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Ahmad A, Bromberg DJ, Shrestha R, Salleh NM, Bazazi AR, Kamarulzaman A, Shenoi S, Altice FL. Higher methadone dose at time of release from prison predicts linkage to maintenance treatment for people with HIV and opioid use disorder transitioning to the community in Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104369. [PMID: 38484531 PMCID: PMC11056294 DOI: 10.1016/j.drugpo.2024.104369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Incarcerated people with HIV and opioid-dependence often experience poor post-release outcomes in the absence of methadone maintenance treatment (MMT). In a prospective trial, we assessed the impact of methadone dose achieved within prison on linkage to MMT after release. METHODS From 2010 to 2014, men with HIV (N = 212) and opioid dependence before incarceration were enrolled in MMT within 6 months of release from Malaysia's largest prison and followed for 12-months post-release. As a prospective trial, allocation to MMT was at random and later by preference design (predictive nonetheless). MMT dosing was individually targeted to minimally achieve 80 mg/day. Time-to-event analyses were conducted to model linkage to MMT after release. FINDINGS Of the 212 participants allocated to MMT, 98 (46 %) were prescribed higher dosages (≥80 mg/day) before release. Linkage to MMT after release occurred in 77 (36 %) participants and significantly higher for those prescribed higher dosages (46% vs 28 %; p = 0.011). Factors associated with higher MMT dosages were being married, on antiretroviral therapy, longer incarceration periods, having higher levels of depression, and methadone preference compared to randomization. After controlling for other variables, being prescribed higher methadone dosage (aHR: 2.53, 95 %CI: 1.42-4.49) was the only independent predictor of linkage to methadone after release. INTERPRETATION Higher doses of methadone prescribed before release increased the likelihood of linkage to MMT after release. Methadone dosing should be introduced into international guidelines for treatment of opioid use disorder in prisons and further post-release benefits should be explored. FUNDING National Institute of Drug Abuse (NIDA).
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Affiliation(s)
- Ahsan Ahmad
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel J Bromberg
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Roman Shrestha
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, USA
| | - Na Mohd Salleh
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya, Faculty of Medicine, Department of Social and Preventive Medicine, Kuala Lumpur, Malaysia
| | - Alexander R Bazazi
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Adeeba Kamarulzaman
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya, Faculty of Medicine, Department of Social and Preventive Medicine, Kuala Lumpur, Malaysia
| | - Sheela Shenoi
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Yale University School of Public Health, Department Epidemiology of Microbial Diseases, New Haven, CT, USA.
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Austin A, Favril L, Craft S, Thliveri P, Freeman TP. Factors associated with drug use in prison: A systematic review of quantitative and qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104248. [PMID: 37952319 DOI: 10.1016/j.drugpo.2023.104248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND About a third of people use drugs during their incarceration, which is associated with multiple adverse health and criminal justice outcomes. Many studies have examined factors associated with in-prison drug use, but this evidence has not yet been systematically reviewed. We aimed to systematically review and synthesise the evidence on factors related to drug use in prison. METHODS Three databases (PubMed, PsycINFO and Embase) were systematically searched as well as grey literature, for quantitative, qualitative and mixed-methods studies examining factors related to drug use inside prison. We excluded studies that did not explicitly measure in prison drug use or only measured alcohol and/or tobacco use. Study quality was assessed using the Newcastle Ottawa Scale (NOS) for quantitative studies and Critical Appraisal Skills Programme (CASP) for qualitative studies. The review was prospectively registered on PROSPERO (CRD42021295898). RESULTS Fifty-four studies met the inclusion criteria, reporting data on 26,399 people in prison. Most studies were of low or moderate-quality, and all used self-report to assess drug use. In quantitative studies, studies found that previous criminal justice involvement, poor prison conditions, pre-prison drug use and psychiatric diagnosis were positively associated with drug use in prison. In qualitative studies, reasons for drug use were closely linked to the prison environment lacking purposeful activity and the social context of the prison whereby drug use was seen as acceptable, necessary for cohesion and pressurised. CONCLUSION In the first systematic review of factors associated with drug use in prison, key modifiable risk factors identified from quantitative and qualitative studies were psychiatric morbidity and poor prison conditions. Non-modifiable factors included previous drug use and criminal history linked to substance use. Our findings indicate an opportunity to intervene and improve the prison environment to reduce drug use and associated adverse outcomes.
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Affiliation(s)
- Alice Austin
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Louis Favril
- Faculty of Law and Criminology, Ghent University, Belgium
| | - Sam Craft
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Phoebe Thliveri
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK.
