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Research Proposal: Chlamydia Trachomatis

Gap Analysis

Advanced Practice Nurses (APNs) have a significant role to play in every health care setting. APNs should empower and enable their clients to achieve the best health outcomes. The targeted topic for this discussion is Chlamydia Trachomatis. Hammerschlag (2011) defines “Chlamydia Trachomatis as a gram-negative bacterium that causes different sexually transmitted Diseases (STDs) in different parts of the world” (p. 100). This bacterium has been observed “to infect different parts, among the most common are the urethra, vulva, cervix, and rectum” (Pellowe & Pratt, 2006, p. 18). It also causes a disease known as Chlamydia. According to Miller (2006), the bacterium can attack non-genital parts such as the eyes and lungs. This fact explains why the bacterium is one of the leading causes of blindness in many children.

This topic is of great interest due to the high prevalence and incidence rates associated with Chlamydia even though action plans, such as the Minnesota Chlamydia Partnership, have been developed (2012). According to the CDC statistics for 2015, Chlamydial infection is the most frequently reported infectious disease in the United States (CDC, 2015). Its prevalence is highest in persons aged ≤24 years. Several sequelae can result from Chlamydia Trachomatis infection in women, the most serious of which include PID, ectopic pregnancy, and infertility (CDC, 2015). In the United States, efforts are already underway to promote the prevention of Chlamydia Trachomatis. In addition, various research studies have aimed to evaluate the most effective intervention strategies that can be used to encourage healthy behavior, and subsequently reduce the occurrence of Chlamydia. Hence, this assignment will be governed by two research questions:

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Why is the prevalence of Chlamydia Trachomatis among women still high despite the fact that interventions are already underway to aid in its prevention?

Which are the most effective strategies that have been shown to prevent Chlamydia Trachomatis?

Relevance of the Questions

Statistics show that over 80 million people in the world have eye infections caused by Chlamydia Trachomatis (Rours et al., 2008). That being the case, women should be sensitized about the best preventive measures to deal with this bacterium because there might be gap in how these interventions are implemented or perceived. The above questions will make it easier for me to deliver evidence-based facts to scholars, academicians, decision makers, and researchers. The targeted population will understand how Chlamydia Trachomatis continues to affect more women than men in the world. This knowledge will make it possible to identify the best preventive strategies for Chlamydia.

The second question will identify the best measures towards winning the war against Chlamydia Trachomatis. Subsequently, healthcare workers can encourage women to embrace effective clinical tests to aid in early detection and prompt treatment of the disease. Also, clinical and associated healthcare professionals will make ideal recommendations in the treatment for the bacterium and other STIs. The researcher also aims to “inform more women about the best drugs and treatment regimes depending on the infected site or age” (Hammerschlag, 2011, p. 101). Treated patients will be expected to encourage their sexual partners to get appropriate medication. The main goal is to empower the population to practice preventive methods against Chlamydia and other STIs.

The proposed topic will present useful insights and ideas to more women about STDs. The targeted women will understand the clinical issues associated with Chlamydia Trachomatis. They will also understand the major implications and problems arising from Chlamydia infection. The knowledge will make it possible for more communities develop proper health promotion models against STDs (Miller, 2006).

Literature Analysis/Review

A deeper understanding into sexually transmitted diseases (STDs/STIs) is imperative, and especially with reference to interventions aimed at reducing the associated high prevalence and incidence rates, which are highest among the adolescents and young adults aged 15 to 24 years, according to the Centers for Disease Control and Prevention (2013). As noted in the first section of this paper, the most common STI is Chlamydia Trachomatis; hence, the reason this paper focuses on it. Therefore, this paper seeks to review two peer-reviewed journal articles that have reviewed behavioral approaches that could be employed to address the high rates of STDs, including Chlamydia among these adolescents and young adults with a bias towards women.

