阿片类激动剂治疗连续性的脆弱性对监狱人员丙型肝炎再暴露问题的影响:一项定性研究

IF 4.4 2区 医学 Q1 SUBSTANCE ABUSE
Lise Lafferty , Tracey Brown , Colette McGrath , Thomas Wright , Charles Henderson , Andrew R Lloyd , Jason Grebely , Carla Treloar
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引用次数: 0

摘要

背景:丙型肝炎病毒(HCV)在监狱服刑人员中普遍存在。提供阿片类激动剂治疗(OAT)已被证明可降低社区中HCV传播的风险。关于监狱中丙型肝炎病毒(再)暴露的导航,以及人们在监禁期间使用OAT作为降低风险策略的经历和利用,我们知之甚少。方法对澳大利亚新南威尔士州一所城市接收(接收)和还押(等待判决)监狱中的25名男性进行半结构化访谈。通过脆弱的治疗环境镜头,将去识别转录本进行演绎编码和主题分析,重点关注OAT治疗作为HCV(再)暴露的风险缓解策略。结果共纳入25名男性,其中13名接受长效注射丁丙诺啡治疗。参与者认为HCV(再)暴露的风险是监狱注射吸毒的一部分。服用长效注射丁丙诺啡的参与者称,在监禁期间,这种治疗有助于减少注射毒品的使用。然而,OAT剂量并不总是被认为是“足够的”,一些参与者报告说,由于规定的OAT剂量缺乏持续到下一次剂量的有效性,他们补充了“院子计划”(在院子/细胞中注射药物)。由于人们从监狱到社区再到监狱,护理的连续性很脆弱,人们在社区中错过预定剂量后被移出OAT项目,通常是因为参与者“在逃”。结论:OAT和HCV治疗的连续性对于进出监狱的人来说仍然是一种脆弱的体验。在社区中错过OAT约会的人可能会在重新入狱后等待几个月才能重新进入OAT计划。这使得人们在拘留期间容易受到共用注射的影响,随后,在等待重新开始OAT或恢复到最佳剂量水平时,丙型肝炎病毒(再)暴露的风险增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implications of the fragility of opioid agonist treatment continuity on hepatitis C re-exposure concerns among people in prison: a qualitative study

Background

Hepatitis C virus (HCV) is prevalent among people who are incarcerated. Provision of opioid agonist treatment (OAT) has been shown to reduce risk of HCV transmission in the community. Little is known about the navigation of HCV (re-)exposure in prisons, and people’s experiences and utilisation of OAT as a risk reduction strategy while incarcerated.

Methods

Semi-structured interviews were completed with n=25 men incarcerated in an urban reception (intake) and remand (awaiting sentencing) prison in New South Wales, Australia. De-identified transcripts were coded deductively and analysed thematically, informed by a fragile treatment environment lens focused on OAT treatment as a risk mitigation strategy for HCV (re-)exposure.

Results

Overall, 25 men were included (all had previously been diagnosed with HCV, 13 were receiving long-acting injectable buprenorphine). Participants viewed risk of HCV (re-)exposure as part of injecting drug use in prison. Participants who were prescribed long-acting injectable buprenorphine described the treatment as supporting reduced injection drug use while incarcerated. However, OAT dosage was not always experienced as ‘adequate’, with some participants reporting supplementing with ‘the yard program’ (injecting drug use in the yard/cells) as the prescribed OAT dose lacked effectiveness to sustain until the next dose. Continuity of care was tenuous as people cycled from prison to community to prison, with people being removed from their OAT program after missing a scheduled dose in the community often due to a participant being ‘on the run’.

Conclusion

Continuity of OAT and HCV care remains a fragile experience for people who cycle in and out of incarceration. People who miss their OAT appointment in the community might wait several months upon re-incarceration to re-enter the OAT program. This leaves people vulnerable to injection sharing in custody and, subsequently, increased risk of HCV (re-)exposure while waiting to recommence OAT or to return to the optimal dosing level.
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来源期刊
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.
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