Identifying barriers and facilitators to accessing harm reduction services in prisons: A systematic narrative synthesis

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-06-14 DOI:10.1016/j.drugpo.2025.104761

O. Varsaneux , M. Charest , K. Ma , J. Stone , M. Brouwers , N. Kronfli , A. Krentel

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Abstract

Background

Drug use is prevalent in carceral settings globally. Although a comprehensive harm reduction package for people in prison (PIP) is recommended by international agencies, its implementation is limited. The aim of this systematic narrative synthesis was to explore barriers and facilitators to accessing harm reduction services (HRS) in prisons.

Methods

We searched MEDLINE, PsycINFO, SCOPUS, and CINAHL for English and French language articles published before June 26, 2024. Studies evaluating any HRS defined as condoms, pre-exposure prophylaxis, post-exposure prophylaxis, opioid agonist therapy, needle syringe programs, and hepatitis B vaccination in prison were included. Two independent reviewers evaluated articles selected for full text review. Disagreements were resolved by consensus. We performed a qualitative content analysis based on the Socio-Ecological Model, utilizing constant comparative methods to generate themes and subthemes.

Results

A total of 8,324 unique articles were identified, 400 were eligible for full text review, and 94 were included in the final analysis; 80 studies (85%) were conducted in high-income countries. Individual-level barriers included fear of repercussions due to HRS participation, interpersonal-level barriers such as negative perceptions of HRS in PIP and staff, institutional-level barriers such as limited resource allocation and public policy/societal-level barriers including rigid administrative policies. Facilitators of HRS use included education about risk prevention, positive previous experiences with HRS, and support from prison leadership.

Conclusion

Several multi-level barriers and facilitators to accessing prison-based HRS exist. To improve HRS uptake, implementing holistic education for PIP and carceral employees, enhancing awareness of HRS through peer-led initiatives, and ensuring buy-in and support from prison leadership will be important. Furthermore, allocation of specific resources and enhanced policies that promote HRS will be beneficial.

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确定在监狱中获得减少伤害服务的障碍和促进因素：系统叙述综合

药物使用在全球范围内的癌症环境中普遍存在。虽然国际机构建议为监狱服刑人员制定一项全面的减少伤害一揽子计划，但其执行情况有限。这一系统叙述综合的目的是探讨在监狱中获得减少伤害服务的障碍和促进因素。方法检索MEDLINE、PsycINFO、SCOPUS和CINAHL检索2024年6月26日之前发表的英文和法文文章。评估任何HRS定义为安全套、暴露前预防、暴露后预防、阿片类激动剂治疗、针头注射计划和监狱中的乙型肝炎疫苗接种的研究包括在内。两名独立的审稿人对选定的文章进行全文评审。分歧通过协商一致得到解决。我们在社会生态模型的基础上进行了定性内容分析，利用恒定的比较方法来生成主题和副主题。结果共鉴定出8324篇独特文献，其中400篇符合全文评审条件，94篇纳入最终分析；80项研究（85%）在高收入国家进行。个人层面的障碍包括对参与人力资源调查的影响的恐惧，人际层面的障碍，如PIP和工作人员对人力资源调查的负面看法，机构层面的障碍，如有限的资源分配和公共政策/社会层面的障碍，包括僵化的行政政策。促进HRS使用的因素包括风险预防教育、以往使用HRS的积极经验以及监狱领导的支持。结论基于监狱的HRS获取存在多层障碍和促进因素。为了提高对人力资源管理制度的接受程度，对PIP和监狱员工实施全面教育，通过同伴领导的举措提高对人力资源管理制度的认识，并确保监狱领导层的支持将是重要的。此外，分配具体资源和加强促进人力资源登记的政策将是有益的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.