The articles reviewed include: “Programs to Reduce Teen Pregnancy, Sexually Transmitted Infections, and Associated Sexual Risk Behaviors: A systematic Review” by Goesling, B., Colman, S., Trenholm, C., Terzian, M., and Moore, K., published in the Journal of Adolescent Health in the year 2014. The second article was “Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: A Systematic Review for the U.S. Preventive Services Task Force” authored by O’Connor, E., Lin, J., Burda, B., Henderson, J., Walsh, E., and Whitlock, E., published in the Annals for Internal Medicine Journal in the year 2014.

Hypotheses

Apparently, Goesling et al. (2014) have not articulately stated a hypothesis (es). However, the reader can decipher that the study aims to test the hypothesis that there is a relationship between behavioral-related preventive programs and reduction of pregnancy, STIs, or associated sexual risk behaviors among adolescents and young adults. The study by O’Connor et al. (2014) is also a review, but it contrasts with that of Goesling et al. (2014) because it has a well-stated and specific hypothesis, which is to test high-intensity behavioral counseling intervention as an effective strategy for reducing STDs/STIs among sexually active adolescents and adults at risk. However, O’Connor et al. (2014) have not indicated the adult age-bracket, yet it was imperative to do so because that the study gives background information related to young adults.

Methods

Both article reviews were guided by a pre-specified protocol with both inclusion and exclusion criteria. Whereas Goesling et al. (2014) executed the protocol in two stages, O’Connor et al. (2014) executed the protocol in just a single phase. The first protocol in the prior mentioned study was developed in the fall of 2009 to identify and review studies from 1989 to January 2010 (Goesling et al., 2014). The second protocol entailed an update of the previous protocol in the fall of 2010, and newer studies from January 2010 to January 2011 were reviewed. This protocol is in reference to the Office of Adolescent Health (2015). The study utilized a four-itemized inclusion criteria. To begin with, the study had to focus on intervention effects using quantitative data, hypothesis testing, and statistical analysis. Then, the study had to adopt randomized controlled trials or quasi-experimental approaches in their research designs. Secondly, the study focused on the measure (s) related to “pregnancy, STIs, or associated sexual risk behaviors” (Goesling et al., 2014, p. 500). Thirdly, the studies included had to focus on teenagers/young adults, who were 19 years or younger during recruitment of the sample. Lastly, the programs had to combine any of educational, skill-building, and/or psychosocial interventions. The protocol adopted by O’Connor et al. (2014) differed from Goesling’s et al. (2014) in that it focused on more recent studies from the year 2007. In addition, this study included studies with experimental approaches, and both studies were restricted to the U.S. population. Whereas the study by O’Connor et al. (2014) excluded studies focusing on incarcerated persons or those with HIV/AIDs, Goesling et al. (2014) did not restrict its study population to either criterion.

Findings

Results by O’Connor et al. (2014) were meta-analyzed using the Der Simonian-Laird method while Goesling et al. (2014) aggregated their results based on the levels of significance presented within the individual studies. In both reviews, the information delivered was relatively the same because it focused on STIs and contraceptive use. The study by O’Connor et al. (2014) indicated that other than gonorrhea, Chlamydia was the other commonly reported STI. In addition, in both reviews, the African-American population was highlighted as a target group of interest depicting high STIs rates that have been affirmed by the Center for Disease Control and Prevention (2012). Also, both studies revealed that women are a vulnerable group for STDs/STIs. Goesling et al. (2014) included 31 studies, out of the initial 1900+ result list. Out of these 31 studies, all the five programs that focused on STIs showed significant outcomes while the 14 studies focusing on contraceptive use also showed positive outcomes.

The same number of studies was reviewed by O’Connor et al. (2014). The results by O’Connor et al. (2014) also indicated a positive effect of the studied intervention in reducing the incidence of STIs. High-intensity counseling intervention of more than 2 hours in all 8 studies targeting the adolescents led to a 62% reduction in the incidence of STIs after 12 months. Moderate-intensity training resulted in a 50% success rate based on the 2 studies that were presented while low-intensity results were not conclusive. In addition, positive behavior change through increased use of condom use was realized.

