1
|
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).
Collapse
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.
| |
Collapse
|
2
|
Loh DA, Plugge E, Van Hout MC. Continuity of opioid substitution treatment between prison and community in Southeast Asia: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103957. [PMID: 36693296 DOI: 10.1016/j.drugpo.2023.103957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Criminalisation of drug use and compulsory detention has largely characterised the Southeast Asia region's response to people who use drugs. Whilst access to and provision of healthcare for people living in prison are mandated by international human rights standards, many opioid dependent people living in prison continue to lack access to opioid substitution treatment (OST) during incarceration, and face uncertainties of continuity of care beyond the prison gate. METHODS A scoping review using Arksey and O'Malley's framework mapped what is currently known about the continuity of OST post-release in Southeast Asia, with a focus on the three countries (Indonesia, Malaysia, Vietnam) that provide OST in at least one prison. A multi-lingual systematic search (English, Malay, Indonesian, Vietnamese) on Medline, CINAHL, Scopus, Web of Science, PsycINFO and the Cochrane Library collected and reviewed extant relevant published empirical and grey literature including government reports between 2011 and 2021. Of the 365 records found, 18 were eligible for inclusion following removal of duplicates and application of exclusion criteria. These records were charted and thematically analysed. RESULTS Three main themes were generated: Facilitators of post release continuity of care, Barriers to post release continuity of care and Therapeutic considerations supporting post release continuity of care. When individual and structural gaps exist, disruptions to continuity of OST care post release are observed. Adequate methadone dosage of >80mg/day appears significantly associated with retention in post-release OST. CONCLUSIONS The review highlights the facilitators, barriers and therapeutic considerations of continuity of care of OST between prison and community for people living in prisons from Indonesia, Malaysia and Vietnam. Improving community services with family support are key to supporting continued OST adherence post release along with reducing societal stigma towards people who use drugs and those entering or leaving prison. Further efforts are warranted to ensure parity, quality and continuity of OST care post release.
Collapse
Affiliation(s)
- Debbie Ann Loh
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Emma Plugge
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Marie-Claire Van Hout
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom.
| |
Collapse
|
3
|
Curtis M, Dietze P, Wilkinson AL, Agius PA, Stewart AC, Cossar RD, Butler T, Walker S, Kirwan A, Winter RJ, Stoové M. Discontinuation of opioid agonist treatment following release from prison in a cohort of men who injected drugs prior to imprisonment in Victoria, Australia: A discrete-time survival analysis. Drug Alcohol Depend 2023; 242:109730. [PMID: 36516552 DOI: 10.1016/j.drugalcdep.2022.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Retention in opioid agonist treatment (OAT) following release from prison is associated with improved outcomes, however factors associated with post-release OAT discontinuation in Australia are poorly understood. We examined post-release OAT discontinuation in a cohort of men who engaged in approximately monthly injecting drug use (IDU) prior to imprisonment in Victoria, Australia. METHODS Longitudinal data were used to calculate incidence of first-event post-release OAT discontinuation among men released from prison receiving OAT, and single-event discrete-time survival methods were used to estimate associations with post-release OAT discontinuation. RESULTS Among 110 participants, 55 OAT discontinuations were observed in the two years post-release, an overall crude incidence rate (IR) of 46 per 100 person-years (PY) (95 % confidence interval [95 %CI]: 36-60 per 100PY). Incidence was greatest between release from prison and first follow-up (IR: 84 per 100PY, 95 %CI: 62-116 per 100PY). Initiating OAT during index imprisonment (versus transitioning from community OAT; adjusted hazard rate [AHR]: 2.17, 95 %CI: 1.14-4.13) and identifying as Aboriginal and/or Torres Strait Islander (AHR: 4.95, 95 %CI: 2.00-12.25) were associated with an increased hazard of OAT discontinuation. CONCLUSION In a cohort of men with recent histories of IDU released from prison receiving OAT, half reported OAT discontinuation within two years of release from prison, with incidence of discontinuation greatest soon after prison-release. Targeted support for men who initiate OAT during episodes of imprisonment and Aboriginal and/or Torres Strait Islander peoples is necessary to reduce incidence of OAT discontinuation among people at greatest risk of discontinuation.
Collapse
Affiliation(s)
- Michael Curtis
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia.
| | - Paul Dietze
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Anna L Wilkinson
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul A Agius
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ashleigh C Stewart
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Forensic Medicine, Monash University, VIC, Australia; Victorian Institute of Forensic Medicine, Melbourne, VIC, Australia
| | - Reece D Cossar
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- Justice Health Research Program, School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Shelley Walker
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Amy Kirwan
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Rebecca J Winter
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
| | - Mark Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
4
|
Bazazi AR, Culbert GJ, Wegman MP, Heimer R, Kamarulzaman A, Altice FL. Impact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia. BMC Infect Dis 2022; 22:837. [PMID: 36368939 PMCID: PMC9652918 DOI: 10.1186/s12879-022-07804-6] [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: 11/05/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Maintenance with opioid agonist therapy (OAT) like methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison. METHODS This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n = 291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n = 64) and participant choice (n = 246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival. RESULTS Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5-89.4). Most deaths were of infectious etiology, mostly related to HIV. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6-3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5-2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0-1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1-3.9), and lower CD4+ T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7-1.0). CONCLUSIONS Postrelease mortality in this sample of men with HIV and OUD was extraordinarily high, and most deaths were likely of infectious etiology. No effect of prerelease methadone on postrelease mortality was observed, which may be due to study limitations or an epidemiological context in which inadequately treated HIV, and not inadequately treated OUD, is the main cause of death after prison release. TRIAL REGISTRATION NCT02396979. Retrospectively registered 24/03/2015.
Collapse
Affiliation(s)
- Alexander R. Bazazi
- grid.47100.320000000419368710Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-228 USA
- grid.47100.320000000419368710Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California, San Francisco, San Francisco, CA USA
| | - Gabriel J. Culbert
- grid.185648.60000 0001 2175 0319Population Health Nursing Science, University of Illinois at Chicago, Chicago, IL USA
| | - Martin P. Wegman
- grid.47100.320000000419368710Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-228 USA
| | - Robert Heimer
- grid.47100.320000000419368710Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
| | - Adeeba Kamarulzaman
- grid.47100.320000000419368710Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-228 USA
- grid.10347.310000 0001 2308 5949Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L. Altice
- grid.47100.320000000419368710Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-228 USA
- grid.47100.320000000419368710Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- grid.10347.310000 0001 2308 5949Faculty of Medicine, Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Paynter M, Heggie C, Low C, McKibbon S, Martin-Misener R. Community-based models of health care for women, trans and nonbinary people released from prisons: An international scoping review with implications for Canada. J Clin Nurs 2022. [PMID: 35941807 DOI: 10.1111/jocn.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes. BACKGROUND Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada. DESIGN Scoping review using the Joanna Briggs Institute scoping review methodology. METHODS In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines. RESULTS Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic. CONCLUSIONS Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration. RELEVANCE TO CLINICAL PRACTICE Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition. PATIENT OR PUBLIC CONTRIBUTION A member of the research team brings lived experience expertise with respect to the criminal justice system.
Collapse
Affiliation(s)
- Martha Paynter
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | | | | | | | | |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Moallef S, DeBeck K, Fairbairn N, Cui Z, Brar R, Wilson D, Johnson C, Milloy MJ, Hayashi K. Inability to contact opioid agonist therapy prescribers during the COVID-19 pandemic in a Canadian setting: a cross-sectional analysis among people on opioid agonist therapy. Addict Sci Clin Pract 2022; 17:73. [PMID: 36522789 PMCID: PMC9751503 DOI: 10.1186/s13722-022-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and consequent public health response may have undermined key responses to the protracted drug poisoning crisis, including reduced access to opioid agonist therapy (OAT) among people with opioid use disorder. Our study objectives were to estimate the prevalence of and identify factors associated with inability to contact OAT prescribers when in need among people on OAT in a Canadian setting during the dual public health crises. METHODS Survey data were collected from three prospective cohort studies of community-recruited people who use drugs between July and November 2020, in Vancouver, Canada. A multivariable logistic regression analysis was used to identify potential factors associated with inability to contact OAT prescribers among patients who accessed OAT in the past 6 months. RESULTS Among 448 respondents who reported accessing OAT in the past 6 months, including 231 (54.9%) men, 85 (19.0%) reported having been unable to contact OAT prescribers when needed, whereas 268 (59.8%) reported being able to talk to their prescriber when needed, and 95 (21.2%) reported that they did not want to talk to their medication prescriber in the previous 6 months. Among those who reported inability to contact prescribers, 45 (53.6%) reported that their overall ability to contact prescribers decreased since the start of the pandemic. In multivariable analyses, factors independently associated with inability to talk to OAT prescribers included: chronic pain (Adjusted Odds Ratio [AOR] = 1.82; 95% Confidence Interval [CI] 1.02, 3.27), moderate to severe symptoms of depression or anxiety (AOR = 4.74; 95% CI 2.30, 9.76), inability to access health/social services (AOR = 2.66; 95% CI 1.41, 5.02), and inability to self-isolate or socially distance most or all of the time (AOR = 2.13; 95% CI 1.10, 4.14). CONCLUSIONS Overall, approximately one fifth of the sample reported inability to contact their OAT prescribers when needed, and those people were more likely to have co-occurring vulnerabilities (i.e., co-morbidities, inability to access health/social services) and higher vulnerability to COVID-19. Interventions are needed to ensure optimal access to OAT and mitigate the deepening health inequities resulting from the COVID-19 pandemic and the escalating drug poisoning crisis.
