Reproductive health

Maria Trent's long crusade to help teens with pelvic inflammatory disease

You hear Maria Trent's resolve as soon as she starts to explain her work. Her sentences come rapid fire, a cascade of statistics and clinical terms leavened by compassion. An associate professor at the School of Medicine, Trent has spent the last 15 years focused on the treatment of pelvic inflammatory disease, a common infection of female reproductive organs caused by sexually transmitted diseases. Now in the fourth year of a major study that wraps up in 2017, Trent says she's found new ways to reach the disease's most vulnerable victims: urban African-American teenage girls.

Trent first directed her attention to PID in 2001 after a 15-year-old girl, doubled over with abdominal pain, showed up at her practice in an East Baltimore clinic. The girl had been diagnosed with PID a few weeks earlier during a late-night visit to the emergency room. The ER staff sent her home that night with a prescription for antibiotics, but the girl hadn't really understood why she should take all the pills or when to seek more care. Now she was back, in great pain. "At no point in my career was I accustomed to seeing adolescents with PID fend for themselves in an outpatient setting," Trent says. "Expecting this girl to manage the disorder on her own, without support and advice, was unacceptable to me. In my opinion, the system had failed her." Trent was moved to begin a systematic study of the problem, and the work morphed into her current study, a five-year, $2.5 million randomized controlled clinical trial funded by the National Institute of Nursing Research.

Trent has designed interventions that blend technology—cellphones and Web portals—with home visits by community health nurses. Her team has worked with more than 200 mostly low-income minority women and girls in the Baltimore area, ages 13 to 25 and diagnosed with PID.

"The CDC now recommends that young women with PID have a follow-up visit with a provider to reassess within 72 hours of their diagnosis, but these patients have a poor record of coming back for those visits," Trent says. So patients in her intervention group receive a home visit from a nurse and cellphone text reminders about their medication, appointments, and self-care. Patients in the control group did not receive the nursing care or text messages and were simply asked to book a follow-up visit. Trent reports a retention rate of more than 90 percent among her teen patients through the duration of the study so far, despite the complexities in these young women's lives, complexities that can include everything from unstable housing and incarceration to disconnected phones and suspensions from school.

Using community health nurses for adolescent STD follow-up care is new. About half of the patients in the study have already been pregnant and half have had STDs. "A lot has to go on in that follow-up visit: STD and HIV risk reduction, family planning counseling, and more," Trent says. "That nurse visit is a powerful thing." The home visits cost less than a trip to a physician or the emergency room and may prove more effective in reducing short-term rates of repeat infections, she notes. "Anything we can do for adolescents as they start making their own decisions is important. Young people of all cultures say that being a parent is very important to their future. My work is designed to use innovation in science, technology, and clinical care to protect their future fertility while they navigate the sexual health risks associated with emerging personal autonomy."