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Ponticiello M, Azbel L, Tate MM, Bromberg DJ, Pykalo I, Kiriazova T, Saichuk N, Altice FL. Introducing methadone maintenance therapy into Ukrainian prisons: a qualitative study of criminal subculture, Russia's full-scale invasion, and contested methadone objects. Front Psychiatry 2023; 14:1227216. [PMID: 38098632 PMCID: PMC10720714 DOI: 10.3389/fpsyt.2023.1227216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023] Open
Abstract
Background After pilot testing, methadone was newly being introduced into Ukrainian prisons in 2021 as part of a national scale-up strategy to treat opioid use disorder and prevent transmission of HIV and HCV infections. Opioid agonist therapy (OAT) scale-up in Eastern Europe and Central Asia prisons has been hampered by varying levels of influence of criminal subculture, an extralegal informal governance by a social hierarchy that operates in parallel to formal prison authorities. This study examined the socio-environmental factors influencing the uptake of methadone treatment in Ukrainian prisons, including changes that evolved during Russia's full-scale invasion of Ukraine and the displacement of people deprived of liberty (PDL) from conflict to non-conflict regions. Methods In-depth qualitative interviews (N = 37) were conducted from January 2021 to October 2022 in the only two Ukrainian prisons where methadone was being introduced with PDL (N = 18). These two prisons continued to provide methadone after the full-scale invasion. Former PDL (N = 4) were also interviewed and prison staff (N = 15). Interviews were audio-recorded, transcribed, and translated into English. Four authors independently reviewed, coded, and applied a phenomenological framework for data analysis, delineating themes related to criminal subculture, drug use, methadone uptake, and evolving changes during the Russian invasion. Findings Criminal subculture perceptions varied, with some seeing it as strongly discouraging drug use among certain groups, while others described it as a residual and weak influence from a more distant past. The influence of the subculture on methadone treatment uptake, however, was less clear. PDL and prison staff struggled to identify and articulate differences between illicit street-bought methadone, used recreationally, and medically prescribed methadone. Thus, the meaning of "methadone" varies in interpretation as it is being introduced, making it potentially conflicting for patients to opt into this evidence-based treatment. As Russia invaded Ukraine in 2022, PDL from conflict zones were transferred to non-conflict regions where methadone was being introduced. The prison environment became more enabling for PDL to start methadone as they were segregated and not subject to the existing criminal subculture's rules and lacked the social ties necessary to procure drugs illegally. Conclusion It appears that the criminal subculture is variable and evolving in Ukrainian prisons and appears to be impacted differently by the invasion of Russia. As methadone scale-up in prisons expands, it will be important to distinguish the meaning of methadone perpetuated negatively by the prison subculture versus that in which it is intended as a medical treatment by the formal prison authorities. The current invasion of Ukraine by Russia provides a potential disruption to alter this course.
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Affiliation(s)
- Matthew Ponticiello
- Yale School of Medicine, Yale University, New Haven, CT, United States
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, United States
| | - Lyu Azbel
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, United States
| | - Mary M. Tate
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, United States
| | - Daniel J. Bromberg
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, United States
| | - Iryna Pykalo
- European Institute on Public Health Policy, Kyiv, Ukraine
| | | | | | - Frederick L. Altice
- Yale School of Medicine, Yale University, New Haven, CT, United States
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, United States
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Ivasiy R, Madden LM, Farnum SO, Shumskaya N, de Leon SJG, Bromberg DJ, Kurmanalieva A, Duishenaliev A, Tokubaev R, Altice FL. Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100075. [PMID: 36267100 PMCID: PMC9581459 DOI: 10.1016/j.dadr.2022.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
Background Methadone maintenance treatment (MMT) is the most effective and cost-effective strategy to control HIV in Central Asian countries, where the epidemic is concentrated among people who inject drugs (PWID) who use opioids. Methods Using data from a prospective observational database of all people initiated on MMT in Kyrgyzstan since 2008, we analyzed a more contemporary subset of data for all persons receiving MMT from January 2017 through June 2021 after the national treatment guidelines were changed. Retention on MMT was assessed at 1, 6, 12, and 24 months and predictive variables included were dosage levels, HIV status, and type of clinical setting using survival analysis. Predictors of treatment dropout were estimated using Cox multivariate regression models. Results Among the 940 MMT patients, the proportion receiving low (<40mg), medium (40-85mg), and high (>85mg) dosage levels was 37.9%, 42.2%, and 19.9%, respectively. Increasing MMT dosage level was significantly (p<0.0001) correlated with retention at 1 (90%, 98%, 100%), 6 (42%, 63%, 95%), 12 (33%, 55%, 89%), and 24 (16%, 45%, 80%) months, respectively, with no differences between community and correctional settings. Significant predictors of dropout at 12 months included low (aHR=8.0; 95%CL=5.8-11.0) and medium (aHR=3.5; 95%CL=2.5-4.9) methadone dosage level relative to high dose, receiving MMT in three administrative regions relative to the capital Bishkek, and lower in the tuberculosis-specialized clinic in Bishkek. Clients with HIV receive higher average MMT doses (79.5mg vs 63.1mg; p<0.0001), but MMT retention did not differ after controlling for dosage in this group. Conclusions The proportion of patients receiving optimal dosage was low (19.9%). An implementation strategy that focused on getting a larger proportion of MMT on the optimal dosage to promote retention could potentially improve the quality of existing treatment and promote further scale-up of MMT in Kyrgyzstan.
