Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney, NSW 2052, Australia; The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney, NSW 2052, Australia.
Int J Drug Policy. 2024 Aug;130:104540. doi: 10.1016/j.drugpo.2024.104540. Epub 2024 Jul 29.
Elimination of bloodborne viruses including HIV and hepatitis C virus from prisons requires high coverage of evidence-based interventions that prevent bloodborne virus transmission, including needle and syringe programs. Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake identified by correctional officers and healthcare workers.
Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group. We identified the highest-ranking responses (≥10 % of the overall votes) to questions about barriers and facilitators to PNEP uptake.
Between September 2023 and February 2024, 16 focus groups were conducted with 118 participants (n = 51 correctional officers; n = 67 healthcare workers). Among correctional officers, the top perceived barriers were bullying from peers (22 %), fear of being targeted by correctional officers (14 %), and fear of repercussions due to drug use (13 %). The top facilitators were safe injection sites (30 %), provision of wrap-around services (16 %), and education of correctional officers (10 %). Among healthcare workers, the top perceived barriers were lack of confidentiality (16 %), fear of being targeted by correctional officers (12 %), and a long and complex application process (11 %). The top facilitators were education of correctional officers (29 %), delivery of PNEP by an external provider (15 %), automatic approval for participation in the PNEP (13 %), and safe injection sites (12 %).
Multiple modifiable barriers and solutions to improving PNEP uptake in Canadian federal prisons were identified by correctional employees. Both participant groups identified the potential for safe injection sites and education to correctional officers as enabling PNEP uptake. These data will inform Canadian efforts to improve engagement and to expand PNEP coverage.
消除监狱中的血源性病毒（包括 HIV 和丙型肝炎病毒）需要广泛采用基于证据的干预措施，包括针具和注射器方案。加拿大于 2018 年在 9 所联邦监狱启动了监狱针具交换计划（PNEP）；然而，监狱内注射毒品者对该计划的参与率仍然很低。我们旨在探索被惩教人员和医务人员确定的提高 PNEP 参与度的障碍和促进因素。
参与有 PNEP 的 9 所联邦监狱的惩教人员和医护人员使用名义群体技术（一种快速混合方法共识策略）完成了焦点小组讨论。由每个利益相关者群体生成、排序和优先考虑回应。我们确定了对 PNEP 参与度的障碍和促进因素的最高排名回应（占总票数的≥10%）。
在 2023 年 9 月至 2024 年 2 月期间，进行了 16 次焦点小组讨论，共有 118 名参与者参加（n=51 名惩教人员；n=67 名医护人员）。在惩教人员中，被认为是最大的障碍是来自同事的欺凌（22%）、害怕成为惩教人员的目标（14%）以及因吸毒而受到惩罚的恐惧（13%）。最大的促进因素是安全注射点（30%）、提供全面服务（16%）和教育惩教人员（10%）。在医护人员中，被认为最大的障碍是缺乏保密性（16%）、害怕成为惩教人员的目标（12%）以及申请程序冗长复杂（11%）。最大的促进因素是教育惩教人员（29%）、由外部供应商提供 PNEP（15%）、自动批准参与 PNEP（13%）以及安全注射点（12%）。
惩教人员确定了提高加拿大联邦监狱中 PNEP 参与度的多个可修改障碍和解决方案。两个参与群体都确定了安全注射点和对惩教人员的教育有潜力提高 PNEP 的参与度。这些数据将为加拿大提高参与度和扩大 PNEP 覆盖范围的努力提供信息。
