A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons

Abstract

Purpose 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. Findings 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. Practical implications 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. Social implications 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.

Empowerment of Women with Narcotic Cases

“…This finding supports the argument of who advocates the importance of judges making decisions that reflect the condition of women who are already experiencing socioeconomic problems. This involves displaying a sensitivity that involves exercising discretion and encouraging participants to redefine sentencing options outside prison (Komalasari et al, 2021a). These participants sought to reduce sentences with the aim of releasing women drug users from prison earlier than required by law and allowing them to receive treatment outside prison.…”

“…Previous studies have shown that DTTO II is overused with women even though there are fewer women in the Criminal Justice System. (49% of women received DTTO II) compared to men (51%) (Komalasari et al, 2021a). This is partly a reflection of DTTO II targeting low-rate violators (Malloch 2011).…”

“…Health and women's empowerment are some of the important factors implemented to achieve the 'best interests of women' (Siscawati et al, 2020). Women's health and empowerment are strategies used to protect women's rights to obtain proper health and empowerment without discrimination (Komalasari et al, 2021a). Conventions and international treaties relating to gender equality that have been ratified are evidence that equal legal protection has been recognized and implemented in several countries.…”

Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study

“…Linkage to care in the community poses another significant challenge to PrEP care among criminal justice–involved individuals. Currently, providing continuity of care for both pretrial individuals as well as those sentenced to a period of confinement poses a challenge, particularly for those who are HIV-positive, are impacted by substance use disorder, or have general medical needs [ 49 , 50 ]. The availability and accessibility of PrEP care providers is likely to vary significantly based on geographic region, an individual’s insurance status, and the existence of other health linkage programs unrelated to PrEP care [ 51 , 52 ].…”

Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys

“…Socioecological approaches allow for the exploration of issues across five levels: individual, intrapersonal, organisational, community and policy [ 38 ]. Such models are increasingly used to study public health issues, including opioid use and dependency (e.g., [ 39 , 40 , 41 , 42 , 43 , 44 ]). However, only a small number of studies have adopted this approach to specifically explore experiences of OAT [ 39 , 45 , 46 ], and, to our knowledge, no studies have been conducted in a UK treatment context.…”