| Title: |
Multi-level implementation factors that influence scale-up of methadone maintenance treatment in Moldovan prisons: A qualitative study |
| Authors: |
O'Hara, G.; Liberman, A.; Polonsky, M.; Azbel, L.; Marcus, R.; Doltu, S.; Cugut, S.; Altice, F. |
| Source: |
Journal of Substance Abuse Treatment 1-11 |
| Publication Year: |
2022 |
| Subject Terms: |
adult; article; content analysis; controlled study; criminal justice; demography; female; health care quality; health care utilization; human; incidence; injection drug user; major clinical study; Male; mathematical model; methadone treatment; Moldova; mortality; opiate addiction; quantitative analysis; sexuality; thematic analysis; virus transmission; Correctional Facility; Human immunodeficiency virus infection; opiate substitution treatment; prisoner; substance abuse |
| Description: |
Introduction: People who inject drugs PWID are overrepresented in prison populations, especially in the Eastern European and Central Asian region EECA, where HIV incidence and mortality continue to rise. Modeling data suggest that methadone maintenance treatment MMT scale-up in prison with continuation after release could substantially reduce new HIV infections. Moldova, one of four countries in the EECA to have introduced MMT in prisons, has faced challenges with its scale-up. Method: To improve implementation of MMT in Moldovan prisoners, we analyzed the qualitative interviews of 44 recently released Moldovan prisoners with opioid use disorder who either accepted or rejected MMT while incarcerated; these 44 were among a subset of 56 participants in a quantitative survey who had complete interview data. After translating and back-translating interviews, we used content analysis to identify key barriers and facilitators to MMT uptake. Results: Our qualitative analyses revealed that positive attitudes toward methadone facilitated treatment uptake, yet the study identified three thematic barriers as to why PWID do not accept MMT while in prison, including: 1 negative personal attitudes toward MMT; 2 stigmatization of MMT by informal hierarchies within prison; and 3 distrust of the formal prison hierarchy i.e., administration, which provides MMT. Conclusion: Overall, the social forces of the two prisoner hierarchies and distrust between them appeared to outweigh the perceived benefits of MMT and impacted MMT uptake. Here we provide strategies to promote MMT more effectively in prison settings. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
07405472 |
| Relation: |
https://ibn.idsi.md/vizualizare_articol/216948; urn:issn:07405472 |
| DOI: |
10.1016/j.jsat.2021.108660 |
| Availability: |
https://ibn.idsi.md/vizualizare_articol/216948; https://doi.org/10.1016/j.jsat.2021.108660 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.DFB8A2A1 |
| Database: |
BASE |