these two STDs will be sent to the
state STD Control Program. Information will also be collected from participants' medical
charts on STD history, health history, and babies' health history. Outcome measures will
include incidence of STD infection, rapid repeat pregnancy, degree of sexual risk behavior,
and perinatal and psychosocial factors.

Inclusion Criteria:

- Pregnant

- Able to attend group treatment sessions conducted in English or Spanish

Exclusion Criteria:

- Positive HIV infection

- Severe medical problem requiring individualized assessment and tracking as high-risk
pregnancy