Lise Lafferty , Tracey Brown , Colette McGrath , Thomas Wright , Charles Henderson , Andrew R Lloyd , Jason Grebely , Carla Treloar
{"title":"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","authors":"Lise Lafferty , Tracey Brown , Colette McGrath , Thomas Wright , Charles Henderson , Andrew R Lloyd , Jason Grebely , Carla Treloar","doi":"10.1016/j.drugpo.2025.104831","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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’.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"142 ","pages":"Article 104831"},"PeriodicalIF":4.4000,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implications of the fragility of opioid agonist treatment continuity on hepatitis C re-exposure concerns among people in prison: a qualitative study\",\"authors\":\"Lise Lafferty , Tracey Brown , Colette McGrath , Thomas Wright , Charles Henderson , Andrew R Lloyd , Jason Grebely , Carla Treloar\",\"doi\":\"10.1016/j.drugpo.2025.104831\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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’.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":48364,\"journal\":{\"name\":\"International Journal of Drug Policy\",\"volume\":\"142 \",\"pages\":\"Article 104831\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-05-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Drug Policy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0955395925001318\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SUBSTANCE ABUSE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Drug Policy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0955395925001318","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SUBSTANCE ABUSE","Score":null,"Total":0}
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.
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.