PROBLEM: In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed. APPROACH: After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) - those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners' release. LOCAL SETTING: Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy. RELEVANT CHANGES: STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners' release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners. LESSONS LEARNT: Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.
PROBLEM: In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed. APPROACH: After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) - those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners' release. LOCAL SETTING: Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy. RELEVANT CHANGES: STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners' release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners. LESSONS LEARNT: Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.
Authors: Frederick L Altice; Adeeba Kamarulzaman; Vincent V Soriano; Mauro Schechter; Gerald H Friedland Journal: Lancet Date: 2010-07-31 Impact factor: 79.321
Authors: Robert P Schwartz; David A Highfield; Jerome H Jaffe; Joseph V Brady; Carol B Butler; Charles O Rouse; Jason M Callaman; Kevin E O'Grady; Robert J Battjes Journal: Arch Gen Psychiatry Date: 2006-01
Authors: Elizabeth L C Merrall; Azar Kariminia; Ingrid A Binswanger; Michael S Hobbs; Michael Farrell; John Marsden; Sharon J Hutchinson; Sheila M Bird Journal: Addiction Date: 2010-06-23 Impact factor: 6.526
Authors: Jacob M Izenberg; Chethan Bachireddy; Jeffrey A Wickersham; Michael Soule; Tetiana Kiriazova; Sergii Dvoriak; Frederick L Altice Journal: Int J Drug Policy Date: 2014-02-28
Authors: Chethan Bachireddy; Michael C Soule; Jacob M Izenberg; Sergey Dvoryak; Konstantin Dumchev; Frederick L Altice Journal: Drug Alcohol Depend Date: 2013-09-27 Impact factor: 4.492
Authors: Alexander R Bazazi; Jeffrey A Wickersham; Martin P Wegman; Gabriel J Culbert; Veena Pillai; Roman Shrestha; Haider Al-Darraji; Michael M Copenhaver; Adeeba Kamarulzaman; Frederick L Altice Journal: Contemp Clin Trials Date: 2017-05-04 Impact factor: 2.226
Authors: Jeffrey A Wickersham; Muhammad Muhsin Zahari; Marwan M Azar; Adeeba Kamarulzaman; Frederick L Altice Journal: Drug Alcohol Depend Date: 2013-02-13 Impact factor: 4.492