Collapse
Affiliation(s)
- Soroush Moallef
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Kora DeBeck
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494School of Public Policy, Simon Fraser University, Burnaby, BC Canada
| | - Nadia Fairbairn
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Zishan Cui
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Rupinder Brar
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada ,grid.417243.70000 0004 0384 4428Vancouver Coastal Health Authority, Vancouver, BC Canada
| | - Dean Wilson
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Cheyenne Johnson
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, BC Canada
| | - M.-J. Milloy
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Kanna Hayashi
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| |
Collapse
|
10
|
Ramlan AR, Mohamed Nazar NI, Tumian A, Ab Rahman NS, Mohamad D, Abdul Talib MS, Zakaria KFM, Izuddin MA, Zainal Abidin NA, T Syed Manso SS, Wan Hassan WNK. Time to Treatment Initiation and Retrospective Analysis of Antiretroviral Therapy Outcomes among HIV-positive Methadone Maintenance Therapy Clients in Primary Health-care Centers, Kuantan, Pahang. J Pharm Bioallied Sci 2020; 12:S810-S815. [PMID: 33828381 PMCID: PMC8021067 DOI: 10.4103/jpbs.jpbs_3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Methadone maintenance therapy (MMT) program helped to improve access to antiretroviral therapy (ART) among people who inject drugs (PWID) with human immunodeficiency virus (HIV). However, the time to treatment initiation (TTI) and outcomes of ART intervention in this population have scarcely been analyzed. Objectives: The aim of this study was to analyze the TTI and outcomes of ART among MMT clients in primary health-care centers in Kuantan, Pahang. Materials and Methods: This was a retrospective evaluation of MMT clients from 2006 to 2019. The TTI was calculated from the day of MMT enrolment to ART initiation. The trends of CD4 counts and viral loads were descriptively evaluated. Cox proportional hazard model was used to analyze the survival and treatment retention rate. Results: A total of 67 MMT clients from six primary health-care centers were HIV-positive, of which 37 clients were started on ART. The mean TTI of ART was 27 months. The clients who were given ART had a mean CD4 count of 119 cells/mm3 at baseline and increased to 219 cells/mm3 after 6 months of ART. Only two patients (5.4%) in the ART subgroup had an unsuppressed viral load. The initiation of ART had reduced the risk of death by 72.8% (hazard ratio = 0.27, P = 0.024), and they are 13.1 times more likely to remain in treatment (P < 0.01). Conclusion: The TTI of ART was delayed in this population. MMT clients who were given ART have better CD4 and viral load outcomes, helped reduced death risk and showed higher retention rates in MMT program.
Collapse
Affiliation(s)
- Aida Roziana Ramlan
- Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.,Department of Pharmacy, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia, Kuantan, Pahang, Malaysia
| | | | - Afidalina Tumian
- Kulliyyah of Engineering, International Islamic University Malaysia, Gombak, Selangor, Malaysia
| | | | - Dzawani Mohamad
- Medical Department, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia, Kuantan, Pahang, Malaysia
| | | | | | | | | | | | | |
Collapse
|
11
|
Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review. PLoS Med 2019; 16:e1003002. [PMID: 31891578 PMCID: PMC6938347 DOI: 10.1371/journal.pmed.1003002] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration. METHODS AND FINDINGS We systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273-131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27-960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15-1,557) and 44 (range 27-382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36-55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research. CONCLUSIONS In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.
Collapse
|
12
|
Mamat R, Nasrulddin NAA, Yusoff NAM. Continued Use of Illicit Substance among Methadone Treatment Patients in Primary Health Care Clinics in East Coast Region of Malaysia. ALCOHOLISM TREATMENT QUARTERLY 2019. [DOI: 10.1080/07347324.2019.1672600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Ruzmayuddin Mamat
- Kuantan Health District Office, Ministry of Health Malaysia, Pejabat Kesihatan Daerah, Kuantan
| | | | | |
Collapse
|
13
|
Shanmugam PK. Exploring trends and challenges from mandated treatment to voluntary treatment outcomes in addiction treatment in Malaysia: moving toward a person-centered service provision. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Prem Kumar Shanmugam
- Department of Psychology, Manchester Metropolitan University, UK
- Solace Asia, Kota Kinabalu, Malaysia
| |
Collapse
|
14
|
Lall P, Saifi R, Baggio D, Schoenberger SF, Choo M, Gilbert L, West B, El-Bassel N, Kamarulzaman A. Risk Factors for a Positive Hepatitis C Status in Fishermen in Kuantan Malaysia. Asia Pac J Public Health 2019; 31:227-237. [PMID: 30983376 DOI: 10.1177/1010539519841294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malaysia currently has an estimated hepatitis C virus (HCV) prevalence of 1.3% with an infected population of 384,000. Fishermen in Malaysia are at risk of HCV infection due to injection drug use and disproportionately high rates of incarceration. This study used quantitative data from Project WAVES, a large-scale mixed methods project charting environmental drivers of risk-taking behaviors among a respondent-driven sample of 406 fishermen in Malaysia. Over a quarter of participants (27.9%) reported injecting drugs in the past month; 49.8% of the sample tested positive for HCV. Respondents who had previously been arrested displayed increased odds of being HCV-positive (adjusted odds ratio = 4.79, confidence Interval = 2.46-9.35). Participants who reported being in lock-up displayed close to 6-fold odds of being HCV-infected (adjusted odds ratio = 5.49, confidence interval = 2.77-10.90, P < .001). These findings underscore the need for policies and structural interventions targeting the negative effects of aggressive incarceration contributing to the burden of HCV among high-risk communities.
Collapse
Affiliation(s)
- Priya Lall
- 1 Queen Mary University of London, London, UK.,2 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rumana Saifi
- 2 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Diva Baggio
- 3 Monash University, Clayton, Victoria, Australia
| | | | - Martin Choo
- 2 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | |
Collapse
|
15
|
Azbel L, Wegman MP, Polonsky M, Bachireddy C, Meyer J, Shumskaya N, Kurmanalieva A, Dvoryak S, Altice FL. Drug injection within prison in Kyrgyzstan: elevated HIV risk and implications for scaling up opioid agonist treatments. Int J Prison Health 2019; 14:175-187. [PMID: 30274558 DOI: 10.1108/ijph-03-2017-0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose Within-prison drug injection (WPDI) is a particularly high HIV risk behavior, yet has not been examined in Central Asia. A unique opportunity in Kyrgyzstan where both methadone maintenance treatment (MMT) and needle-syringe programs (NSP) exist allowed further inquiry into this high risk environment. The paper aims to discuss these issues. Design/methodology/approach A randomly selected, nationally representative sample of prisoners within six months of release in Kyrgyzstan completed biobehavioral surveys. Inquiry about drug injection focused on three time periods (lifetime, 30 days before incarceration and during incarceration). The authors performed bivariate and multivariable generalized linear modeling with quasi-binomial distribution and logit link to determine the independent correlates of current WPDI. Findings Of 368 prisoners (13 percent women), 109 (35 percent) had ever injected drugs, with most (86 percent) reporting WPDI. Among those reporting WPDI, 34.8 percent had initiated drug injection within prison. Despite nearly all (95 percent) drug injectors having initiated MMT previously, current MMT use was low with coverage only reaching 11 percent of drug injectors. Two factors were independently correlated with WPDI: drug injection in the 30 days before the current incarceration (AOR=12.6; 95%CI=3.3-48.9) and having hepatitis C infection (AOR: 10.1; 95%CI=2.5-41.0). Originality/value This study is the only examination of WPDI from a nationally representative survey of prisoners where both MMT and NSP are available in prisons and in a region where HIV incidence and mortality are increasing. WPDI levels were extraordinarily high in the presence of low uptake of prison-based MMT. Interventions that effectively scale-up MMT are urgently required as well as an investigation of the environmental factors that contribute to the interplay between MMT and WPDI.
