Comparative Outcomes Following Randomization to a Pilot Facebook-Based HIV Prevention Intervention Among Appalachian Women Involved in the Criminal Legal System.

Introduction: Rural Appalachian women who use drugs and are involved in the criminal legal system are at increased risk for health consequences (such as HIV/Hepatitis C). Service barriers throughout rural communities have prompted a need to examine the effectiveness of novel intervention delivery methods (e.g., social media). Purpose: This study aims to determine if enhancing an existing HIV prevention intervention with additional modules delivered via Facebook improves service access by examining short-term outcomes among Appalachian women returning to the community following jail release. Methods: Between 2019 and 2022, consenting women from two rural Appalachian jails were randomly selected, screened, interviewed, and randomized to either the National Institute on Drug Abuse (NIDA) Standard alone (n=30) or the NIDA Standard delivered via Facebook post-incarceration (n=30). Women were included in the final sample after completing both baseline and three-month follow-up interviews (N=50). In 2022, bivariate analyses were used to identify differences in drug use, injection drug use, and drug use before sex across intervention groups, and McNemar's test was used to measure changes in these risk behaviors within groups over time. Results: The percent of individuals reporting past three-month HIV-risk behaviors significantly decreased between baseline and follow-up for both groups. There were no between-group differences in risk behaviors. Implications: Results suggest that high-risk, rural Appalachian women may benefit from HIV prevention interventions delivered via Facebook, particularly during community re-entry following jail release. Facebook intervention delivery is an efficient way to expand the reach of HIV prevention services in a region with known barriers to traditional modes of intervention delivery.