Komalasari Rita, Wilson Sarah, Haw Sally
Faculty of Health Science, University of Stirling, Stirling, UK, and Faculty of Medicine, Yarsi University, Jakarta Pusat, Indonesia.
Sociology in the School of Applied Social Science at the University of Stirling, UK.
Int J Prison Health. 2021 Nov 17;17(4):477-496. doi: 10.1108/IJPH-04-2020-0020.
Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM).
DESIGN/METHODOLOGY/APPROACH: The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically.
The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources.
RESEARCH LIMITATIONS/IMPLICATIONS: The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant.
Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners' families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons.
The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons.
ORIGINALITY/VALUE: This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.
监狱中的阿片类激动剂治疗（OAT）项目在预防人类免疫缺陷病毒（HIV）方面发挥着重要作用。尽管已证实其有效性，但监狱OAT项目的可及性和覆盖范围仍然很低。这项印度尼西亚的研究运用社会生态模型（SEM）探讨了监狱中美沙酮项目实施的促进因素和障碍。
设计/方法/途径：该研究采用定性案例研究方法，包括两所设有美沙酮项目的监狱和一所未设美沙酮项目的监狱。采用目的抽样和滚雪球抽样的方法招募研究参与者。总共对监狱管理人员、医护人员、狱警和囚犯进行了57次深入访谈。对数据进行了主题分析。
研究结果确定了在SEM的所有三个层面上监狱OAT项目实施的促进因素和障碍如下：个人层面的障碍包括对HIV传播、OAT项目的减少伤害作用、美沙酮依赖和戒断症状的误解；人际层面的障碍，如OAT治疗过程缺乏灵活性以及监狱中非法药物的广泛可得性；社会结构层面的障碍，尤其是普遍缺乏资源。
研究局限性/影响：研究结果突出了组织、人际以及个人因素的重要性和重叠性。在中低收入国家实施和开展美沙酮项目的背景下，这种方法尤为重要，因为资源匮乏问题非常严重。
提出了三项主要的改进策略如下：为囚犯和所有监狱工作人员制定全面的教育和培训计划；重新评估美沙酮给药的相关做法，并对监狱中的减少伤害策略进行全面审查，应考虑囚犯家庭的作用以增加对囚犯参与的支持；重新评估监狱政策以支持监狱中美沙酮项目的实施。
作者认为持续的国际支持和国家毒品政策对于监狱中美沙酮项目的持续开展和可持续性至关重要。
原创性/价值：本研究为中等收入监狱环境下的OAT项目的总体证据基础做出了贡献。
