SexHealth Mobile is grounded in formative research and centered on reproductive justice and harm reduction principles. The intervention featured “SexHealth Mobile Days” where the MMU, clinical staff, and study staff would visit each recovery center. In preparation, we worked with the FHQC leadership and clinical staff to integrate contraceptive services within the MMU. This included one nurse practitioner with experience in patient-centered contraception care for SUD patients, one care assistant, and materials required for on-site provision of contraceptive medications (e.g., pregnancy tests, needles, syringes). The nurse practitioner (author AA) specialized in women’s health, independently placed contraceptive devices, and had worked at the partner FHQC for seven years (including previously providing general health care on the MMU). We worked with recovery centers and FHQC staff to ensure services were provided in a way that was acceptable to potential patients, including arranging for pregnancy testing with urine collected by patients themselves within recovery center facilities.
On SexHealth Mobile Days, the provider offered contraceptive options on the MMU free of charge, including hormonal (i.e., pills, transdermal patch, vaginal ring, injection, subdermal implant) and non-hormonal (diaphragm, condoms). Participants who chose short-term hormonal contraception (pills, patch, ring, injection) were given dosage for three months of pregnancy prevention and instructions for refills/follow-up at the main FQHC. The MMU was not outfitted with a standard patient exam table that could be used for gynecological procedures, thus we could not offer same-day IUDs. However, participants interested in IUDs could speak to the provider on the MMU, schedule a facility-based IUD insertion appointment at the main FHQC with the same provider, and obtain a bridging method to protect against pregnancy until IUD insertion. Further, participants interested in sexual and reproductive health services beyond contraception were also able to speak with the MMU provider and schedule appropriate facility-based FHQC appointments. Study staff also offered free condoms and home pregnancy tests at the enrollment table for anyone at the recovery center. We conducted ten SexHealth Mobile Days before reaching our target recruitment in intervention period, with four visits at the larger residential center, two at the smaller residential center, and four at the outpatient center.
At each recovery center, 2–4 individuals who already occupied formal roles as trusted resources for clients (7 peer mentors, 3 social workers) were trained as “outreach leaders” to promote SexHealth Mobile Days and organize interested clients. Training covered basic principles of reproductive justice and harm reduction, contraception options, needs and challenges faced by individuals with SUD in preventing unintended pregnancies, and strategies for using client-centered and trauma-informed approaches when talking about contraception.
Outreach leaders and study staff stressed that all activities on SexHealth Mobile Days were completely voluntary, and people could obtain a clinic referral or meet with MMU providers and receive free contraception even if they chose not to enroll in the study, or were not eligible due to previous enrollment in the EUC period or other ineligibility criteria. Individuals could also enroll in the study and meet with MMU providers even if they were unsure or not interested in taking up contraception.
On SexHealth Mobile Days, the provider offered contraceptive options on the MMU free of charge, including hormonal (i.e., pills, transdermal patch, vaginal ring, injection, subdermal implant) and non-hormonal (diaphragm, condoms). Participants who chose short-term hormonal contraception (pills, patch, ring, injection) were given dosage for three months of pregnancy prevention and instructions for refills/follow-up at the main FQHC. The MMU was not outfitted with a standard patient exam table that could be used for gynecological procedures, thus we could not offer same-day IUDs. However, participants interested in IUDs could speak to the provider on the MMU, schedule a facility-based IUD insertion appointment at the main FHQC with the same provider, and obtain a bridging method to protect against pregnancy until IUD insertion. Further, participants interested in sexual and reproductive health services beyond contraception were also able to speak with the MMU provider and schedule appropriate facility-based FHQC appointments. Study staff also offered free condoms and home pregnancy tests at the enrollment table for anyone at the recovery center. We conducted ten SexHealth Mobile Days before reaching our target recruitment in intervention period, with four visits at the larger residential center, two at the smaller residential center, and four at the outpatient center.
At each recovery center, 2–4 individuals who already occupied formal roles as trusted resources for clients (7 peer mentors, 3 social workers) were trained as “outreach leaders” to promote SexHealth Mobile Days and organize interested clients. Training covered basic principles of reproductive justice and harm reduction, contraception options, needs and challenges faced by individuals with SUD in preventing unintended pregnancies, and strategies for using client-centered and trauma-informed approaches when talking about contraception.
Outreach leaders and study staff stressed that all activities on SexHealth Mobile Days were completely voluntary, and people could obtain a clinic referral or meet with MMU providers and receive free contraception even if they chose not to enroll in the study, or were not eligible due to previous enrollment in the EUC period or other ineligibility criteria. Individuals could also enroll in the study and meet with MMU providers even if they were unsure or not interested in taking up contraception.
Free full text: Click here
