Despite a wide array of HIV prevention approaches and related research, there is a decade-long trend of 11,000 new HIV diagnoses each day globally. Injection drug users (IDUs) remain a target population as they represent a significant vector for the transmission of new HIV infections, which occur through preventable drug- and sex- related HIV risk behaviors. The criminal justice approach to addressing chemical dependency has primarily been incarceration, resulting in concentration of HIV+ in prison settings. A number of evidence-based HIV risk reduction interventions are now widely available as complete behavioral intervention packages. Very few evidence-based interventions have been designed and adapted for HIV+ prisoners transitioning from the prison to the community setting. None have used integrated models. Methadone maintenance treatment (MMT), an evidence-based pharmacological approach to treating opioid dependence, has also not been widely implemented as a secondary HIV risk reduction intervention for released prisoners. MMT has been demonstrated to reduce drug- related injection risks, but arguably has little influence on sexual risk-taking. Public health authorities struggle to implement best practice interventions to intercede with HIV transmission among IDUs, who routinely interface with criminal justice system. As part of our specific aims, we propose: 1) to create a new prison-release behavioral counseling intervention, "Positive Transitions" (PT), by adapting the Holistic Health Recovery Project for HIV+s (HHRP+) for prisoners released to the community and within the Malaysian context in order to improve health outcomes and reduce HIV transmission behaviors;and 2) using a 2x2 multi-factorial design, to conduct a prospective, randomized controlled trial of HIV+ prisoners who meet DSM- IV criteria for opioid dependence to compare prison-release as usual (control group) versus Positive Transitions alone, MMT alone, or the combination of MMT plus Positive Transitions to determine the optimal prison-release intervention. Results from this trial will inform public health authorities about how to best reduce HIV transmission among released HIV+ prisoners with opioid dependence. A team of U.S. and Malaysian investigators with significant previous collaboration and expertise with prisoners, HIV infection, substance abuse treatment and behavioral intervention research pools their collective experience to assist in answering important public health questions regarding evidence-based interventions for released HIV+ prisoners.

Public Health Relevance

HIV+ prisoners with opioid dependence figure greatly in fueling the 11,000 new daily HIV infections globally. Effective prison-release programs that target HIV risk reduction for HIV+s have not been developed or studied using rigorous methodologies. This 2x2 multifactorial, randomized controlled trial of methadone maintenance treatment and an evidence-based behavioral intervention for HIV+s (Holistic Health Recovery Project) will advise public health authorities about how to best intervene with HIV+ prisoners who are transitioning from prison to the community.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1-KXH-C (06))
Program Officer
Aklin, Will
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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Bazazi, Alexander R; Zelenev, Alexei; Fu, Jeannia J et al. (2015) High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study. Int J Drug Policy 26:675-81
Izenberg, Jacob M; Bachireddy, Chethan; Wickersham, Jeffrey A et al. (2014) Within-prison drug injection among HIV-infected Ukrainian prisoners: prevalence and correlates of an extremely high-risk behaviour. Int J Drug Policy 25:845-52
Jin, Harry; Earnshaw, Valerie A; Wickersham, Jeffrey A et al. (2014) An assessment of health-care students' attitudes toward patients with or at high risk for HIV: implications for education and cultural competency. AIDS Care 26:1223-8
Al-Darraji, Haider Abdulrazzaq Abed; Wong, Kee Cheong; Yeow, David Gan Eng et al. (2014) Tuberculosis screening in a novel substance abuse treatment center in Malaysia: implications for a comprehensive approach for integrated care. J Subst Abuse Treat 46:144-9
Wickersham, Jeffrey A; Marcus, Ruthanne; Kamarulzaman, Adeeba et al. (2013) Implementing methadone maintenance treatment in prisons in Malaysia. Bull World Health Organ 91:124-9
Abed Al-Darraji, Haider Abdulrazzaq; Abd Razak, Humaira; Ng, Kee Peng et al. (2013) The diagnostic performance of a single GeneXpert MTB/RIF assay in an intensified tuberculosis case finding survey among HIV-infected prisoners in Malaysia. PLoS One 8:e73717
Margolis, B; Al-Darraji, H A A; Wickersham, J A et al. (2013) Prevalence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia. Int J Tuberc Lung Dis 17:1538-44
Wickersham, Jeffrey A; Zahari, Muhammad Muhsin; Azar, Marwan M et al. (2013) Methadone dose at the time of release from prison significantly influences retention in treatment: implications from a pilot study of HIV-infected prisoners transitioning to the community in Malaysia. Drug Alcohol Depend 132:378-82
Al-Darraji, H A A; Kamarulzaman, A; Altice, F L (2012) Isoniazid preventive therapy in correctional facilities: a systematic review. Int J Tuberc Lung Dis 16:871-9
Bachireddy, Chethan; Bazazi, Alexander R; Kavasery, Ravi et al. (2011) Attitudes toward opioid substitution therapy and pre-incarceration HIV transmission behaviors among HIV-infected prisoners in Malaysia: implications for secondary prevention. Drug Alcohol Depend 116:151-7

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