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J Urban Health. 2018 Aug;95(4):508-522. doi: 10.1007/s11524-018-0256-4.

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

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Section of Infectious Diseases, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
London School of Hygiene & Tropical Medicine, London, UK.
University of California in San Francisco School of Medicine, San Francisco, CA, USA.
Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
Academy of Labor, Social Relations and Tourism, Kyiv, Ukraine.
Section of Infectious Diseases, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.


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.


Eastern Europe and Central Asia; HIV; Incarceration; Methadone; Opioid agonist treatment; People who inject drugs; Post-release challenges; Prisoners

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