Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA.
Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA.
J Subst Abuse Treat. 2022 May;136:108660. doi: 10.1016/j.jsat.2021.108660. Epub 2021 Nov 14.
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.
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.
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.
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.
注射毒品者（PWID）在监狱人口中所占比例过高，尤其是在东欧和中亚地区（EECA），那里的艾滋病毒发病率和死亡率继续上升。建模数据表明，在监狱中扩大美沙酮维持治疗（MMT）并在释放后继续进行，可能会大大减少新的艾滋病毒感染。摩尔多瓦是在监狱中引入 MMT 的四个 EECA 国家之一，其 MMT 的扩大面临挑战。
为了改善摩尔多瓦囚犯中 MMT 的实施，我们分析了 44 名最近从监狱中释放的阿片类药物使用障碍的摩尔多瓦囚犯的定性访谈，这些囚犯在监禁期间接受或拒绝了 MMT；这 44 人是 56 名参与者的一个子集，他们参加了一项定量调查，这些参与者完成了完整的访谈数据。在翻译和回译访谈后，我们使用内容分析来确定接受 MMT 的主要障碍和促进因素。
我们的定性分析表明，对美沙酮的积极态度有助于治疗的接受，但研究发现了三个主题障碍，说明为什么 PWID 在监狱中不接受 MMT，包括：1）对 MMT 的个人负面态度；2）监狱内部非正式等级制度对 MMT 的污名化；3）对提供 MMT 的正式监狱等级制度（即行政）的不信任。
总体而言，两个囚犯等级制度的社会力量以及它们之间的不信任似乎超过了 MMT 的预期好处，并影响了 MMT 的接受。在这里，我们提供了在监狱环境中更有效地推广 MMT 的策略。
