Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Arts and Sciences



First Advisor

Dr. Christal Badour


Justice-involved women in rural Appalachian Kentucky are a particularly vulnerable group in need of targeted risk-reduction interventions for hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Compared to women in the general U.S. population, justice-involved women in rural Appalachia report dramatically higher rates of HCV/HIV risk behaviors (e.g., injection drug use and risky sex), interpersonal violence (IV; e.g., physical, sexual, or emotional abuse), and posttraumatic stress disorder (PTSD). IV and PTSD may exacerbate rural Appalachian women’s risk for contracting and transmitting HIV/HCV, indicating a need to approach HCV/HIV risk-reduction interventions from a trauma-informed perspective.

Brief motivational interviewing and psychoeducation interventions have both demonstrated efficacy in decreasing HCV/HIV risk behaviors among incarcerated women, including those with IV histories. Yet, few studies have considered the impact of PTSD on the effectiveness of these interventions. Therefore, this study aimed to examine the impact of PTSD on the effectiveness of HCV/HIV risk-reduction interventions administered to incarcerated rural Appalachian women with IV histories.

Participants included a sample of 320 IV-exposed women who were enrolled in the Women’s Intervention to Stop HIV and HCV study. Women were randomized to receive an enhanced motivational interviewing-based HCV/HIV intervention or a standard HCV/HIV psychoeducational intervention while they were incarcerated. Women were then followed at 3, 6, and 12 months after being released into the community.

Our findings indicate women’s change in HCV/HIV risk behavior after being released from jail did not differ based on whether they received a brief psychoeducation alone or enhanced with motivational interviewing while incarcerated. Moreover, PTSD symptoms were not associated with women’s change in injection drug or sexual risk behavior after community re-entry. PTSD symptoms trended toward decreasing more during re-entry for women who received a motivational-interviewing enhanced intervention compared to women who received psychoeducation alone, although this should be interpreted with caution. An unexpected finding was that anxiety and depressive symptoms prior to and during incarceration were associated with different trajectories of change in sexual, but not injection drug, risk behavior post-release.

Results from this study address the call for evidence-based HCV/HIV interventions to be evaluated through a trauma-informed perspective and can inform targeted prevention and intervention efforts aimed at reducing HCV/HIV risk behaviors among rural Appalachian women.

Digital Object Identifier (DOI)

Funding Information

This project is registered with (NCT 01840722) and was supported by the National Institute on Drug Abuse (R01 DA033866 [2012-2017]; T32 DA035200 [2018-2021]) through the National Institutes of Health (NIH). This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH. The authors have no conflicts of interest to disclose.