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Affiliation(s)
- Roman Ivasiy
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Center for Interdisciplinary Research on AIDS at Yale University, New Haven, USA
| | - Lynn M. Madden
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- APT Foundation, New Haven, USA
| | - Scott O. Farnum
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- APT Foundation, New Haven, USA
| | - Natalia Shumskaya
- Public Foundation “AIDS Foundation East-West in the Kyrgyz Republic”, Bishkek, Kyrgyzstan
| | - Samy J. Galvez de Leon
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
| | - Daniel J. Bromberg
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Center for Interdisciplinary Research on AIDS at Yale University, New Haven, USA
| | - Ainura Kurmanalieva
- Public Foundation “AIDS Foundation East-West in the Kyrgyz Republic”, Bishkek, Kyrgyzstan
| | | | | | - Frederick L. Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
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Dorgay CE, Bromberg DJ, Doltu S, Litz T, Galvez S, Polonsky M, Dvoryak S, Altice FL. A pilot implementation study to scale-up methadone in incarcerated persons with opioid use disorder and retain them on treatment after release in Moldova. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103683. [PMID: 35417790 PMCID: PMC9827420 DOI: 10.1016/j.drugpo.2022.103683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of the few countries in this region that offers methadone within prisons, but uptake and post-release retention remains suboptimal. Screening, brief intervention, and referral to treatment (SBIRT) procedures are a potential implementation strategy to address this problem. METHODS From June 1, 2017 to March 3, 2018, we conducted a 2-stage SBIRT strategy in nine prisons and four pre-trial detention facilities in Moldova among incarcerated persons with opioid use disorder (OUD; N = 121) and within 90 days of release. Survey results were analyzed to evaluate the effect of the SBIRT strategy on the uptake of and post-release retention on methadone maintenance treatment (MMT). RESULTS Among the 121 screened with OUD, 27 were on MMT at baseline within the prison and this number increased to 41 after the two-step SBIRT intervention, reflecting a 51.9% increase over baseline. Eleven (78.6%) of the 14 participants that newly started MMT did so only after completing both SBIRT sessions. The brief intervention did not significantly improve knowledge about methadone but did improve attitudes towards it. Among the 41 participants who received methadone during this trial, 40 (97.6%) were retained 6 months after release; the one participant not retained was on methadone at the time of the intervention and had planned to taper off. CONCLUSION The SBIRT strategy significantly improved participant attitudes, but treatment initiation mostly occurred after completing both sessions, including soon after release, but remained low overall. Work within the Moldovan prison subculture to dispel negative myths and misinformation is needed to further scale-up OAT in Moldova.
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Affiliation(s)
- Coriann E Dorgay
- Yale School of Public Health, Yale University, 60 College Street, New Haven, Connecticut, 06510, United States
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University, 60 College Street, New Haven, Connecticut, 06510, United States; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Svetlana Doltu
- Act For Involvement, 7A Varșovia street, Chișinău, 2060, Republic of Moldova
| | - Taylor Litz
- Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Samy Galvez
- Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States; Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Maxim Polonsky
- Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, 5 Biloruska Str. Office 20, 27, Kyiv, 04050 Ukraine
| | - Frederick L Altice
- Yale School of Public Health, Yale University, 60 College Street, New Haven, Connecticut, 06510, United States; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States; Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States; University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Smith LR, Shumskaia N, Kurmanalieva A, Patterson TL, Werb D, Blyum A, Algarin AB, Yeager S, Cepeda J. Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study. Harm Reduct J 2022; 19:53. [PMID: 35614508 PMCID: PMC9131652 DOI: 10.1186/s12954-022-00633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/12/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In Kyrgyzstan and other Eastern European and Central Asian countries, injection drug use and HIV-related intersectional stigma undermines HIV prevention efforts, fueling a rapidly expanding HIV epidemic. The Kyrgyzstan InterSectional Stigma (KISS) Injection Drug Use Cohort is the first study designed to assess the impact of drug use, methadone maintenance treatment (MMT) and HIV stigma experiences among people who inject drugs (PWID) on HIV prevention service utilization. METHODS Adult PWID were recruited from Bishkek city and the surrounding rural Chuy Oblast region in northern Kyrgyzstan via modified time location sampling and snowball sampling. All participants completed a baseline rapid HIV test and interviewer-administered survey. A subsample of participants were prospectively followed for three months and surveyed to establish retention rates for future work in the region. Internal reliability of three parallel stigma measures (drug use, MMT, HIV) was evaluated. Descriptive statistics characterize baseline experiences across these three stigma types and HIV prevention service utilization, and assess differences in these experiences by urbanicity. RESULTS The KISS cohort (N = 279, 50.5% Bishkek, 49.5% Chuy Oblast) was mostly male (75.3%), ethnically Russian (53.8%), median age was 40 years old (IQR 35-46). Of the 204 eligible participants, 84.9% were surveyed at month 3. At baseline, 23.6% had a seropositive rapid HIV test. HIV prevention service utilization did not differ by urbanicity. Overall, we found 65.9% ever utilized syringe service programs in the past 6 months, 8.2% were utilizing MMT, and 60.8% met HIV testing guidelines. No participants reported PrEP use, but 18.5% had heard of PrEP. On average participants reported moderate levels of drug use (mean [M] = 3.25; α = 0.80), MMT (M = 3.24; α = 0.80), and HIV stigma (M = 2.94; α = 0.80). Anticipated drug use stigma from healthcare workers and internalized drug use stigma were significantly higher among PWID from Bishkek (p < 0.05), while internalized HIV stigma among PWID living with HIV was significantly greater among PWID from Chuy Oblast (p = 0.03). CONCLUSION The KISS cohort documents moderate levels of HIV-related intersectional stigma and suboptimal engagement in HIV prevention services among PWID in Kyrgyzstan. Future work will aim identify priority stigma reduction intervention targets to optimize HIV prevention efforts in the region.