Collapse
Affiliation(s)
- Lyuba Azbel
- Yale University , New Haven, Connecticut, USA
| | | | | | - Chethan Bachireddy
- University of Pennsylvania Department of Medicine , Philadelphia, Pennsylvania, USA
| | | | - Natalya Shumskaya
- AIDS Foundation East-West in the Kyrgyz Republic, Bishkek, Kyrgystan
| | | | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Medicine at the School of Medicine, Yale University , New Haven, Connecticut, USA
| |
Collapse
|
16
|
Chandra D, Bazazi AR, Nahaboo Solim MA, Kamarulzaman A, Altice FL, Culbert GJ. Retention in clinical trials after prison release: results from a clinical trial with incarcerated men with HIV and opioid dependence in Malaysia. HIV Res Clin Pract 2019; 20:12-23. [PMID: 31303149 PMCID: PMC6698147 DOI: 10.1080/15284336.2019.1603433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 01/09/2023]
Abstract
Background: Study retention is a major challenge in HIV clinical trials conducted with persons recruited from correctional facilities. Objective: To examine study retention in a trial of within-prison methadone initiation and a behavioral intervention among incarcerated men with HIV and opioid dependence in Malaysia. Methods: In this 2x2 factorial trial, 296 incarcerated men with HIV and opioid dependence were allocated to (1) an HIV risk reduction intervention, the Holistic Health Recovery Program for Malaysia (HHRP-M), (2) pre-release methadone initiation, (3) both interventions, or (4) standard care (NCT02396979). Here we estimate effects of these interventions on linkage to the study after prison release and completion of post-release study visits. Results: Most participants (68.9%) completed at least one post-release study visit but few (18.6%) completed all 12. HHRP-M was associated with a 13.5% (95% confidence interval (CI): 3.8%, 23.2%) increased probability of completing at least one post-release study visit. Although not associated with initial linkage, methadone treatment was associated with an 11% (95% CI: 2.0%, 20.6%) increased probability of completing all twelve post-release study visits. Being subject to forced relocation outside Kuala Lumpur after prison release decreased retention by 43.3% (95% CI: -51.9%, -34.8%). Conclusion: Retaining study participants in HIV clinical trials following prison release is challenging and potentially related to the broader challenges that participants experience during community reentry. Researchers conducting clinical trials with this population may want to consider methadone and HHRP as means to improve post-release retention, even in clinical trials where these interventions are not being directly evaluated.
Collapse
Affiliation(s)
- Divya Chandra
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA
| | - Alexander R. Bazazi
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L. Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
| | - Gabriel J. Culbert
- Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
- Center for HIV/AIDS Nursing Research, Universitas Indonesia, Faculty of Nursing, Depok, Indonesia
| |
Collapse
|
17
|
Abstract
BACKGROUND Employment is a central component of economic independence and is widely viewed as an essential element of social control. Whether frequent drug use reduces the likelihood of employment or obstructs hours worked, wages, and job commitment is therefore an important question about which there remains uncertainty. METHODS We improve on shortcomings of prior research through a monthly within-person analysis of a population at high-risk of both drug use and poor employment outcomes. We present multilevel models of the 18 months spent on the street preceding the arrest that led to incarceration in minimum/medium security facilities in Ohio from a random sample of 250 adult male inmates interviewed during the outset of a prison spell. RESULTS The analysis reveals consistently strong, negative effects of frequent drug use on employment, hours worked, and wages in the month following frequent drug use, including marijuana, cocaine, heroin, and prescription opioids. As well, frequent drug use (with the exception of marijuana) undermines job commitment during the months that participants are employed. CONCLUSIONS The consequences of frequent drug use for future employment are consistently negative within this criminal justice sample. Results suggest that lower levels of drug use may improve the success of postrelease employment programs. In a context of increasing concern over rising opioid and heroin, but also cocaine and marijuana abuse, the findings suggest a renewed focus on and perhaps expansion of evidence-based drug treatment among populations embedded within the criminal justice system, particularly if employment constrains criminal behavior.
Collapse
Affiliation(s)
- Paul E. Bellair
- The Ohio State University, 124 Townshend Hall, 1885 Neil Ave Mall, Columbus, OH 43210
| | - Mike Vuolo
- The Ohio State University, 109 Townshend Hall, 1885 Neil Ave Mall, Columbus, OH 43210, , 614-292-3646 (office)
| | - Eric G. LaPlant
- The Ohio State University, 223A Townshend Hall, 1885 Neil Ave Mall, Columbus, OH 43210, , 614-292-6681 (office)
| |
Collapse
|
18
|
Li DJ, Chung KS, Wu HC, Hsu CY, Yen CF. Factors affecting the dose of methadone among patients receiving methadone maintenance therapy in Taiwan. Am J Addict 2018; 27:225-230. [DOI: 10.1111/ajad.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dian-Jeng Li
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Kuan-Shang Chung
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Hung-Chi Wu
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Cheng-Fang Yen
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Psychiatry; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| |
Collapse
|
19
|
Bick J, Culbert G, Al-Darraji HA, Koh C, Pillai V, Kamarulzaman A, Altice F. Healthcare resources are inadequate to address the burden of illness among HIV-infected male prisoners in Malaysia. Int J Prison Health 2017; 12:253-269. [PMID: 27921633 DOI: 10.1108/ijph-06-2016-0017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ μL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.
Collapse
Affiliation(s)
- Joseph Bick
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.,California Medical Facility, California Correctional Health Care Services, Vacaville, California, USA
| | - Gabriel Culbert
- Department of Health Systems Science, University of Illinois at Chicago , College of Nursing, Chicago, Illinois, USA
| | - Haider A Al-Darraji
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.,Centre for International Health, Department of Preventive and Social Medicine, University of Otago , Dunedin, New Zealand
| | - Clayton Koh
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia
| | - Frederick Altice
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur, Malaysia.,Department of Internal Medicine, Yale University School of Medicine , Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA.,Division of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven, Connecticut, USA
| |
Collapse
|
20
|
Mukherjee TI, Pillai V, Ali SH, Altice FL, Kamarulzaman A, Wickersham JA. Evaluation of a hepatitis C education intervention with clients enrolled in methadone maintenance and needle/syringe programs in Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:144-152. [PMID: 28652072 DOI: 10.1016/j.drugpo.2017.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Approximately 40%-90% of people who inject drugs (PWID) in Malaysia have hepatitis C (HCV). PWID continue to be disproportionately affected by HCV due to their lack of knowledge, perceived risk and interest in HCV treatment. Education interventions may be an effective strategy for increasing HCV knowledge in PWID, and harm reduction services are uniquely positioned to implement and deploy such interventions. METHODS We recruited 176 clients from methadone maintenance treatment (MMT: N=110) and needle/syringe programs (NSP: N=66) between November 2015 and August 2016. After baseline knowledge assessments, clients participated in a standardized, 45-min HCV education program and completed post-intervention knowledge assessments to measure change in knowledge and treatment interest. RESULTS Participants were mostly male (96.3%), Malay (94.9%), and in their early 40s (mean=42.6years). Following the intervention, overall knowledge scores and treatment interest in MMT clients increased by 68% and 16%, respectively (p<0.001). In contrast, NSP clients showed no significant improvement in overall knowledge or treatment interest, and perceived greater treatment barriers. Multivariate linear regression to assess correlates of HCV knowledge post-intervention revealed that optimal dosage of MMT and having had an HIV test in the past year significantly increased HCV knowledge. Having received a hepatitis B vaccine, however, was not associated with increased HCV knowledge after participating in an education session. CONCLUSION Generally, HCV knowledge and screening is low among clients engaged in MMT and NSP services in Malaysia. Integrating a brief, but comprehensive HCV education session within harm reduction services may be a low-cost and effective strategy in improving overall HCV knowledge and risk behaviors in resource-limited settings. In order to be an effective public health approach, however, education interventions must be paired with strategies that improve social, economic and political outcomes for PWID. Doing so may reduce HCV disparities by increasing screening and treatment interest.
Collapse
Affiliation(s)
- Trena I Mukherjee
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Hafizah Ali
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale 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, Division of Epidemiology of Microbial Diseases, CT, USA
| | - Adeeba Kamarulzaman
- Yale 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
| | - Jeffrey A Wickersham
- Yale 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.
| |
Collapse
|
21
|
Factor Predictive of 1-Year Retention on Methadone Maintenance Therapy Program: A Survival Analysis Study. ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Bazazi AR, Wickersham JA, Wegman MP, Culbert GJ, Pillai V, Shrestha R, Al-Darraji H, Copenhaver MM, Kamarulzaman A, Altice FL. Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia. Contemp Clin Trials 2017; 59:1-12. [PMID: 28479216 DOI: 10.1016/j.cct.2017.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/13/2017] [Accepted: 05/03/2017] [Indexed: 12/13/2022]
Abstract
Incarcerated people living with HIV and opioid dependence face enormous challenges to accessing evidence-based treatment during incarceration and after release into the community, placing them at risk of poor HIV treatment outcomes, relapse to opioid use and accompanying HIV transmission risk behaviors. Here we describe in detail the design and implementation of Project Harapan, a prospective clinical trial conducted among people living with HIV and opioid dependence who transitioned from prison to the community in Malaysia from 2010 to 2014. This trial involved 2 interventions: within-prison initiation of methadone maintenance therapy and an evidence-based behavioral intervention adapted to the Malaysian context (the Holistic Health Recovery Program for Malaysia, HHRP-M). Individuals were recruited and received the interventions while incarcerated and were followed for 12months after release to assess post-release HIV transmission risk behaviors and a range of other health-related outcomes. Project Harapan was designed as a fully randomized 2×2 factorial trial where individuals would be allocated in equal proportions to methadone maintenance therapy and HHRP-M, methadone maintenance therapy alone, HHRP-M alone, or control. Partway through study implementation, allocation to methadone maintenance therapy was changed from randomization to participant choice; randomization to HHRP-M continued throughout. We describe the justification for this study; the development and implementation of these interventions; changes to the protocol; and screening, enrollment, treatment receipt, and retention of study participants. Logistical, ethical, and analytic issues associated with the implementation of this study are discussed.