Conclusion

The information obtained from this review indicates that behavioral interventions are effective in reducing the incidence and prevalence rates of STDs/STIs in both adolescents and young adults, which is the population mainly affected by Chlamydia. The results are in alignment with the World Health Organization’s indications as presented by Okigbo and Eke (2013). Hence, women should formulate and implement policies that integrate behavioral approaches to fight Chlamydia.

Research Proposal

This proposal will be guided by the research question: Do Chlamydia prevention programs in the U.S. alleviate the occurrence of Chlamydia?

Gap Analysis and Justification

First, Chlamydia is not a widely investigated STI compared to other sexually transmitted diseases, for example, HIV infection. Intervention programs have been biased towards women due to associated cost-effectiveness, and the reason why most studies on STIs focus on women. Hence, this could be the reason for the continued increases in the incidence rate of Chlamydia infection in the United States (Centers for Disease Control and Prevention, CDC, 2014). Statistics indicate that the prevalence of Chlamydia infection from 1992 to 2012 was 182.3 to 456.7 cases per 100,000 population, respectively. Therefore, there is a problem somewhere; either there is sluggishness in planning more effective intervention programs, or the implementation of proposed programs has not been well implemented. Therefore, the author aim to determine the current active intervention programs for Chlamydia infection, activities involved within the programs, including targeted groups, and associated Chlamydia outcomes. This study is meant to enlighten the already predominant Chlamydia prevention programs on the future direction to visualize more effective strategies that will help realize a reduction in the persistently high Chlamydia prevalence and incidence rates.

There is ample literature on screening for Chlamydia, which could be attributed to its asymptomatic nature. Hence, there is need to find out if more attention is given to screening tests in comparison to preventive programs. CDC (2015) states that preventive programs for Chlamydia focus on screening tests, which, in as much as they may be associated with increased awareness, other interventions on positive living should be integrated. Therefore, the greater need for determining the nature of Chlamydia prevention programs that are underway, and their impact on the population because as stated by the Centers for Disease Control and Prevention (2011), more focus is on the screening programs. Thus, this will help to delineate the adamantly high prevalence rates of Chlamydia are either due to the effectiveness of the screening tests or inadequate preventive programs. In addition, this will help to answer the question of varying incidence rates for Chlamydia among different ethnic groups. In the two reviews the author conducted in week 2 assignment, high intensity risk-reduction counseling was effective in reducing STIs where Chlamydia was part. On the other hand, this high intensity risk-reduction was individualized; yet, individualized counseling might be time consuming and not feasible for large populations. Apparently, the available evidence has solely focused on behavioral counseling, yet other methods are just as effective.

In a study by Davey-Rothwell, Tobin, Yang, Sun, & Latkin (2011), peer-based mentorship has been used to instill long-term behavior change based on HIV studies; yet, there is limited evidence on the use of this intervention to prevent Chlamydia. Thus, this study will help to decipher the novelty and diversity of Chlamydia-specific prevention programs.

This study will be guided by the following research questions:

  1. What is the number of the current prevention programs for Chlamydia?
  2. What is the coverage rate for each Chlamydia prevention program?
  3. What activities define each Chlamydia prevention program?
  4. What is the relationship between the current Chlamydia prevention programs and the occurrence of Chlamydia?

Methodology

This is a cross-sectional analytical study that will seek to identify the current intervention programs for STIs operating within the United States and their influence on Chlamydia outcomes. Corresponding with Harwell’s (2011) description of quantitative studies, this study will collect viable quantitative data for both descriptive and inferential statistical analysis. This study will entail an online search of the current programs used to prevent Chlamydia using keywords such as ‘prevention programs’, ‘Chlamydia’, ‘effective prevention strategies USA, US’, ‘ongoing’, and ‘’current’. Also, the researcher will make personalized visits to institutions that keep account of the prevention programs for STIs and Chlamydia in particular. The researcher will only include programs or sub-programs that focus on Chlamydia.

