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

描述：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发病率较高的地区 艾滋病毒似乎并没有下降。疫情集中在注射吸毒者(注射吸毒者)中，但人们越来越担心疫情可能会转移到使用非毒品的异性恋人群。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，阿片依赖的治疗缺乏有效的治疗方法，因为阿片类药物替代疗法是非法的。此外，俄罗斯有一个 是世界上监禁率最高的国家。在圣彼得堡，这项拟议研究的地点， 被监禁的人中有一半是由于毒品犯罪而入狱的，在符合阿片类药物依赖标准的人中占有相当大的比例。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迅速恢复使用阿片类药物、服药过量或死亡以及从事危险的注射做法的高风险。在这项提案中，我将采用一种混合方法来描述注射吸毒者出狱后面临的风险环境。受访者将从规模更大的家长研究(R01DA029888)中招募。被监禁一段时间的注射吸毒者将被邀请参加这项研究。在数量部分，我们将询问被访者从出狱到再次开始使用阿片类药物之间的时间长短，以及他们在出狱后是否服药过量。这项回溯性队列分析将仅限于曾被监禁的受访者。我们将确定受访者风险环境中可能导致出狱后复发或服药过量的因素。我们假设，大多数被监禁的受访者在获释后一个月内将重新使用阿片类药物。我们的第二个分析将集中在有监禁史的受访者中高风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，已经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有风险的注射。最后，我们将招募在两年内被监禁的受访者，在获释后就其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从定量成分得出的结论。

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.