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Affiliation(s)
- Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA.
| | - Natalia Shumskaia
- AIDS Foundation-East West in the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
- Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Anna Blyum
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Samantha Yeager
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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O'Hara GL, Liberman AR, Polonsky M, Azbel L, Marcus R, Doltu S, Cugut S, Altice FL. Multi-level implementation factors that influence scale-up of methadone maintenance treatment in Moldovan prisons: A qualitative study. J Subst Abuse Treat 2022; 136:108660. [PMID: 34801282 PMCID: PMC10879837 DOI: 10.1016/j.jsat.2021.108660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/22/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION People who inject drugs (PWID) are overrepresented in prison populations, especially in the Eastern European and Central Asian region (EECA), where HIV incidence and mortality continue to rise. Modeling data suggest that methadone maintenance treatment (MMT) scale-up in prison with continuation after release could substantially reduce new HIV infections. Moldova, one of four countries in the EECA to have introduced MMT in prisons, has faced challenges with its scale-up. METHOD To improve implementation of MMT in Moldovan prisoners, we analyzed the qualitative interviews of 44 recently released Moldovan prisoners with opioid use disorder who either accepted or rejected MMT while incarcerated; these 44 were among a subset of 56 participants in a quantitative survey who had complete interview data. After translating and back-translating interviews, we used content analysis to identify key barriers and facilitators to MMT uptake. RESULTS Our qualitative analyses revealed that positive attitudes toward methadone facilitated treatment uptake, yet the study identified three thematic barriers as to why PWID do not accept MMT while in prison, including: 1) negative personal attitudes toward MMT; 2) stigmatization of MMT by informal hierarchies within prison; and 3) distrust of the formal prison hierarchy (i.e., administration), which provides MMT. CONCLUSION Overall, the social forces of the two prisoner hierarchies and distrust between them appeared to outweigh the perceived benefits of MMT and impacted MMT uptake. Here we provide strategies to promote MMT more effectively in prison settings.
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Affiliation(s)
- George L O'Hara
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA
| | - Amanda R Liberman
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA.
| | - Maxim Polonsky
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA
| | - Lyuba Azbel
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA.
| | - Svetlana Doltu
- Act for Involvement (AFI) Nongovernmental organization, Varșovia St 2060, Chișinău 2060, Republic of Moldova
| | - Sergiu Cugut
- Act for Involvement (AFI) Nongovernmental organization, Varșovia St 2060, Chișinău 2060, Republic of Moldova.
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT 06510, USA.
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Bachireddy C, Shrestha R, Bromberg DJ, Azbel L, Kurmanalieva A, Wegman M, Shumskaya N, Rozanova J, Meyer JP, Altice FL. Methadone within prison and linkage to and retention in treatment upon community release for people with opioid use disorder in Kyrgyzstan: Evaluation of a national program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103558. [PMID: 34915426 PMCID: PMC9998103 DOI: 10.1016/j.drugpo.2021.103558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 11/07/2021] [Accepted: 11/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND HIV incidence in Eastern Europe and Central Asia (EECA) continues to increase, primarily among people who inject drugs (PWID) and people in prisons. In Kyrgyzstan, an estimated 35% of people in prison are PWID, and 10% have been diagnosed with HIV. In 2008, Kyrgyzstan became the first country in EECA to provide free and voluntary methadone in prisons. We examine the impact of this national program on methadone within prison as well as linkage to and retention in treatment upon release to the community. METHODS Administrative data from a national methadone registry with de-identified information were assessed retrospectively. We examined the delivery of methadone services, including the duration of treatment both within prison and after release, for all prisoners who were prescribed methadone in Kyrgyz prisons from 2008 to 2018. Reasons for discontinuing methadone, HIV status and methadone dose are also analyzed. RESULTS Between 2008 and 2018, nine of Kyrgyzstan's 16 prisons offered methadone, and 982 incarcerated people initiated methadone within prison. Prisoners prescribed methadone were mostly male (96.2%), in their mid-30s (mean=34.9 years), and had been incarcerated for a relatively long time (mean = 44.1 months); their mean treatment duration in prison was 12.5 months, and 31.6% had HIV. A subsample (N = 645; 65.7%) of these were released to the community. Of these 645 people, 356 (55.2%) were not taking methadone at the time of release, 128 (19.8%) were on methadone and continued it after release, and the remainder (N=161, 25.0%) were on methadone at the time of release, but subsequently discontinued it, most within the first 7 days after release. Among those continuing methadone, 14.8% (N=19) remained on treatment ≥ 12 months. Independent correlates of linkage to methadone after release included positive HIV status (adjusted hazard ratio (aHR)=1.55; p = 0.033), receipt of methadone before their incarceration (aHR=2.01; p = 0.039), and receipt of methadone at the time of release (aHR = 20.81; p<0.001). CONCLUSION This is the first evaluation of within-prison methadone treatment in EECA. Uptake of methadone within prison and retention in treatment after release were both low. Continuous maintenance of treatment throughout incarceration is an opportunity to optimize HIV prevention and link patients to methadone post-release.
