Ethical guidance for health research in prisons in low- and middle-income countries: a scoping review

Abstract

Objectives This study examined the extent, range and nature of the published literature, prison policies and technical guidance relating to the ethical conduct of health research in prisons in low- and middle-income countries (LMICs). Study design Scoping Review. Methods We adhered to the five stages of the scoping review iterative process: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing and content analysis of polices. Disagreements around allocation of content were resolved through team discussion. We also appraised the quality of the included articles. Results We included nine records that examined the ethical aspects of the conduct of health research in prisons in LMICs; eight of these were peer-reviewed publications, and one was a toolkit. Despite the unique vulnerabilities of this group, we could find no comprehensive guidelines on the ethical conduct of health research in prisons in LMICs. Conclusions The majority of the world's imprisoned populations are in LMICs, and they have considerable health needs. Research plays an important role in addressing these needs and in so doing, will contribute to the achievement of the Sustainable Development Goals. With regards to health research, imprisoned people in LMICs are ‘left behind’; there is a lack of clear, prison-focused guidance and oversight to ensure high quality ethical health research so necessary in LMICs. There is an urgent need for prison health experts to work with health research ethics experts and custodial practitioners for procedural issues in the development of prison-specific ethical guidance for health research in LMICs aligned with international standards.

Predicting Violent Reoffending in Individuals Released From Prison in a Lower-Middle-Income Country: A Validation of OxRec in Tajikistan

“…With minor adjustments, including a straightforward recalibration, the OxRec tool can provide an effective way of identifying individuals at highest risk of violent reoffending, and in turn prioritize them for community interventions upon release from prison, such as substance use clinics. Such tools are needed, particularly in LMICs where resources are limited due to low levels of investment in prison and community public health services ( 3 ). Even when available, considerable barriers to accessing resources exist for justice-involved individuals in LMICs, partly due to fear of stigmatization, lack of treatment in community settings and limited linkage between services ( 30 ).…”

“…However, the majority of prison health research has been based on data from high-income countries (HICs). Conducting research in prisons is key to addressing public health challenges in these populations, such as mental health, substance misuse, infectious diseases and violence ( 3 ). However, such efforts are met with many challenges, from funding to operational constraints, ( 4 ) and evidence on people in prison in LMICs is limited ( 5 ).…”

Scoping review of mental health in prisons through the COVID-19 pandemic

“…We used Ako et al ’s 26 definition of ‘prison’ as representing ‘detention facilities housing both on-remand and convicted people. These settings included prisons, police holding cells, pretrial detention, closed youth institutions and camps where drug users are forced into mandatory labour as means of rehabilitation’.…”

Incarcerated individuals’ experiences of COVID-19 in the United States

“…Incarcerated individuals are likely less noticed within the larger debate about who should receive a vaccine and scholars have noted the complex ethical factors related to including incarcerated individuals in vaccine trials (Kronfli and Akiyama, 2020;Wang et al, 2020). These factors stem from a long history of medical exploitation of incarcerated populations and they complicate the ability of researchers to target public health initiatives in correctional spaces both in the USA and abroad (Ahalt et al, 2018;Ako et al, 2020;Appleman, 2020) and have resulted in decreased trust among some incarcerated individuals about medical treatments more broadly (Alagood, 2015). Given the explosive rates of transmission documented within correctional facilities across the USA, many experts are calling for incarcerated individuals to be vaccinated as quickly as possible (Siva, 2020).…”