Collapse
Affiliation(s)
- Alexander R Bazazi
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA; Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| | - Martin P Wegman
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University of Florida College of Medicine, Department of Health Outcomes and Policy, Gainesville, FL, USA
| | - Gabriel J Culbert
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University of Illinois at Chicago College of Nursing, Department of Health Systems Science, Chicago, IL, USA
| | - Veena Pillai
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| | - Roman Shrestha
- University of Connecticut Health Center, Department of Community Medicine & Health Care, Farmington, CT, USA; University of Connecticut, Department of Allied Health Sciences, Storrs, CT, USA
| | - Haider Al-Darraji
- University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia; Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Michael M Copenhaver
- University of Illinois at Chicago College of Nursing, Department of Health Systems Science, Chicago, IL, USA
| | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA; Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| |
Collapse
|
23
|
Majer JM, Harris JC, Jason LA. An Examination of Women Ex-Offenders With Methadone Histories. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2017; 61:711-723. [PMID: 26275413 PMCID: PMC5553198 DOI: 10.1177/0306624x15600834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Criminal (drug and prostitution) charges, employment levels (weekly hours), recent substance use in the past 6 months, and primary sources of income were examined among a sample ( n = 106) of women ex-offenders who had opioid use disorders with and without methadone histories. A general linear model was tested to examine differences in relation to methadone use history. Results from a one-way MANCOVA found that those with methadone histories reported significantly higher levels of drug and prostitution charges than those without any methadone history, but no significant differences in terms of weekly hours of employment or recent substance use were observed between groups. Women ex-offenders with methadone histories reported various sources of income beyond employment, and proportionally, more of these women reported prostitution as a primary source of income. Findings suggest that methadone maintenance treatments are not sufficient in meeting the needs of women ex-offenders.
Collapse
|
24
|
Luo X, Gong X, Zhao P, Zou X, Chen W, Ling L. Re-entry and related predictors among HIV-infected clients receiving methadone maintenance treatment in Guangdong province, China. Biosci Trends 2017; 11:282-291. [PMID: 28420822 DOI: 10.5582/bst.2016.01236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examined the re-entry characteristics and related predictors among HIV-infected methadone maintenance treatment (MMT) clients in Guangdong, China. Data on HIV-infected MMT clients was obtained from the clinic MMT registration system in Guangdong. Of the 653 participants, only 9.0% remained in the MMT program until the end of the study. For the drop-outs, 70.0% returned to MMT at least once by the end of the study. Re-entry was independently associated with marital status (ORnever married = 2.24, 95% CI: 1.02-4.93; ORmarried currently = 2.34, 95% CI: 1.05-5.22), being unemployed (OR = 1.92, 95% CI: 1.12-3.27), lower positive percentages of urine tests (OR<40% = 4.08, 95% CI: 2.21-7.54; OR40%-80% = 2.52, 95% CI: 1.39-4.56), higher maintenance doses (OR = 3.78, 95% CI: 2.21-7.54)and poorer MMT attendance percentages (OR<20% = 282.02, 95% CI: 62.75-1268.11; OR20-49% = 20.75, 95% CI: 10.52-40.93; OR50-79% = 6.07, 95% CI: 3.44-10.73). A higher re-entry frequency was independently associated with lower education level (ORjunior high school = 0.49, 95% CI: 0.26-0.93), average drug use times less than twice (OR = 0.64, 95% CI: 0.41-1.00), lower positive percentages of urine tests (OR = 0.39, 95% CI: 0.22-0.70) and poorer percentages of MMT attendance (OR<20% = 7.24, 95% CI: 2.99-17.55; OR20-49% = 14.30, 95% CI: 5.94-34.42; OR50-79% = 6.15, 95% CI: 2.55-14.85). Re-entry and repeated re-entry were prevalent among HIV-infected MMT clients in Guangdong, underscoring the urgent needs of tailored interventions and health education programs for this population.
Collapse
Affiliation(s)
- Xiaofeng Luo
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University
| | - Xiao Gong
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University
| | - Peizhen Zhao
- Guangdong Provincial Center for Skin Disease and STI Control
| | - Xia Zou
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University
| |
Collapse
|
25
|
Roncero C, Fuster D, Palma-Álvarez RF, Rodriguez-Cintas L, Martinez-Luna N, Álvarez FJ. HIV And HCV infection among opiate-dependent patients and methadone doses: the PROTEUS study. AIDS Care 2017; 29:1551-1556. [DOI: 10.1080/09540121.2017.1313384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Carlos Roncero
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d’Hebron University Hospital- Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Daniel Fuster
- Department of Medicine, Universidad Autónoma de Barcelona, Internal Medicine Service, Badalona (Barcelona), Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Raul Felipe Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d’Hebron University Hospital- Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Laia Rodriguez-Cintas
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d’Hebron University Hospital- Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nieves Martinez-Luna
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d’Hebron University Hospital- Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - F. Javier Álvarez
- Departament of Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| |
Collapse
|
26
|
A Self-Report Measure to Detect Neurocognitive Impairment among Incarcerated People Living with HIV in Malaysian Context: An Exploratory Factor Analysis. Int J Ment Health Addict 2017; 15:812-825. [PMID: 29051714 DOI: 10.1007/s11469-017-9752-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
While neurocognitive impairment (NCI) among people living with HIV (PLWH) who use drugs and its impact on HIV treatment outcomes continue to be widely investigated, there remains a critical gap in NCI assessment among HIV-infected people who use drugs (PWUD) in Malaysian context. The present study, therefore, sought to improve the utility of the existing Neuropsychological Impairment Scale (NIS) as a screening tool for assessing NCI by establishing its psychometric properties in the Malaysian context. The NIS is a brief, self-report measure originally designed to assess NCI by having individuals rate a range of items that may influence cognitive functioning. HIV-infected male prisoners (N=301) administered the full 95-item NIS. An exploratory factor analysis (EFA) was conducted using principal axis factoring and orthogonal varimax rotation. Reliability was measured using Cronbach's alpha. The EFA resulted in an abbreviated, psychometrically sound, eight-factor structure (54-item) revised NIS - now referred to as the Brief Inventory of Neuro-cognitive Impairment-Malaysia (BINI-M). It is better designed to detect NCI in PLWH, ranging from generalized neurocognitive symptoms to more specific forms of impairment with excellent to average reliability. The BINI-M may serve as a useful tool for clinicians and researchers to assess NCI in PLWH and can inform enhanced treatment strategies in the Malaysian context.
Collapse
|
27
|
The Influence of Neurocognitive Impairment, Depression, and Alcohol Use Disorders on Health-Related Quality of Life among Incarcerated, HIV-Infected, Opioid Dependent Malaysian Men: A Moderated Mediation Analysis. AIDS Behav 2017; 21:1070-1081. [PMID: 27544515 DOI: 10.1007/s10461-016-1526-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Prior research has widely recognized neurocognitive impairment (NCI), depression, and alcohol use disorders (AUDs) as important negative predictors of health-related quality of life (HRQoL) among people living with HIV (PLWH). No studies to date, however, have explored how these neuropsychological factors operate together and affect HRQoL. Incarcerated male PLWH (N = 301) meeting criteria for opioid dependence were recruited from Malaysia's largest prison. Standardized scales for NCI, depression, alcohol use disorders (AUDs) and HRQoL were used to conduct a moderated mediation model to explore the extent to which depression mediated the relationship between NCI, HRQoL, and AUDs using an ordinary least squares regression-based path analytic framework. Results showed that increasing levels of NCI (B = -0.1773, p < 0.001) and depression (B = -0.6147, p < 0.001) were negatively associated with HRQoL. The effect of NCI on HRQoL was significantly (Sobel z = -3.5600, p < 0.001) mediated via depression (B = -0.1230, p < 0.001). Furthermore, the conditional indirect effect of NCI on HRQoL via depression for individuals with AUDs was significant (B = -0.9099, p = 0.0087), suggesting a moderated mediation effect. The findings disentangle the complex relationship using a moderated mediation model, demonstrating that increasing levels of NCI, which can be reduced with HIV treatment, negatively influenced HRQoL via depression for individuals with AUDs. This highlights the need for future interventions to target these complex interplay between neuropsychological factors in order to improve HRQoL among PLWH, particularly incarcerated PLWH with AUDs.