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Affiliation(s)
- Chethan Bachireddy
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PS, United States
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States; Yale University School of Medicine, New Haven, CT, United States
| | - Daniel J Bromberg
- Yale University School of Public Health, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
| | - Lyu Azbel
- Yale University School of Medicine, New Haven, CT, United States
| | | | - Martin Wegman
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Natalya Shumskaya
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
| | - Julia Rozanova
- Yale University School of Medicine, New Haven, CT, United States
| | - Jaimie P Meyer
- Yale University School of Medicine, New Haven, CT, United States
| | - Frederick L Altice
- Yale University School of Medicine, New Haven, CT, United States; Yale University School of Public Health, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States.
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9
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Mezaache S, Briand-Madrid L, Laporte V, Rojas Castro D, Carrieri P, Roux P. A syndemic examination of injecting drug use, incarceration and multiple drug-related harms in French opioid users. Int J Prison Health 2021; 18:417-428. [PMID: 34928106 DOI: 10.1108/ijph-06-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE People who inject drugs (PWID) face multiple health problems, including infectious diseases and drug overdoses. Applying syndemic and risk environment frameworks, this paper aims to examine the co-occurrence and clustering of drug-related harms and their association with incarceration experience with or without in-prison drug injection. DESIGN/METHODOLOGY/APPROACH The authors used data from a cross-sectional survey conducted in 2015 among 557 active opioid injectors. Self-reported data were collected through face-to-face or online questionnaires. They distinguished three harm categories, namely, viral infections, bacterial infections and overdoses, and built an index variable by summing the number of harm categories experienced, yielding a score from 0 to 3. Association between incarceration experience and co-occurrence of harms was modelled using a multinomial logistic regression. FINDINGS Of the 557 participants, 30% reported lifetime experience of drug-related viral infection, 46% bacterial infection and 22% drug overdose. Multinomial logistic models showed that those who injected drugs during incarceration were more likely to report two (aOR = 2.35, 95% CI: 1.03-5.36) and three (aOR = 9.72, 95% CI: 3.23-29.22) harm categories than those who had never been incarcerated. They were also more likely to report three harm categories than formerly incarcerated respondents who did not inject drugs in prison (aOR = 5.14, 95% CI: 1.71-15.48). ORIGINALITY/VALUE This study provides insights of the syndemic nature of drug-related harms and highlights that drug injection during incarceration is associated with co-occurring harms. Public health interventions and policy changes are needed to limit the deleterious impact of prison on PWID.
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Affiliation(s)
- Salim Mezaache
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Laélia Briand-Madrid
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Daniela Rojas Castro
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France and Coalition PLUS, Pantin, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Komalasari R, Wilson S, Haw S. A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons. Int J Prison Health 2021. [DOI: 10.1108/ijph-04-2020-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM).
Design/methodology/approach
The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically.
Findings
The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources.
Research limitations/implications
The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant.
Practical implications
Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners’ families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons.
Social implications
The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons.
Originality/value
This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.
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Liberman AR, Bromberg DJ, Azbel L, Rozanova J, Madden L, Meyer JP, Altice FL. Decisional considerations for methadone uptake in Kyrgyz prisons: The importance of understanding context and providing accurate information. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103209. [PMID: 33838398 PMCID: PMC8373625 DOI: 10.1016/j.drugpo.2021.103209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The Kyrgyz Republic (Kyrgyzstan) is one of few countries in Eastern Europe and Central Asia to provide methadone within its prisons, but uptake of this program has been suboptimal, in part because methadone uptake may have personal or social risks and consequences. Decision aids are evidence-based strategies that are designed to inform the patient's choice by objectively providing information that incorporates patient preferences. METHODS We conducted qualitative interviews in Kyrgyz and Russian with currently and formerly incarcerated people (n = 36) in Kyrgyzstan from October 2016 to September 2018. Interviews explored factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. A secondary thematic analysis was conducted to determine factors specific to initiation or continuation of methadone treatment in prisons. RESULTS We identified six interrelated themes affecting an individual's decision to initiate or continue methadone treatment: 1) informal prison governance (incarcerated people governing themselves); 2) informal prison economy; 3) perceived and objective benefits of methadone treatment; 4) perceived and objective side effects of methadone treatment; 5) distrust of formal prison administration (medical and correctional staff); and 6) desire for a "cure" from addiction. CONCLUSION Respondents' perceptions about benefits, side effects, and addiction as a curable disease are not consistent with the available evidence. An evidence-based, informed decision-making aid would need to address the six themes identified here, of which several are specific to the Kyrgyz prison context. Unlike decision aids elsewhere, the unique aspects of incarceration itself alongside the informal governance system strongly present within Kyrgyz prisons will need to be incorporated into decisional processes to promote HIV prevention and treatment in a region with high rates of HIV transmission and mortality.
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Affiliation(s)
- Amanda R Liberman
- Yale School of Medicine, Yale University, 135 College Street, New Haven, CT, United States, 06510.
