Characterizing the post-incarceration risk environment in St. Petersburg, Russia

描述俄罗斯圣彼得堡的监禁后风险环境

• 批准号: 8713242
• 负责人: Javier Cepeda
• 金额: $ 3.89万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8713242
• 关键词: Address; Behavior; Blood-Borne Pathogens; Case-Control Studies; Cessation of life; Cohort Analysis; Communities; Country; Criminal Justice; Cross-Sectional Studies; Data; Dependency; Drug usage; Economics; Environment; Epidemic; Estonia; Event; Face; Frequencies; Government; HIV; Health Services Accessibility; Hepatitis B Virus; Hepatitis C virus; Heterosexuals; Imprisonment; Incidence; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Knowledge; Life; Methods; Opioid; Opioid Rotation; Overdose; Parents; Participant; Patient Self-Report; Pharmaceutical Preparations; Plague; Population; Prevalence; Principal Investigator; Prisons; Public Health; Recording of previous events; Recruitment Activity; Relapse; Research; Research Design; Respondent; Risk; Risk Behaviors; Risk Factors; Russia; Services; Site; System; Time; USSR; Work; cohort; combat; convict; effective therapy; experience; high risk; injection drug use; meetings; non-drug; parent project; patient population; public health relevance; social; success; transmission process

DESCRIPTION: The HIV epidemic in the countries of the former Soviet Union continues to be a growing public health problem. Currently, it is the only region in the world where the incidence of HIV does not appear to be declining. The epidemic is concentrated among injection drug users (IDUs), however there is increasing concern that the epidemic may shift to the non-drug using heterosexual population. Drug treatment in Russia is largely inadequate to meet the needs of the patient population. Treatment for opioid dependency in Russia suffers from a lack of effective therapies because opioid substitution therapy is illegal. Additionally, Russia has one of the highest incarceration rates in the world. In St. Petersburg, the site of the proposed research, half of those incarcerated were in prison due to drug offenses, a substantial fraction of those who met the criteria for opioid dependency. Due to weak linkages between incarceration facilities and the community, incarcerated IDUs upon release face a high risk of quickly resuming to opioid use, overdose or death, and engaging in risky injection practices. In this proposal, I will pursue a mixed methods approach to characterize the risk environment facing IDUs upon release from prison. Respondents will be recruited from a much larger parent study (R01DA029888). IDUs who have spent time incarcerated will be invited to participate in this study. For the quantitative component, we will inquire about the amount of time that elapsed from when the respondent was released from prison to when the respondent began using opioids again and whether they experienced an overdose after being released. This retrospective cohort analysis will be limited to respondents who have ever been incarcerated. We will identify factors in the respondents risk environment that may have facilitated relapse or overdose after release from prison. We hypothesize that the majority of respondents who have been incarcerated will have relapse to opioid use within a month of release. Our second analysis will focus on the prevalence and frequency of risky injections among respondents who have a history of incarceration and compare these data to respondents who have never been incarcerated. We hypothesize that IDUs who have been incarcerated will have engaged in more risky injections than IDUs who have never been incarcerated. Lastly, we will recruit respondents who have been incarcerated within two years for in-depth qualitative interviewing pertaining to their risk environment after release. The purpose of the qualitative analysis is to confirm and explain the findings from the quantitative components.

艾滋病毒在前苏联国家的流行仍然是一个日益严重的公共卫生问题。目前，它是世界上唯一一个 艾滋病毒似乎没有下降。该流行病集中在注射毒品使用者中，但人们日益担心该流行病可能转移到不使用毒品的异性恋人群中。俄罗斯的药物治疗在很大程度上不足以满足患者群体的需求。在俄罗斯，阿片类药物依赖的治疗缺乏有效的疗法，因为阿片类药物替代疗法是非法的。此外，俄罗斯有一个 世界上最高的监禁率。在拟议研究的地点--圣彼得堡， 一半的被监禁者是由于毒品犯罪而入狱的，这是符合阿片类药物依赖标准的人的很大一部分。由于监禁设施与社区之间的联系薄弱，被监禁的注射吸毒者在获释后面临着迅速恢复使用类阿片、过量或死亡以及从事危险注射做法的高风险。在本建议中，我将采用混合方法来描述注射吸毒者出狱后面临的风险环境。将从一项更大规模的母研究（R 01 DA 029888）中招募受试者。将邀请曾被监禁的注射吸毒者参加本研究。对于定量部分，我们将询问从被调查者从监狱释放到被调查者再次开始使用阿片类药物的时间，以及他们在被释放后是否过量服用。这项回顾性队列分析将仅限于曾经被监禁的受访者。我们将确定受访者风险环境中可能导致出狱后复吸或吸毒过量的因素。我们假设，大多数被监禁的受访者将在释放后一个月内复发阿片类药物使用。我们的第二项分析将侧重于有监禁史的受访者中危险注射的流行率和频率，并将这些数据与从未被监禁的受访者进行比较。我们假设，被监禁的注射吸毒者将比从未被监禁的注射吸毒者进行更危险的注射。最后，我们将招募在两年内被监禁的受访者，对其释放后的风险环境进行深入的定性访谈。定性分析的目的是确认和解释定量分析的结果。