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Perceptions of Health-Related Community Reentry Challenges among Incarcerated Drug Users in Azerbaijan, Kyrgyzstan, and Ukraine

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Abstract

Facing competing demands with limited resources following release from prison, people who inject drugs (PWID) may neglect health needs, with grave implications including relapse, overdose, and non-continuous care. We examined the relative importance of health-related tasks after release compared to tasks of everyday life among a total sample of 577 drug users incarcerated in Ukraine, Azerbaijan, and Kyrgyzstan. A proxy measure of whether participants identified a task as applicable (easy or hard) versus not applicable was used to determine the importance of each task. Correlates of the importance of health-related reentry tasks were analyzed using logistic regression, with a parsimonious model being derived using Bayesian lasso method. Despite all participants having substance use disorders and high prevalence of comorbidities, participants in all three countries prioritized finding a source of income, reconnecting with family, and staying out of prison over receiving treatment for substance use disorders, general health conditions, and initiating methadone treatment. Participants with poorer general health were more likely to prioritize treatment for substance use disorders. While prior drug injection and opioid agonist treatment (OAT) correlated with any interest in methadone in all countries, only in Ukraine did a small number of participants prioritize getting methadone as the most important post-release task. While community-based OAT is available in all three countries and prison-based OAT only in Kyrgyzstan, Kyrgyz prisoners were less likely to choose help staying off drugs and getting methadone. Overall, prisoners consider methadone treatment inapplicable to their pre-release planning. Future studies that involve patient decision-making and scale-up of OAT within prison settings are needed to better improve individual and public health.

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Funding

This work was supported by grants R01 DA029910 (Altice), R01 DA033679 (Altice), and R36 DA042643 (Morozova) from NIDA.

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Author notes

  1. Julia Rozanova and Olga Morozova contributed equally to this work.

Authors and Affiliations

  1. Section of Infectious Diseases, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA

    Julia Rozanova & Frederick L. Altice

  2. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

    Olga Morozova & Frederick L. Altice

  3. London School of Hygiene & Tropical Medicine, London, UK

    Lyuba Azbel

  4. University of California in San Francisco School of Medicine, San Francisco, CA, USA

    Chethan Bachireddy & Jacob M. Izenberg

  5. Leonard Davis Institute of Health Economics, Philadelphia, PA, USA

    Chethan Bachireddy

  6. Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA

    Chethan Bachireddy

  7. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine

    Tetiana Kiriazova

  8. Academy of Labor, Social Relations and Tourism, Kyiv, Ukraine

    Sergiy Dvoryak

  9. Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia

    Frederick L. Altice

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  1. Julia Rozanova
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Rozanova, J., Morozova, O., Azbel, L. et al. Perceptions of Health-Related Community Reentry Challenges among Incarcerated Drug Users in Azerbaijan, Kyrgyzstan, and Ukraine. J Urban Health 95, 508–522 (2018). https://doi.org/10.1007/s11524-018-0256-4

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