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University, 135 College Street, New Haven, Connecticut, United States, 06510; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, United States, 06510
| | - Lyuba Azbel
- Yale School of Medicine, Yale University, 135 College Street, New Haven, CT, United States, 06510; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, United States, 06510
| | - Julia Rozanova
- Yale School of Medicine, Yale University, 135 College Street, New Haven, CT, United States, 06510
| | - Lynn Madden
- Yale School of Medicine, Yale University, 135 College Street, New Haven, CT, United States, 06510; APT Foundation, 495 Congress Ave, New Haven, Connecticut, United States, 06519
| | - Jaimie P Meyer
- Yale School of Medicine, Yale University, 135 College Street, New Haven, CT, United States, 06510
| | - Frederick L Altice
- Yale School of Medicine, Yale University, 135 College Street, New Haven, CT, United States, 06510; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, United States, 06510
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Mitchell MM, Kelly SM, O'Grady KE, Jaffe JH, Mitchell SG, Schwartz RP. HIV-Risk Behavior Among Adults with Opioid Use Disorder During 12 Months Following Pre-trial Detention: Results from a Randomized Trial of Methadone Treatment. AIDS Behav 2021; 25:1247-1256. [PMID: 33196937 PMCID: PMC7979478 DOI: 10.1007/s10461-020-03090-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/26/2022]
Abstract
This was a three group randomized clinical trial of interim methadone and patient navigation involving 225 pre-trial detainees with opioid use disorder in Baltimore. The HIV Risk Assessment Battery (RAB) was administered at baseline (in jail), and at 6 and 12 months post-release. Generalized linear mixed model analyses indicated the condition × time interaction effect failed to reach significance (ps > .05) for both the drug risk and sex risk subscale scores. Therefore, findings suggest that there were no intervention effects on drug or sex risk behaviors. However, increased use of cocaine at baseline was associated with increases in drug- (b = .04, SE = .02) and sex-risk (b = .01, SE = .003) behaviors. These results suggest that interventions targeting cocaine use among pre-trial detainees may serve as a means of reducing HIV risk associated with drug- and sex-risk behaviors.Clinical Trials Registration: Clinicaltrials.gov NCT02334215.
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Affiliation(s)
- M M Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.
| | - S M Kelly
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - K E O'Grady
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - J H Jaffe
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - S G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - R P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
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Dmitrieva A, Stepanov V, Svyrydova K, Lukash IG, Doltu S, Golichenko M, Kalivoshko V, Khanyukov E, Kosmukhamedova Z, Torkunov O, Zagrebelnyi O. More evidence or stronger political will: exploring the feasibility of needle and syringe programs in Ukrainian prisons. Harm Reduct J 2021; 18:10. [PMID: 33468162 PMCID: PMC7814436 DOI: 10.1186/s12954-020-00459-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2007, the World Health Organization (WHO) recommended for prison authorities to introduce prison needle and syringe programs (PNSP) if they have any evidence that injecting drug use is taking place in prisons. This article presents descriptive evidence that injecting drug use takes place in Ukrainian prisons, it discusses how (denial of) access to injection equipment is regulated in the current system and what changes should be considered in order to implement PNSP. BACKGROUND Ukrainian prisons still live by the laws and policies adopted in the Soviet Union. Besides laws and regulations, these legacies are replicated through the organization and infrastructure of the prison's physical space, and through "carceral collectivism" as a specific form of living and behaving. Inviolability of the prison order over time helps the prison staff to normalize and routinely rationalize punishment enforcement as a power "over" prisoners, but not a power "for" achieving a specific goal. METHODS The Participatory Action Research approach was used as a way of involving different actors in the study's working group and research process. The data were gathered through 160 semi-structured interviews with prison health care workers, guards, people who inject drugs (PWID) who served one or several terms and other informants. RESULTS The "expertise" in drug use among prisoners demonstrated by prison staff tells us two things-they admit that injecting use takes place in prisons, and that the surveillance of prisoner behavior has been carried out constantly since the very beginning as a core function of control. The communal living conditions and prison collectivism may not only produce and reproduce a criminal subculture but, using the same mechanisms, produce and reproduce drug use in prison. The "political will" incorporated into prison laws and policies is essential for the revision of outdated legacies and making PNSP implementation feasible. CONCLUSION PNSP implementation is not just a question of having evidence of injecting drug use in the hands of prison authorities. For PNSP to be feasible in the prison environment, there is a need for specific changes to transition from one historical period and political leadership to another. And, thus, to make PNSP work requires making power work for change, and not just for reproducing the power itself.