Collapse
|
28
|
Shrestha R, Copenhaver M, Bazazi AR, Huedo-Medina TB, Krishnan A, Altice FL. A Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence. AIDS Behav 2017; 21:1059-1069. [PMID: 28108877 DOI: 10.1007/s10461-017-1693-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although it is well established that HIV-related stigma, depression, and lack of social support are negatively associated with health-related quality of life (HRQoL) among people living with HIV (PLH), no studies to date have examined how these psychosocial factors interact with each other and affect HRQoL among incarcerated PLH. We, therefore, incorporated a moderated mediation model (MMM) to explore whether depression mediates the effect of HIV-related stigma on HRQoL as a function of the underlying level of social support. Incarcerated HIV-infected men with opioid dependence (N = 301) were recruited from the HIV units in Kajang prison in Malaysia. Participants completed surveys assessing demographic characteristics, HIV-related stigma, depression, social support, and HRQoL. Results showed that the effect of HIV-related stigma on HRQoL was mediated via depression (a1:β = 0.1463, p < 0.001; b1:β = -0.8392, p < 0.001), as demonstrated by the two-tailed significance test (Sobel z = -3.8762, p < 0.001). Furthermore, the association between social support and HRQoL was positive (β = 0.4352, p = 0.0433), whereas the interaction between HIV-related stigma and depression was negatively associated with HRQOL (β = -0.0317, p = 0.0133). This indicated that the predicted influence of HIV-related stigma on HRQoL via depression had negative effect on HRQoL for individuals with low social support. The results suggest that social support can buffer the negative impact of depression on HRQoL and highlights the need for future interventions to target these psychosocial factors in order to improve HRQoL among incarcerated PLH.
Collapse
Affiliation(s)
- Roman Shrestha
- Department of Community Medicine & Health Care, University of Connecticut Health Center, 263 Farmington Avenue, MC 6325, Farmington, CT, 06030-6325, USA.
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA.
| | - Michael Copenhaver
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Alexander R Bazazi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
| | - Tania B Huedo-Medina
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Archana Krishnan
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
- Department of Communication, University at Albany, State University of New York, Albany, USA
| | - Frederick L Altice
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
- Department of Communication, University at Albany, State University of New York, Albany, USA
| |
Collapse
|
29
|
Wegman MP, Altice FL, Kaur S, Rajandaran V, Osornprasop S, Wilson D, Wilson DP, Kamarulzaman A. Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study. Lancet Glob Health 2017; 5:e198-e207. [PMID: 27964869 PMCID: PMC5657487 DOI: 10.1016/s2214-109x(16)30303-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs. METHODS We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confirmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098). FINDINGS Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse 31 days [IQR 26-32] vs 352 days [256-unestimable], log rank test, p<0·0001). VTC participants had an 84% (95% CI 75-90) decreased risk of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying effect modelling revealed the largest hazard ratio reduction, at 91% (95% CI 83-96), occurs during the first 50 days in the community. INTERPRETATION Opioid-dependent individuals in CDDCs are significantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatments such as methadone, suggesting that CDDCs have no role in the treatment of opioid-use disorders. FUNDING The World Bank Group, Doris Duke Charitable Foundation, National Institute on Drug Abuse, Australian National Health & Medical Research Council, National Institute of Mental Health, and the University of Malaya-Malaysian Ministry of Higher Education High Impact Research Grant.
Collapse
Affiliation(s)
- Martin P Wegman
- Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Florida College of Medicine, Gainesville, FL, USA
| | - Frederick L Altice
- Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Vanesa Rajandaran
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Adeeba Kamarulzaman
- Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
30
|
Ferro EG, Culbert GJ, Wickersham JA, Marcus R, Steffen AD, Pauls HA, Westergaard RP, Lee CK, Kamarulzaman A, Altice FL. Physician Decisions to Defer Antiretroviral Therapy in Key Populations: Implications for Reducing Human Immunodeficiency Virus Incidence and Mortality in Malaysia. Open Forum Infect Dis 2017; 4:ofw219. [PMID: 28480230 PMCID: PMC5414088 DOI: 10.1093/ofid/ofw219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is recommended for all people living with human immunodeficiency virus (HIV), yet physician attitudes and prescribing behaviors toward members of key risk populations may limit ART access and undermine treatment as prevention strategies. METHODS Physicians in Malaysia (N = 214) who prescribe antiretroviral therapy (ART) responded in an Internet-based survey to hypothetical clinical scenarios of HIV patients, varying by key risk population and CD4+ T-cell count, on whether they would initiate or defer ART compared with a control patient with sexually acquired HIV. RESULTS The proportion of physicians who would defer ART in patients with advanced HIV (CD4 = 17 cells/μL) was significantly higher (P < .0001) for 4 key populations, including people who inject drugs ([PWID] 45.3%) or consume alcohol (42.1%), released prisoners (35.0%), and those lacking social support (26.6%), compared with a control patient (4.2%). People who inject drugs with advanced HIV (CD4 = 17 cells/μL) were 19-fold (adjusted odds ratio [AOR] = 18.9; 95% confidence interval [CI], 9.8-36.5) more likely to have ART deferred compared with the control. This effect was partially mitigated for PWID receiving methadone (AOR = 2.9; 95% CI, 1.5-5.7). At the highest CD4+ T-cell count (CD4 = 470 cells/μL), sex workers (AOR = 0.55; 95% CI, .44-.70) and patients with an HIV-uninfected sexual partner (AOR = 0.43; 95% CI, .34-.57) were significantly less likely to have ART deferred. CONCLUSIONS Physicians who prescribe antiretroviral therapy in Malaysia may defer ART in some key populations including PWID and released prisoners, regardless of CD4+ T-cell count, which may help to explain very low rates of ART coverage among PWID in Malaysia. Reducing HIV incidence and mortality in Malaysia, where HIV is concentrated in PWID and other key populations, requires clinician-level interventions and monitoring physician adherence to international evidence-based treatment guidelines.
Collapse
Affiliation(s)
- Enrico G Ferro
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut; University of Illinois at Chicago, College of Nursing
| | | | - Jeffrey A Wickersham
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut; University of Illinois at Chicago, College of Nursing
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Malaysia
| | - Ruthanne Marcus
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut; University of Illinois at Chicago, College of Nursing
| | - Alana D Steffen
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut; University of Illinois at Chicago, College of Nursing
| | | | | | - Christopher K Lee
- Department of Medicine, Hospital Sungai Buloh, Jalan Hospital, Selangor, Malaysia
| | - Adeeba Kamarulzaman
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut; University of Illinois at Chicago, College of Nursing
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Malaysia
| | - Frederick L Altice
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut; University of Illinois at Chicago, College of Nursing
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Malaysia
- Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, Connecticut
| |
Collapse
|
31
|
Polonsky M, Rozanova J, Azbel L, Bachireddy C, Izenberg J, Kiriazova T, Dvoryak S, Altice FL. Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators. AIDS Behav 2016; 20:2950-2960. [PMID: 27011378 PMCID: PMC5035551 DOI: 10.1007/s10461-016-1375-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this study, we use data from a survey conducted in Ukraine among 196 HIV-infected people who inject drugs, to explore attitudes toward drug addiction and methadone maintenance therapy (MMT), and intentions to change drug use during incarceration and after release from prison. Two groups were recruited: Group 1 (n = 99) was currently incarcerated and Group 2 (n = 97) had been recently released from prison. This paper's key finding is that MMT treatment and addiction recovery were predominantly viewed as mutually exclusive processes. Group comparisons showed that participants in Group 1 (pre-release) exhibited higher optimism about changing their drug use, were less likely to endorse methadone, and reported higher intention to recover from their addiction. Group 2 participants (post-release), however, reported higher rates of HIV stigma. Structural equation modeling revealed that in both groups, optimism about recovery and awareness of addiction mediated the effect of drug addiction severity on intentions to recover from their addiction.
