in young expectant mothers
Reducing risk for HIV and other sexually transmitted infections (STIs) during and after pregnancy among adolescents in underserved communities is the focus of a grant totaling over $8 million that was awarded to the School of Medicine and the Clinical Directors Network Inc., in collaboration with the Centering Pregnancy and Parenting Association.
The Yale researchers will receive $5 million and the Clinical Directors Network (CDN) will receive over $3 million in a linked grant award from the National Institutes of Mental Health (NIMH) and the Office of AIDS Research. Researchers will study adolescents receiving prenatal care in 14 Community Health Centers (CHCs) funded by the Health Resources and Services Administration, serving predominantly African-American and Latina communities in the metropolitan New York area.
The team will test the dissemination and translation of an innovative model of group prenatal care called CenteringPregnancy Plus (CP+) into a network of safety net health care providers. CP+ combines instruction on HIV prevention along with prenatal care. The approach uses group visits to promote social learning and emphasizes the dynamic relationship between an individual and her social environment. CP+ has helped to improve birth outcomes and to reduce HIV/STI risk in a previous NIMH-funded study conducted at Yale.
The research team is led by Jeannette Ickovics, professor in the Department of Epidemiology and Public Health (EPH) at Yale's School of Medicine, and Jonathan N. Tobin, president and chief executive officer of CDN and associate clinical professor of epidemiology and population health at Albert Einstein College of Medicine of Yeshiva University.
"The goal of this study is to translate what we have learned about this health management approach to community health centers and to prevent sexually transmitted infections and rapid repeat pregnancies among vulnerable and underserved young women," says Ickovics. "Because all women are motivated to have a healthy pregnancy, this can be a vital window of opportunity for health promotion.
"Our research shows that teens engage in HIV-risk reduction during and immediately after pregnancy," Ickovics adds. "With effective intervention, changes initiated during pregnancy could be maintained postpartum."
CP+ focuses on self-care, social support and empowerment. The program builds on the work of grant participant Sharon Schindler Rising, developer of the CenteringPregnancy® model of prenatal care. It provides all prenatal care in a group setting with 8 to 12 women at the same stage of pregnancy, allowing women to have 10 times more interaction with their health care provider at no extra cost to the health system. Women receive their prenatal check-up, share and gain support from other women and gain knowledge and skills related to pregnancy, childbirth and parenting from week 14 of pregnancy through one month postpartum.
Rising, of the CenteringPregnancy and Parenting Association in Cheshire, says CP+ is a promising way to nurture long-term relationships between adolescent women and their health care providers and to provide sustainable care and HIV/STI prevention in a culturally-tailored setting.
"Community health centers are a wonderful place for women and families to receive care and represent the majority of sites that currently provide CP+ care nationally," says Rising. "This study will allow us to look more closely at the specific challenges of instituting a major paradigm change in the delivery of prenatal care within these complex, very busy systems."
Additional investigators and consultants on the grant at Yale include Trace Kershaw, Jessica Lewis, Kim Blankenship and Dr. Urania Magriples. The grant also includes David Holtgrave of Johns Hopkins University, John Jemmott of University of Pennsylvania and Dr. Peter Bernstein of Montefiore Medical Center/Albert Einstein College of Medicine of Yeshiva University.
For more information on the project, contact Jessica Lewis, associate director of Connecticut Women's Health Project at Yale. (203) 764-9835 or jessica.lewis@yale.edu.
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