According to Israel (2009), the researcher will adopt the concept of proportions when determining sample size; hence, Yamane’s formula as shown below will be sufficient. Upon identifying the programs to be included in the study, the researcher will determine the total population size by adding aggregate values from each program. Subsequently, the researcher will use proportionate sampling to recruit the sample from the different programs. A questionnaire will be developed and administered to the respondents online. The variables of concern will be coverage of the program by identifying the areas where the program has been implemented in relation to sociodemographic characteristics of the region covered and group (s) targeted, activities defining each program, and success indicators for each program based on coverage, behavior change, knowledge and attitudes, and substance use. These variables will rely on records from the programs’ performance records. These will be correlated with the prevalence rates of Chlamydia within the regions where different programs are stationed.

Descriptive statistics will define the variables in relation to proportions of interest, for example, coverage rate, knowledge and attitude, behavior change, and substance use. Inferential statistics will help to determine the correlation between the prevalence rate of Chlamydia and knowledge and attitude, coverage rate, behavior change, and substance use through regression analysis while chi-square will determine the association between categorical. Analysis of variance (ANOVA) will be used to determine differences among samples (Vogt, Vogt, Gardner, & Haeffele, 2014).

References

Centers for Disease Control and Prevention (CDC). (2015). STD Data and Statistics. Atlanta, GA: CDC.

Centers for Disease Control and Prevention (CDC). (2014). Chlamydia. Atlanta, GA: CDC.

Centers for Disease Control and Prevention (CDC). (2013). Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States. Atlanta: Division of STD Prevention, CDC.

Centers for Disease Control and Prevention (CDC). (2012). STDs in Racial and Ethnic Minorities. Atlanta: Division of STD Prevention, CDC.

Centers for Disease Control and Prevention (CDC). (2011). CDC grand rounds: Chlamydia prevention: challenges and strategies for reducing disease burden and sequelae. Morbidity and Mortality Weekly Report (MMWR). Atlanta, GA: CDC.

Davey-Rothwell, M. A., Tobin, K., Yang, C., Sun, C. J., & Latkin, C. A. (2011). Results of a randomized controlled trial of a peer mentor HIV/STI prevention intervention for women over an 18 month follow-up. AIDS and Behavior15(8), 1654–1663. Web.

Goesling, B., Colman, S., Trenholm, C.,Terzian, M., & Moore, K. (2014). Programs to Reduce Teen Pregnancy, Sexually Transmitted Infections, and Associated Sexual Risk Behaviors: A systematic Review. Journal of Adolescent Health, 54, 499-507.

Hammerschlag, M. (2011). Chlamydial and Gonococcal Infections in Infants and Children. Clinical Infectious Diseases, 53(3), 99-102.

Harwell, M.R. (2011). Research design: Qualitative, quantitative, and mixed methods. In C. Conrad & R.C. Serlin (Eds.), The Sage handbook for research in education: Pursuing ideas as the keystone of exemplary inquiry (2nd ed.) (pp. 147-163). Thousand Oaks, CA: Sage.

Israel, G. (2009). Determining Sample Size. Gainesville, FL: Florida State University.

Miller, K. (2006). Diagnosis and Treatment of Chlamydia Trachomatis Infection. American Family Physician, 73(8), 1411-1416.

Minnesota Chlamydia Partnership. (2012). Web.

O’Connor, E., Lin, J., Burda, B., Henderson, J., Walsh, E., & Whitlock, E. (2014). Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: A Systematic Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 161(12), 874-883.

Office of Adolescent Health. (2015). TPP Resource Center: Evidence-Based Programs. Web.

Vogt, W. P., Vogt, E. R., Gardner, D. C., & Haeffele, L. M. (2014). Selecting the right analyses for your data: Quantitative, qualitative, and mixed methods. London: The Guilford Press.