Collapse
Affiliation(s)
- Maxim Polonsky
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Julia Rozanova
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Lyuba Azbel
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jacob Izenberg
- University of California San Francisco School of Medicine, Department of Psychiatry, San Francisco, CA, USA
| | | | - Sergii Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale School of Public health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA
| |
Collapse
|
32
|
Azbel L, Polonsky M, Wegman M, Shumskaya N, Kurmanalieva A, Asanov A, Wickersham JA, Dvoriak S, Altice FL. Intersecting epidemics of HIV, HCV, and syphilis among soon-to-be released prisoners in Kyrgyzstan: Implications for prevention and treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:9-20. [PMID: 27455177 PMCID: PMC5124506 DOI: 10.1016/j.drugpo.2016.06.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/31/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Central Asia is afflicted with increasing HIV incidence, low antiretroviral therapy (ART) coverage and increasing AIDS mortality, driven primarily by people who inject drugs (PWID). Reliable data about HIV, other infectious diseases, and substance use disorders in prisoners in this region is lacking and could provide important insights into how to improve HIV prevention and treatment efforts in the region. METHODS A randomly sampled, nationwide biobehavioural health survey was conducted in 8 prisons in Kyrgyzstan among all soon-to-be-released prisoners; women were oversampled. Consented participants underwent computer-assisted, standardized behavioural health assessment surveys and testing for HIV, HCV, HBV, and syphilis. Prevalence and means were computed, and generalized linear modelling was conducted, with all analyses using weights to account for disproportionate sampling by strata. RESULTS Among 381 prisoners who underwent consent procedures, 368 (96.6%) were enrolled in the study. Women were significantly older than men (40.6 vs. 36.5; p=0.004). Weighted prevalence (%), with confidence interval (CI), for each infection was high: HCV (49.7%; CI: 44.8-54.6%), syphilis (19.2%; CI: 15.1-23.5%), HIV (10.3%; CI: 6.9-13.8%), and HBV (6.2%; CI: 3.6-8.9%). Among the 31 people with HIV, 46.5% were aware of being HIV-infected. Men, compared to women, were significantly more likely to have injected drugs (38.3% vs.16.0%; p=0.001). Pre-incarceration and within-prison drug injection, primarily of opioids, was 35.4% and 30.8%, respectively. Independent correlates of HIV infection included lifetime drug injection (adjusted odds ratio [AOR]=38.75; p=0.001), mean number of years injecting (AOR=0.93; p=0.018), mean number of days experiencing drug problems (AOR=1.09; p=0.025), increasing duration of imprisonment (AOR=1.08; p=0.02 for each year) and having syphilis (AOR=3.51; p=0.003), while being female (AOR=3.06; p=0.004) and being a recidivist offender (AOR=2.67; p=0.008) were independently correlated with syphilis infection. CONCLUSION Drug injection, syphilis co-infection, and exposure to increased risk during incarceration are likely to be important contributors to HIV transmission among prisoners in Kyrgyzstan. Compared to the community, HIV is concentrated 34-fold higher in prisoners. A high proportion of undiagnosed syphilis and HIV infections presents a significant gap in the HIV care continuum. Findings highlight the critical importance of evidence-based responses within prison, including enhanced testing for HIV and sexually transmitted infections, to stem the evolving HIV epidemic in the region.
Collapse
Affiliation(s)
- Lyuba Azbel
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Maxim Polonsky
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Martin Wegman
- University of Florida, Departments of Epidemiology and of Health Outcomes and Policy, Gainesville, FL, USA
| | - Natalya Shumskaya
- AIDS Foundation East-West in the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | | | - Akylbek Asanov
- Department for Medical and Sanitary Services of the State Service on Penalty Execution, Kyrgyzstan
| | - Jeffrey A Wickersham
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.
| |
Collapse
|
33
|
Altice FL, Azbel L, Stone J, Brooks-Pollock E, Smyrnov P, Dvoriak S, Taxman FS, El-Bassel N, Martin NK, Booth R, Stöver H, Dolan K, Vickerman P. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia. Lancet 2016; 388:1228-48. [PMID: 27427455 PMCID: PMC5087988 DOI: 10.1016/s0140-6736(16)30856-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes-with neither available in prisons-despite the country's high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28-55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.
Collapse
Affiliation(s)
- Frederick L Altice
- School of Medicine and School Public Health, Yale University, New Haven, CT, USA.
| | - Lyuba Azbel
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack Stone
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | | | - Pavlo Smyrnov
- ICF International Alliance for Public Health, Kiev, Ukraine
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - Faye S Taxman
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
| | | | - Natasha K Martin
- School of Social and Community Medicine, Bristol University, Bristol, UK; Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Robert Booth
- Department of Psychiatry, University of Colorado, Denver, CO, USA
| | - Heino Stöver
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Kate Dolan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol University, Bristol, UK
| |
Collapse
|
34
|
Kamarulzaman A, Reid SE, Schwitters A, Wiessing L, El-Bassel N, Dolan K, Moazen B, Wirtz AL, Verster A, Altice FL. Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners. Lancet 2016; 388:1115-1126. [PMID: 27427456 DOI: 10.1016/s0140-6736(16)30769-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis are higher in prisons than in the general population in most countries worldwide. Prisons have emerged as a risk environment for these infections to be further concentrated, amplified, and then transmitted to the community after prisoners are released. In the absence of alternatives to incarceration, prisons and detention facilities could be leveraged to promote primary and secondary prevention strategies for these infections to improve prisoners health and reduce risk throughout incarceration and on release. Effective treatment of opioid use disorders with opioid agonist therapies (eg, methadone and buprenorphine) prevents blood-borne infections via reductions in injection in prison and after release. However, large gaps exist in the implementation of these strategies across all regions. Collaboration between the criminal justice and public health systems will be required for successful implementation of these strategies.
Collapse
Affiliation(s)
- Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, New Haven, CT, USA.
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | | | - Kate Dolan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Babak Moazen
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Frederick L Altice
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
35
|
Culbert GJ, Pillai V, Bick J, Al-Darraji HA, Wickersham JA, Wegman MP, Bazazi AR, Ferro E, Copenhaver M, Kamarulzaman A, Altice FL. Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia. J Neuroimmune Pharmacol 2016; 11:446-55. [PMID: 27216260 PMCID: PMC5118227 DOI: 10.1007/s11481-016-9676-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/22/2016] [Indexed: 12/17/2022]
Abstract
Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs (PWID) and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the negative synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a 'perfect storm' of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent PWID. Although promoted by official policy, evidence-based addiction treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80 % of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, amplifying the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced morbidity and mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0 % and 75.7 %, respectively. We discuss the further deployment of these interventions in Malaysian prisons.
Collapse
Affiliation(s)
- Gabriel J Culbert
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Joseph Bick
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Haider A Al-Darraji
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jeffrey A Wickersham
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA
| | - Martin P Wegman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alexander R Bazazi
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Enrico Ferro
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA.
- Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA.
| |
Collapse
|
36
|
Brown SE, Wickersham JA, Pelletier AR, Marcus RM, Erenrich R, Kamarulzaman A, Altice FL. Attitudes toward medication-assisted treatment among fishermen in Kuantan, Malaysia, who inject drugs. J Ethn Subst Abuse 2016; 16:363-379. [PMID: 27404914 DOI: 10.1080/15332640.2016.1196632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fishermen who inject drugs represent an understudied group at high risk for HIV in Malaysia. This study describes fishing, drug use, and attitudes toward medication-assisted treatment (MAT) for opioid use disorders. Thirty-four male ethnic Malay fishermen completed semistructured interviews analyzed by content analysis. Analysis revealed four themes surrounding opioids, which they called ubat ("medicine"): (a) the fishing lifestyle facilitating substance use, (b) previous unsuccessful attempts to quit, (c) categorizing substances as haram or halal, and (d) attitudes toward MAT. Fishermen's environment permits substance use, including injecting drugs on boats. Fishermen expressed more positive attitudes toward methadone and negative attitudes toward buprenorphine.
Collapse
Affiliation(s)
| | - Jeffrey A Wickersham
- a Yale University School of Medicine , New Haven , Connecticut.,b University of Malaya , Kuala Lumpur , Malaysia
| | | | | | | | - Adeeba Kamarulzaman
- a Yale University School of Medicine , New Haven , Connecticut.,b University of Malaya , Kuala Lumpur , Malaysia
| | - Frederick L Altice
- a Yale University School of Medicine , New Haven , Connecticut.,b University of Malaya , Kuala Lumpur , Malaysia.,e Yale University School of Public Health , New Haven , Connecticut
| |
Collapse
|
37
|
Bojko MJ, Mazhnaya A, Marcus R, Makarenko I, Islam Z, Filippovych S, Dvoriak S, Altice FL. The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment. J Subst Abuse Treat 2016; 66:37-47. [PMID: 27211995 PMCID: PMC4919997 DOI: 10.1016/j.jsat.2016.03.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/03/2016] [Accepted: 03/13/2016] [Indexed: 12/22/2022]
Abstract
Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.
