Adapting an Evidence-Based Intervention Targeting HIV-Infected Prisoners in Malaysia

Abstract

HIV-infected prisoners in Malaysia represent a critical target population for secondary HIV risk reduction interventions and care. We report on the process and outcome of our formative research aimed at systematically selecting and adapting an EBI designed to reduce secondary HIV risk and improve adherence to antiretroviral therapy among soon-to-be-released HIV-infected prisoners. Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews and focus groups with key stakeholders, members of the target population, and their family members. Based on all information, we adapted the Holistic Health Recovery Program targeting people living with HIV (HHRP+), an EBI, to consist of eight 2-hour sessions that cover a range of specified topics so that participants may individually apply intervention content as needed to accommodate their particular substance abuse, HIV risk, and antiretroviral adherence issues. This study provides a complete example of the process of selecting and adapting an EBI—taking into account both empirical evidence and input from target organization stakeholders and target population members and their families—for use in real world prison settings where high-risk populations are concentrated.

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

“…In the process of adapting HHRP to the Malaysian context (HHRP-M), we learned that HIV status disclosure, social support, and accessing ART after release were seen by prisoners as especially challenging and therefore adapted HHRP to address the knowledge and interpersonal skills needed to successfully access care and negotiate safer sex, harm reduction, and HIV status disclosure during the immediate post-release period (Copenhaver et al 2011). …”

Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia

“…47 Briefly, the Holistic Health Recovery Program for PLH (HHRP+) was selected because of its demonstrated efficacy in reducing sexual and drug-related HIV risk behaviors, drug use, and addiction severity, and in improving adherence to ART among opioid-dependent people who inject drugs living with HIV as well as because of the feasibility of adapting it for implementation in the prison setting. 32,47 Formative work involved critical examination of established evidence-based interventions complemented by data from structured interviews and focus groups with key stakeholders, members of the target population, and their family members. Based on this work, the original HHRP+ intervention was adapted to consist of 8 sessions designed to address challenges to reducing HIV risk behaviors and adhering to ART faced by incarcerated PLH in the Malaysian correctional system as they transition back to the community.…”

“…Based on this work, the original HHRP+ intervention was adapted to consist of 8 sessions designed to address challenges to reducing HIV risk behaviors and adhering to ART faced by incarcerated PLH in the Malaysian correctional system as they transition back to the community. The adapted intervention is called the Holistic Health Recovery Program for Malaysia, HHRP-M. 47 …”

“…45,46 In Project Harapan (Bahasa Malaysia for “hope”), HHRP+ was adapted for prisoners living with HIV and opioid dependence in Malaysia (HHRP-M). 47 Project Harapan was designed as a 2×2 factorial randomized controlled trial to evaluate the efficacy of pre-release initiation of methadone maintenance therapy (MMT) and HHRP-M alone and in combination on post-release HIV transmission behaviors, drug use, and a range of other health and social outcomes.…”

HIV/AIDS in prison: state of the art of scientific productions

“…It would take bold political actions and progressive to impro-ve the health and welfare of the prison population. Among these actions: mandatory adoption of HIV testing in the prison systems, initiatives enhancing continuity of care to the infected inmates returning to the community, better opportunities for community-based organizations and health services to the population incarcerated can have access to education and prevention services to HIV/AIDS [17,32].…”