University of stirling, United Kingdom, University of Yarsi, Indonesia.
Dr, Senior Lecturer in Sociology in the School of Applied Social Science at the University of Stirling.
Int J Drug Policy. 2021 Jan;87:102978. doi: 10.1016/j.drugpo.2020.102978. Epub 2020 Oct 28.
Opioid Agonist Treatment (OAT) programmes are regarded as a gold standard treatment for people living with Opioid Use Disorders (OUDs). However, OAT programmes are often unavailable or poorly implemented in prisons, in spite of the large numbers of people living with OUDs and the high risk of HIV transmission in prison settings. Unusually, this systematic review synthesizes qualitative evidence relating to barriers to, and facilitators of, the implementation of OAT programmes in prisons in high- and low/middle-income countries (LMICs) to provide more nuanced, contextualised understandings of how prison stakeholders perceive and/or experience OAT programmes within different prison settings.
We systematically reviewed six electronic databases for studies published between January 2005 and December 2019 involving prison stakeholders: policy-makers, governors, healthcare staff, prison officers, and prisoners. The search identified 8091 studies, of which only 16 incorporated qualitative methods (including qualitative elements of mixed methods) and met our quality criteria. Four of these studies were conducted in LMICs (Kyrgyzstan, Iran (2) and Indonesia).
Findings were organized under three broad themes: (1) perceived benefits of OAT programmes; (2) barriers to the implementation and development of OAT programmes; and (3) treatment processes.
A lack of a clear understanding of the roles of OAT programmes and doubts regarding their effectiveness for people living with OUDs in prisons are critical barriers to prisoner participation in both high-and LMIC countries. Prison systems, particularly in LMICs, often lack the resources to mitigate problems with implementation. This review highlights an urgent need to develop further qualitative studies into prison OAT programmes, employing varied methods to explore such contexts in greater depth and minimize the impact of harms relating to OUDs in prisons.
阿片类药物激动剂治疗（OAT）方案被认为是治疗阿片类药物使用障碍（OUD）患者的金标准。然而，尽管监狱中有大量患有 OUD 的人，而且在监狱环境中 HIV 传播的风险很高，但 OAT 方案在监狱中往往无法获得或实施不佳。不同寻常的是，本系统评价综合了高质量的证据，这些证据涉及到在高收入和低收入/中等收入国家（LMIC）的监狱中实施 OAT 方案的障碍和促进因素，以便更细致、更具背景地了解监狱利益相关者如何在不同的监狱环境中看待和/或体验 OAT 方案。
我们系统地审查了六个电子数据库，以获取 2005 年 1 月至 2019 年 12 月期间涉及监狱利益相关者（政策制定者、典狱长、医疗保健人员、监狱官员和囚犯）的研究。搜索共确定了 8091 项研究，其中只有 16 项研究采用了定性方法（包括混合方法的定性部分），并且符合我们的质量标准。其中四项研究在 LMIC 进行（吉尔吉斯斯坦、伊朗（2）和印度尼西亚）。
研究结果组织在三个广泛的主题下：（1）OAT 方案的预期收益；（2）实施和发展 OAT 方案的障碍；（3）治疗过程。
对 OAT 方案的作用缺乏清晰的理解以及对患有 OUD 的囚犯在监狱中实施 OAT 方案的有效性的疑虑，是高收入和 LMIC 国家囚犯参与方案的关键障碍。监狱系统，特别是在 LMIC 中，往往缺乏缓解实施问题的资源。本综述强调了迫切需要进一步开展监狱 OAT 方案的定性研究，采用各种方法更深入地探讨这些背景，并最大限度地减少监狱中与 OUD 相关的危害。