Collapse
Affiliation(s)
- Martha J Bojko
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | | | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
38
|
Schwartz RP, Kelly SM, Mitchell SG, Dunlap L, Zarkin GA, Sharma A, O'Grady KE, Jaffe JH. Interim methadone and patient navigation in jail: Rationale and design of a randomized clinical trial. Contemp Clin Trials 2016; 49:21-8. [PMID: 27282117 PMCID: PMC4969178 DOI: 10.1016/j.cct.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Methadone maintenance is an effective treatment for opioid dependence but is rarely initiated in US jails. Patient navigation is a promising approach to improve continuity of care but has not been tested in bridging the gap between jail- and community-based drug treatment programs. METHODS This is an open-label randomized clinical trial among 300 adult opioid dependent newly-arrested detainees that will compare three treatment conditions: methadone maintenance without routine counseling (termed Interim Methadone; IM) initiated in jail v. IM and patient navigation v. enhanced treatment-as-usual. The two primary outcomes will be: (1) the rate of entry into treatment for opioid use disorder within 30days from release and (2) frequency of opioid positive urine tests over the 12-month follow-up period. An economic analysis will examine the costs, cost-effectiveness, and cost-benefit ratio of the study interventions. RESULTS We describe the background and rationale for the study, its aims, hypotheses, and study design. CONCLUSIONS Given the large number of opioid dependent detainees in the US and elsewhere, initiating IM at the time of incarceration could be a significant public health and clinical approach to reducing relapse, recidivism, HIV-risk behavior, and criminal behavior. An economic analysis will be conducted to assist policy makers in determining the utility of adopting this approach. ClinicalTrials.gov: NCT02334215.
Collapse
Affiliation(s)
| | | | | | - Laura Dunlap
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Jerome H Jaffe
- Friends Research Institute, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
39
|
Mukherjee TI, Wickersham JA, Desai MM, Pillai V, Kamarulzaman A, Altice FL. Factors associated with interest in receiving prison-based methadone maintenance therapy in Malaysia. Drug Alcohol Depend 2016; 164:120-127. [PMID: 27207155 PMCID: PMC5592792 DOI: 10.1016/j.drugalcdep.2016.04.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Methadone maintenance therapy (MMT) is crucial for HIV prevention and treatment in people who inject opioids. In Malaysia, a large proportion of the prison population is affected by both HIV and opioid use disorders. This study assessed individual preferences and factors associated with interest in receiving MMT among male prisoners meeting criteria for opioid dependence in Malaysia. METHODS A convenience sample of 96 HIV-positive and 104 HIV-negative incarcerated men who met pre-incarceration criteria for opioid dependence was interviewed using a structured questionnaire to examine participant characteristics and attitudes toward MMT. Factors associated with interest in prison-based MMT initiation were identified using logistic regression analysis. RESULTS Among all participants, 85 (42.5%) were interested in receiving MMT within prison. Independent correlates of interest in prison-based MMT were being previously married (AOR=4.15, 95% CI: 1.15, 15.02), previously incarcerated (AOR=5.68, 95% CI: 1.54, 21.02), depression (AOR=3.66, 95% CI: 1.68, 7.98), daily heroin use in the 30days prior to incarceration (AOR=5.53, 95% CI: 1.65, 18.58), and more favorable attitudes toward MMT (AOR=19.82, 95% CI: 6.07, 64.74). CONCLUSIONS Overall, interest in receiving prison-based MMT was low, and was associated with adverse social, mental health, and drug use consequences. Incarceration provides a unique opportunity to initiate MMT for those who need it, however, optimal scale-up efforts must be systemic and address modifiable factors like improving attitudes toward and motivation for MMT. Informed or shared decision-making tools may be useful in improving expectations and acceptability of MMT.
Collapse
Affiliation(s)
- Trena I. Mukherjee
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | - Jeffrey A. Wickersham
- Yale 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
| | - Mayur M. Desai
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Yale 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 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 School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA,Corresponding author at: Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College St., Suite 323, New Haven, CT, USA., (F.L. Altice)
| |
Collapse
|
40
|
Pretreatment drug use characteristics and experiences among patients in a voluntary substance abuse treatment center in Malaysia: A mixed-methods approach. Subst Abus 2016; 37:542-549. [PMID: 26914230 DOI: 10.1080/08897077.2016.1146648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) centers. To best serve the needs of regional C&C centers, data on drug use are essential among patients accessing treatment. Using a mixed-methods approach, the authors examined pretreatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan-a religiously conservative state in northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns. METHODS A mixed-methods study utilizing surveys (n = 96) and semistructured interviews (n = 20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan. RESULTS Survey results showed that 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use, followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C center on drug rehabilitation. CONCLUSIONS The drug use profile of the Kelantan C&C center enrollees shows extensive pretreatment amphetamine use, polysubstance use, and injection drug use, including high-risk behaviors such as sharing needles, syringes, and containers. Evidence points to the need for integration of social support-oriented practices and behavioral interventions into the rehabilitation of drug users in this region.
Collapse
|
41
|
Mazhnaya A, Bojko MJ, Marcus R, Filippovych S, Islam Z, Dvoriak S, Altice FL. In Their Own Voices: Breaking the Vicious Cycle of Addiction, Treatment and Criminal Justice Among People who Inject Drugs in Ukraine. DRUGS (ABINGDON, ENGLAND) 2016; 23:163-175. [PMID: 27458326 PMCID: PMC4957015 DOI: 10.3109/09687637.2015.1127327] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/27/2015] [Indexed: 11/13/2022]
Abstract
AIMS To understand how perceived law enforcement policies and practices contribute to the low rates of utilization of opioid agonist therapies (OAT) among people who inject drugs (PWIDs) in Ukraine. METHODS Qualitative data from 25 focus groups (FGs) with 199 opioid-dependent PWIDs in Ukraine examined domains related to lived or learned experiences with OAT, police, arrest, incarceration, and criminal activity were analyzed using grounded theory principles. FINDINGS Most participants were male (66%), in their late 30s, and previously incarcerated (85%) mainly for drug-related activities. When imprisoned, PWIDs perceived themselves as being "addiction-free". After prison-release, the confluence of police surveillance, societal stress contributed to participants' drug use relapse, perpetuating a cycle of searching for money and drugs, followed by re-arrest and re-incarceration. Fear of police and arrest both facilitated OAT entry and simultaneously contributed to avoiding OAT since system-level requirements identified OAT clients as targets for police harassment. OAT represents an evidence-based option to 'break the cycle', however, law enforcement practices still thwart OAT capacity to improve individual and public health. CONCLUSION In the absence of structural changes in law enforcement policies and practices in Ukraine, PWIDs will continue to avoid OAT and perpetuate the addiction cycle with high imprisonment rates.
Collapse
Affiliation(s)
- Alyona Mazhnaya
- ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - Martha J. Bojko
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | | | - Sergey Dvoriak
- Ukrainian Institute for Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| |
Collapse
|
42
|
Wickersham JA, Loeliger KB, Marcus R, Pillai V, Kamarulzaman A, Altice FL. Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:98-110. [PMID: 26636885 DOI: 10.3109/00952990.2015.1101467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. OBJECTIVES To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. METHODS A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. RESULTS Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. CONCLUSION Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.
Collapse
Affiliation(s)
- Jeffrey A Wickersham
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Kelsey B Loeliger
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA
| | - Ruthanne Marcus
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA
| | - Veena Pillai
- c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Adeeba Kamarulzaman
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Frederick L Altice
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| |
Collapse
|
43
|
Vijay A, Bazazi AR, Yee I, Kamarulzaman A, Altice FL. Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia. J Subst Abuse Treat 2015; 54:29-36. [PMID: 25841703 PMCID: PMC4758679 DOI: 10.1016/j.jsat.2015.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. METHODS In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experiences with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). RESULTS All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), higher stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. CONCLUSION There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.
Collapse
Affiliation(s)
- Aishwarya Vijay
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA
| | - Alexander R Bazazi
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA; Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Ilias Yee
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA; Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, New Haven, CT 06510, USA; Yale University School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
| |
Collapse
|
44
|
Azbel L, Wickersham JA, Wegman MP, Polonsky M, Suleymanov M, Ismayilov R, Dvoryak S, Rotberga S, Altice FL. Burden of substance use disorders, mental illness, and correlates of infectious diseases among soon-to-be released prisoners in Azerbaijan. Drug Alcohol Depend 2015; 151:68-75. [PMID: 25861943 PMCID: PMC4447560 DOI: 10.1016/j.drugalcdep.2015.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities. METHODS A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis. RESULTS Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV. CONCLUSION HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.
Collapse
Affiliation(s)
- Lyuba Azbel
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Jeffrey A. Wickersham
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Martin P. Wegman
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Maxim Polonsky
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Murad Suleymanov
- Main Medical Department of the Ministry of Justice of the Azerbaijan Republic, Baku, Azerbaijan
| | - Rafik Ismayilov
- Independent Assistance and Consultancy Center “For the Sake of Civil Society”, Baku, Azerbaijan
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - Signe Rotberga
- Head of UNODC Program Office in Kazakhstan, Astana, Kazakhstan
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA,Corresponding author at: 135 College Street, Suite 323, New Haven, CT 06511, USA. Tel.: +1 203 737 2883; fax: +1 203 737 4051. (F.L. Altice)
| |
Collapse
|
45
|
Within-prison drug injection among HIV-infected male prisoners in Indonesia: a highly constrained choice. Drug Alcohol Depend 2015; 149:71-9. [PMID: 25659895 PMCID: PMC5108518 DOI: 10.1016/j.drugalcdep.2015.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/16/2015] [Accepted: 01/17/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. AIMS This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. METHODS 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. RESULTS Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥ 10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR = 3.29, 95%CI = 1.30-8.31, p = 0.011) and daily drug injection before arrest (AOR = 5.23, 95%CI = 1.42-19.25, p = 0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. CONCLUSIONS Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm.