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Affiliation(s)
| | - Vladimir Stepanov
- Support, Research and Development Center, Kyiv, Ukraine
- Doctoral School at National University of “Kyiv-Mohyla Academy” (NaUKMA), Kyiv, Ukraine
| | | | - Ievgeniia-Galyna Lukash
- Support, Research and Development Center, Kyiv, Ukraine
- Doctoral School at National University of “Kyiv-Mohyla Academy” (NaUKMA), Kyiv, Ukraine
| | - Svetlana Doltu
- Council for Preventing and Eliminating Discrimination and Ensuring Equality, Chisinau, Republic of Moldova
- Council for the Prevention of Torture (National Preventive Mechanism), Chisinau, Republic of Moldova
| | | | | | - Evgeniy Khanyukov
- Global Fund and PATH Projects in State Penitentiary Service, Kyiv, Ukraine
| | - Zhannat Kosmukhamedova
- Regional Programme Office for the Eastern Europe United Nations Office on Drugs and Crime, Kyiv, Ukraine
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14
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Marotta PL, Terlikbayeva A, Gilbert L, Davis A, Wu E, Metsch L, Feaster D, El-Bassel N. Dyadic analysis of criminal justice involvement and hiv risks among couples who inject drugs and their intimate partners in almaty, kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102950. [PMID: 33099160 PMCID: PMC8694887 DOI: 10.1016/j.drugpo.2020.102950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incarceration increases HIV risk behaviors and strains intimate partnerships of couples of people who inject drugs (PWID) in Kazakhstan. Studies are yet to examine dyadic relationships between criminal justice involvement and injection drug and sexual HIV risk behaviors of couples who inject drugs in Kazakhstan. This study examined associations between individual and partner level criminal justice involvement and injection drug and sexual HIV risk behaviors among 216 intimate dyads (n = 432) of PWID in Almaty, Kazakhstan. METHODS The Actor Partner Interdependence Model (APIM) using structural equation modeling examined individual (actor), partner and dyadic patterns (actor-partner) of associations between arrest, incarceration and drug crime conviction of dyads of male and female intimate partners of PWID using baseline data from Project Renaissance, a couples-focused HIV prevention intervention for PWID and their intimate partners. RESULTS Results from the APIM identified significant associations between lifetime (β=0.10, CI95%=0.01.20, p=.021) and recent (β=0.12, CI95%=0.01.26, p=.045) arrest and increased risk of injection drug use with any partner for female partners. Partner-only effects were identified in which male PWID's recent arrest was associated with an increase in their study partners' injection drug risk behaviors (β=0.10 CI95%=0.02, 0.20, p=.044). For female partners, prior incarceration was associated with increased engagement in injection drug risk behaviors (β=0.10 CI95% =0.02, 0.20, p=.035) with any partner. For male partners' prior incarceration was associated with injection drug risk behaviors with their study partners (β=0.10 CI95%= 0.02, 0.20. p<.05). Female partners prior drug crime conviction was associated with their own (β=0.14 CI95%=0.01, 0.28, p=.048) and their intimate partners' (β=0.18, CI95%=0.03, 0.33, p=.024) engagement in injection drug risk behaviors with any injecting partner. Recent drug crime conviction (β=0.12, CI95%=0.01, 0.24, p=.038) and arrest (β=0.13, CI95%, p=.022) was associated with increased engagement in sexual risk behaviors among female partners. CONCLUSION Findings from this study identified differences in how criminal justice involvement impacts sexual and injection drug and sexual risk behaviors between male and female partners of PWID. Future research must investigate how structural interventions at the dyadic level could address the negative impact of criminal justice involvement on sexual and injection drug HIV risks within the contexts of couples who are PWID.
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Affiliation(s)
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; School of Social Work, Columbia University, New York, New York United States of America
| | - Louisa Gilbert
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; School of Social Work, Columbia University, New York, New York United States of America
| | - Alissa Davis
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; School of Social Work, Columbia University, New York, New York United States of America
| | - Elwin Wu
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; School of Social Work, Columbia University, New York, New York United States of America
| | - Lisa Metsch
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Sociomedical Sciences, Mailman School of Public Health Columbia University New York, United States of America
| | - Dan Feaster
- Biostatistics Division, Department of Public Health Sciences, Miller School of Medicine University of Miami, Miami, FL, United States of America
| | - Nabila El-Bassel
- Biostatistics Division, Department of Public Health Sciences, Miller School of Medicine University of Miami, Miami, FL, United States of America
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Komalasari R, Wilson S, Haw S. A systematic review of qualitative evidence on barriers to and facilitators of the implementation of opioid agonist treatment (OAT) programmes in prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102978. [DOI: 10.1016/j.drugpo.2020.102978] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 01/22/2023]
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Meyer JP, Culbert GJ, Azbel L, Bachireddy C, Kurmanalieva A, Rhodes T, Altice FL. A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction. Harm Reduct J 2020; 17:86. [PMID: 33129341 PMCID: PMC7603760 DOI: 10.1186/s12954-020-00435-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/21/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To reduce opioid dependence and HIV transmission, Kyrgyzstan has introduced methadone maintenance therapy and needle/syringe programs into prisons. Illicit injection of diphenhydramine, an antihistamine branded as Dimedrol®, has been anecdotally reported as a potential challenge to harm reduction efforts in prisons but has not been studied systematically. METHODS We conducted qualitative interviews in Kyrgyz or Russian with prisoners (n = 49), former prisoners (n = 19), and stakeholders (n = 18), including prison administrators and prisoner advocates near Bishkek, Kyrgyzstan from October 2016 to September 2018. Interviews explored social-contextual factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. Dimedrol injection emerged as an important topic, prompting a dedicated analysis. RESULTS After drinking methadone, some people in prison inject crushed Dimedrol tablets, a non-prescription antihistamine that is banned but obtainable in prison, to achieve a state of euphoria. From the perspectives of the study participants, Dimedrol injection was associated with devastating physical and mental health consequences, including psychosis and skin infections. Moreover, the visible wounds of Dimedrol injecting contributed to the perception of methadone as a harmful drug and supporting preference for heroin over methadone. CONCLUSION Dimedrol injecting is a potentially serious threat to harm reduction and HIV prevention efforts in Kyrgyzstan and elsewhere in the Eastern European and Central Asian region and requires further investigation.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| | - Gabriel J Culbert
- Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Lyuba Azbel
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA
| | | | | | - Tim Rhodes
- The London School of Tropical Hygiene and Tropical Medicine, London, UK
| | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA
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Abstract
PURPOSE OF REVIEW People with HIV and HCV are concentrated within criminal justice settings globally, primarily related to criminalization of drug use. This review examines updated prevention and treatment strategies for HIV and HCV within prison with a focus on people who inject drugs and the challenges associated with the provision of these services within prisons and other closed settings and transition to the community. RECENT FINDINGS The prevalence of HIV and HCV are several-fold higher in the criminal justice system than within the broader community particularly in regions with high prevalence of injecting drug use, such as Asia, Eastern Europe and North America and where drug use is criminalized. Strategies to optimize management for these infections include routine screening linked to treatment within these settings and medication-assisted treatments for opioid dependence and access to syringe services programs. We build upon the 2016 WHO Consolidated Guidelines through the lens of the key populations of prisoners. Linkage to treatment postrelease, has been universally dismal, but is improved when linked to medication-assisted therapies like methadone, buprenorphine and overdose management. In many prisons, particularly in low-income and middle-income settings, provision of even basic healthcare including mental healthcare and basic HIV prevention tools remain suboptimal. SUMMARY In order to address HIV and HCV prevention and treatment within criminal justice settings, substantial improvement in the delivery of basic healthcare is needed in many prisons worldwide together with effective screening, treatment and linkage of treatment and prevention services to medication-assisted therapies within prison and linkage to care after release.
