Methods: A longitudinal secondary data analysis examining depression as a moderator on HIV/STI drug and sexual risk outcomes (main study outcomes). Depression, modeled continuously using the BSI depression sub-scale, was moderated on (1) the “intervention effect” of assignment to the active treatment conditions of the WORTH intervention (a multimedia version of the WORTH intervention or a traditional paper-based version) versus assignment to the control arm (Wellness Promotion); and (2) within those assigned to the active treatment condition, the “modality effect” of the delivery method (multimedia versus traditional). Intention-to-treat analyses were used to estimate the effects in the main study. Intervention and modality effects were obtained by applying generalized linear models with random effects for repeated measures in multiple imputed data. For the secondary data analysis, depression (baseline) was modeled against primary study outcomes obtained from self-reported HIV/STI drug and sexual risk data collected at 3-, 6- and 12-months.
Results: Depression significantly moderated sexual risk outcomes for the intervention effects model, both as a main effect and as an interaction term. Depressed, substance-using participants assigned to either intervention arm were significantly more likely to engage in risky HIV/STI sexual behaviors at the 3- and/or 6-month mark (e.g. number and proportion of unprotected vaginal and/or anal sex with primary and other sexual partners; inconsistent condom use during vaginal sex with primary partner or other sexual partners) when compared to depressed participants assigned to the control arm, thus increasing their risk for HIV/STIs. Depression did not moderate the modality effects model or substance-use risk behaviors (e.g. crack cocaine, injection drug use).
Conclusions and implications: Study findings has implications across multiple social work grand challenges given the ongoing need to “Close the Health Gap” experienced by highly vulnerable populations. Given the identified moderation between depression and HIV/STI sexual risk behaviors, and the lack of behavioral/mental health services available in low-resourced US criminal justice settings, there is a public health need to address the moderating effect of depression on HIV/STI study outcomes. Our presentation will feature a nuanced discussion regarding intervention 1) adaptation, 2) targeting, and 3) delivery to maximize HIV/STI intervention outcomes for substance-using and depressed female community corrections populations. We will also discuss the role of evidence-based interventions in addressing behavioral health risks for which they were not designed.