Collapse
|
46
|
Moradi G, Farnia M, Shokoohi M, Shahbazi M, Moazen B, Rahmani K. Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran. Int J Health Policy Manag 2015; 4:583-9. [PMID: 26340487 DOI: 10.15171/ijhpm.2015.60] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/07/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As one of the most important components of harm reduction strategy for high-risk groups, following the HIV epidemics, Methadone Maintenance Treatment (MMT) has been initiated in prisoners since 2003. In this paper, we aimed to assess the advantages and shortcomings of the MMT program from the perspective of people who were involved with the delivery of prison healthcare in Iran. METHODS On the basis of grounded theory and through conducting 14 Focus Group Discussions (FGDs), 7 FGDs among physicians, consultants, experts, and 7 FGDs among directors and managers of prisons (n= 140) have been performed. The respondents were asked about positive and negative elements of the MMT program in Iranian prisons. RESULTS This study included a total of 48 themes, of which 22 themes were related to advantages and the other 26 were about shortcomings of MMT programs in the prisons. According to participants' views "reduction of illegal drug use and high-risk injection", "reduction of potentially high-risk behaviors" and "making positive attitudes" were the main advantages of MMT in prisons, while issues such as "inaccurate implementation", "lack of skilled manpower" and "poor care after release from prison" were among the main shortcomings of MMT program. CONCLUSION MMT program in Iran's prisons has achieved remarkable success in the field of harm reduction, but to obtain much more significant results, its shortcomings and weaknesses must be also taken into account by policy-makers.
Collapse
Affiliation(s)
- Ghobad Moradi
- Kurdistan Research Center for Social Determinants of Health (KRCSDH), Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Marzieh Farnia
- Iran Prisons Organization, Health and Treatment Department, Tehran, Iran
| | - Mostafa Shokoohi
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shahbazi
- GFATM Projects in Prisons, United Nations Development Program, Tehran, Iran
| | - Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khaled Rahmani
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
47
|
Milloy MJ, Montaner JSG, Wood E. Incarceration of people living with HIV/AIDS: implications for treatment-as-prevention. Curr HIV/AIDS Rep 2015; 11:308-16. [PMID: 24962285 DOI: 10.1007/s11904-014-0214-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Contact with the criminal justice system, including incarceration, is a common experience for many people living with HIV/AIDS. Optimism has recently been expressed that correctional facilities could be important locations for treatment-as-prevention (TasP)-based initiatives. We review recent findings regarding the effect of incarceration on patterns of HIV transmission, testing, treatment initiation and retention. We found that the prevalence of HIV infection among incarcerated individuals remains higher than analogous non-incarcerated populations. Recent studies have shown that voluntary HIV/AIDS testing is feasible in many correctional facilities, although the number of previously undiagnosed individuals identified has been modest. Studies have implied enhanced linkage to HIV/AIDS treatment and care in jails in the United States was associated with improvements in the HIV cascade of care. However, for many individuals living with HIV/AIDS, exposure to the correctional system remains an important barrier to retention in HIV/AIDS treatment and care. Future research should evaluate structural interventions to address these barriers and facilitate the scale-up of TasP-based efforts among individuals living in correctional settings.
Collapse
Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada,
| | | | | |
Collapse
|
48
|
Ghani MA, Brown SE, Khan F, Wickersham JA, Lim SH, Dhaliwal SK, Kamarulzaman A, Altice FL. An exploratory qualitative assessment of self-reported treatment outcomes and satisfaction among patients accessing an innovative voluntary drug treatment centre in Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:175-82. [PMID: 25577322 PMCID: PMC4291539 DOI: 10.1016/j.drugpo.2014.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 08/29/2014] [Accepted: 10/19/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND In Malaysia, compulsory drug detention centres (CDDCs) hold suspected drug users for two years without adjudication. Acute detoxification without healthcare access has been documented. CDDCs are criticized globally due to ineffectiveness in treating addiction and human rights violations. In response, the Malaysian government began transitioning these facilities into voluntary drug treatment centres known as "Cure and Care" (C&C) centres that embrace a holistic treatment-based approach to drug addiction rehabilitation. METHODS An explorative qualitative study was undertaken to explore patient perspectives and satisfaction regarding treatment and services at the new Cure and Care centre in Kota Bharu, Malaysia. A convenience sample of 20 patients was recruited to participate in semi-structured in-depth interviews. Content analysis was used to identify the salient themes. RESULTS Patients identified methadone treatment, psychosocial programs, religious instruction, and recreational activities as important factors contributing to treatment success for addressing both health and addiction needs. Though many had previously been in a CDDC, adherence to treatment in the C&C centre was perceived to be facilitated by the degree of social support, the voluntary nature and the array of new programs available for selection. CONCLUSION C&Cs represents a dramatic shift in the Malaysian government's approach to drug addiction. Our findings demonstrate positive patient experiences associated with the holistic treatment-based approach of these centres. This exploratory study provides additional evidence to document this ongoing policy transition and may guide continued expansion of new holistic drug treatment programs across the country.
Collapse
Affiliation(s)
- Mansur A Ghani
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA
| | - Shan-Estelle Brown
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA
| | - Farrah Khan
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA
| | - Jeffrey A Wickersham
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA
| | - Sin How Lim
- Centre of Excellence for Research in AIDS (CERiA), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Adeeba Kamarulzaman
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA; Centre of Excellence for Research in AIDS (CERiA), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA; Centre of Excellence for Research in AIDS (CERiA), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| |
Collapse
|
49
|
Design and methods of a double blind randomized placebo-controlled trial of extended-release naltrexone for HIV-infected, opioid dependent prisoners and jail detainees who are transitioning to the community. Contemp Clin Trials 2014; 39:256-68. [PMID: 25240704 DOI: 10.1016/j.cct.2014.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND People with opioid dependence and HIV are concentrated within criminal justice settings (CJS). Upon release, however, drug relapse is common and contributes to poor HIV treatment outcomes, increased HIV transmission risk, reincarceration and mortality. Extended-release naltrexone (XR-NTX) is an evidence-based treatment for opioid dependence, yet is not routinely available for CJS populations. METHODS A randomized, double-blind, placebo-controlled trial of XR-NTX for HIV-infected inmates transitioning from correctional to community settings is underway to assess its impact on HIV and opioid-relapse outcomes. RESULTS We describe the methods and early acceptability of this trial. In addition we provide protocol details to safely administer XR-NTX near community release and describe logistical implementation issues identified. Study acceptability was modest, with 132 (66%) persons who consented to participate from 199 total referrals. Overall, 79% of the participants had previously received opioid agonist treatment before this incarceration. Thus far, 65 (49%) of those agreeing to participate in the trial have initiated XR-NTX or placebo. Of the 134 referred patients who ultimately did not receive a first injection, the main reasons included a preference for an alternative opioid agonist treatment (37%), being ineligible (32%), not yet released (10%), and lost upon release before receiving their injection (14%). CONCLUSIONS Study findings should provide high internal validity about HIV and opioid treatment outcomes for HIV-infected prisoners transitioning to the community. The large number of patients who ultimately did not receive the study medication may raise external validity concerns due to XR-NTX acceptability and interest in opioid agonist treatments. CLINICAL TRIAL NUMBER NCT01246401.
Collapse
|
50
|
Correlates of HIV infection and being unaware of HIV status among soon-to-be-released Ukrainian prisoners. J Int AIDS Soc 2014; 17:19005. [PMID: 25216073 PMCID: PMC4161962 DOI: 10.7448/ias.17.1.19005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/15/2014] [Accepted: 08/07/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction Prisoners bear a disproportionate burden of Ukraine's volatile and transitional HIV epidemic, yet little is known in Eastern Europe about HIV testing, treatment and HIV-related risk among prisoners. Methods A nationally representative biobehavioural health survey linked with serological testing was conducted among soon-to-be released prisoners in 13 Ukrainian prisons from June to November 2011. Results Among 402 participants, 78 (19.4%) tested HIV seropositive of whom 38 (50.7%) were previously unaware of their HIV status. Independent correlates of HIV infection included drug injection (AOR=4.26; 95% CI: 2.23–8.15), female gender (AOR=2.00; 95% CI: 1.06–3.78), previous incarceration (AOR=1.99; 95% CI: 1.07–3.70) and being from Southern Ukraine (AOR=5.46; 95% CI: 2.21–13.46). Those aware of being HIV-positive reported significantly more pre-incarceration sex- and drug-related HIV risk behaviours than those who were unaware. Conclusions Routine rather than risk-based HIV testing and expansion of opioid substitution and antiretroviral therapy among prisoners is urgently needed to reduce HIV transmission in volatile transitional HIV epidemics.
Collapse
|