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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Rhodes T, Azbel L, Lancaster K, Meyer J. The becoming-methadone-body: on the onto-politics of health intervention translations. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1618-1636. [PMID: 31310008 PMCID: PMC7700701 DOI: 10.1111/1467-9566.12978] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this paper, we reflect on health intervention translations as matters of their implementation practices. Our case is methadone treatment, an intervention promoted globally for treating opioid dependence and preventing HIV among people who inject drugs. Tracing methadone's translations in high-security prisons in the Kyrgyz Republic, we notice the multiple methadones made possible, what these afford, and the onto-political effects they make. We work with the idea of the 'becoming-methadone-body' to trace the making-up of methadone treatment and its effects as an intra-action of human and nonhuman substances and bodies. Methadone's embodied effects flow beyond the mere psycho-activity of substances incorporating individual bodies, to material highs and lows incorporating the governing practices of prisoner society. The methadone-in-practice of prisoner society is altogether different to that imagined as being in translation as an intervention of HIV prevention and opioid treatment, and has material agency as a practice of societal governance. Heroin also emerges as an actor in these relations. Our analysis troubles practices of 'evidence-based' intervention and 'implementation science' in the health field, by arguing for a move towards 'evidence-making' intervention approaches. Noticing the onto-politics of health intervention translations invites speculation on how intervening might be done differently.
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Affiliation(s)
- Tim Rhodes
- London School of Hygiene and Tropical Medicine, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Lyuba Azbel
- London School of Hygiene and Tropical Medicine, UK
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Kari Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Jaimie Meyer
- Yale School of Medicine, Yale University, Connecticut, USA
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20
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Evidence-making interventions in health: A conceptual framing. Soc Sci Med 2019; 238:112488. [DOI: 10.1016/j.socscimed.2019.112488] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 01/31/2023]
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Ranjit YS, Azbel L, Krishnan A, Altice FL, Meyer JP. Evaluation of HIV risk and outcomes in a nationally representative sample of incarcerated women in Azerbaijan, Kyrgyzstan, and Ukraine. AIDS Care 2019; 31:793-797. [PMID: 30701981 DOI: 10.1080/09540121.2019.1573969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Eastern European and Central Asian (EECA) is the only region globally where HIV incidence continues to rise. HIV is concentrated among high risk groups like prisoners. HIV prevalence is higher among women than men in both prisons and communities. Data are lacking on the HIV care continuum among female prisoners to inform effective HIV prevention and treatment interventions. This study examined HIV risk, prevalence of infectious diseases, access to care, and psychiatric comorbidities among a representative sample of 220 female prisoners in Azerbaijan, Kyrgyzstan, and Ukraine. Prevalence of comorbid substance use and psychiatric disorders was high with nearly one-third reporting pre-incarceration drug injection and alcohol use disorder (AUD). Half of the sample reported anxiety and depression. Among the subset of 26 (11.8%) women testing HIV+, 44% had CD4 counts <350 cells/μL but less than 2% were on antiretroviral therapy (ART). Most (88.5%) women with HIV were in Ukraine, where women also experienced higher rates of hepatitis C than in Azerbaijan or Kyrgyzstan. Women in Kyrgyzstan prisons experienced higher rates of syphilis compared to the other two countries. Findings suggest that, to achieve global HIV prevention and treatment targets, HIV testing and linkage to care must be scaled up among incarcerated women in the EECA.
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Affiliation(s)
- Yerina S Ranjit
- a Department of Internal Medicine, AIDS Program , Yale University , New Haven , CT , USA
| | - Lyuba Azbel
- b London School of Hygiene and Tropical Medicine , London , UK
| | - Archana Krishnan
- c Department of Communication , University at Albany, State University of New York , Albany , YN , USA
| | - Frederick L Altice
- a Department of Internal Medicine, AIDS Program , Yale University , New Haven , CT , USA
| | - Jaimie P Meyer
- a Department of Internal Medicine, AIDS Program , Yale University , New Haven , CT , USA
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