Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/28543
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dc.contributor.advisorHaw, Sally-
dc.contributor.advisorWilson, Sarah-
dc.contributor.authorKomalasari, Rita-
dc.date.accessioned2019-01-17T16:13:40Z-
dc.date.available2019-01-17T16:13:40Z-
dc.date.issued2018-04-
dc.identifier.urihttp://hdl.handle.net/1893/28543-
dc.description.abstractBackground Heroin dependence is associated with increased risk of the transmission of blood-borne viral (BBV) infections such as HIV, as a result of unsafe injecting practices. Opioid Substitution Treatment (OST) Programmes including Methadone Maintenance Treatment (MMT) programmes are a recommended way of addressing heroin dependence with the dual aims of reducing both heroin use and associated harms. However, OST programmes, particularly in prison settings, are often unavailable, in spite of large numbers of prisoners with heroin dependence and the high risk of HIV transmission in the prison setting. Little is currently known about the delivery of OST programmes within prison settings. A systematic literature review conducted within this study revealed that there are only a small number of studies from middle and lower-income countries and the perspectives of the range of stakeholders are often underrepresented. Aim and setting of this study This aim of this study was to understand the role of Methadone Maintenance Treatment (MMT) programmes within the context of HIV prevention programmes and to identify barriers and facilitators that influence the implementation, routine delivery and sustainability of methadone programmes in Indonesian prisons. Study design Three prison settings were selected as part of a qualitative case study. These comprised: a narcotics prison that provided methadone, a general prison that provided methadone, and a general prison, where there was no methadone programme. This allowed the exploration of multiple perspectives of prisoners and the diverse range of staff involved in the implementation of programmes. Interview and observational data were supplemented by data from medical case notes. Qualitative data underwent thematic analysis, with the help of framework analysis for data management. Principal findings This study found that there were many misconceptions about methadone programmes. HIV infection was not recognised as a problem and prison staff, healthcare staff and prisoners alike lacked understanding of the roles of methadone programmes. Prisoners participating in programmes were often stigmatised, while many prisoners believed methadone withdrawal was dangerous and could lead to death. These factors all contributed to low level participation, observed in both prisons with methadone programmes. Lack of confidentiality and associated stigmatisation as well as inappropriate assessment criteria also contributed to this, as did a lack of support systems. A reduction in international funding and a shift in national drug policy priorities away from the provision of methadone to drug-free Therapeutic Community (TC) programmes, together with a failure to embed methadone programmes within the daily prison routine currently pose challenges to effective implementation, delivery and programme sustainability. Conclusion Educating policy makers and practitioners could improve understanding of the roles of methadone programmes and increase support for programme delivery within prisons. It is therefore recommended that Indonesian government and prison policy focuses on ensuring effective delivery and sustainability of methadone programmes for people with heroin dependence in the prison setting.en_GB
dc.language.isoenen_GB
dc.publisherUniversity of Stirlingen_GB
dc.subjectOpioid Substitution Treatmenten_GB
dc.subjectMethadone Maintenance Treatmenten_GB
dc.subjectin the prison settingen_GB
dc.subjectA systematic literature reviewen_GB
dc.subjectqualitative case studyen_GB
dc.subjectIndonesian prisonsen_GB
dc.subjecteffective deliveryen_GB
dc.subjectsustainabilityen_GB
dc.subject.lcshMethadone maintenanceen_GB
dc.subject.lcshPrison systemen_GB
dc.subject.lcshOpioids.en_GB
dc.subject.lcshHIV prevention & control.en_GB
dc.subject.lcshIndonesiaen_GB
dc.titleKey Perspectives on Opioid Substitution Treatment (OST) Programmes, Using Methadone Maintenance Treatment (MMT) Programmes in Indonesian Prisons as a Case Studyen_GB
dc.typeThesis or Dissertationen_GB
dc.type.qualificationlevelDoctoralen_GB
dc.type.qualificationnameDoctor of Philosophyen_GB
dc.rights.embargodate2023-04-30-
dc.rights.embargoreasonI need time to write articles for publication from my thesis. I have requested an official embargo preventing access to both the electronic or paper copies of my thesis. My supervisors agreed on all point.en_GB
dc.contributor.funderIndonesia Endowment Fund for Educationen_GB
dc.author.emailrita.komalasari2012@gmail.comen_GB
dc.contributor.affiliationFaculty of Health Sciences and Sporten_GB
dc.rights.embargoterms2023-05-01-
dc.rights.embargoliftdate2023-05-01-
Appears in Collections:Faculty of Health Sciences and Sport eTheses

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