Combined prevention programs within criminal justice systems examples from malaysia
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Combined prevention programs within criminal justice systems – examples from Malaysia. A Kamarulzaman , S Kaur , MN Nazar , M Azahari , C Koh , H AlDarraji , J Fu, J Wickersham, F Altice. Global Rates of Incarceration. Imprisonment per Capita. Malaysia. 39,758 prisoners 5441 in Puspen

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Combined prevention programs within criminal justice systems examples from malaysia

Combined prevention programs within criminal justice systems – examples from Malaysia

A Kamarulzaman, S Kaur, MN Nazar, M Azahari, C Koh, H AlDarraji, J Fu, J Wickersham, F Altice


Global rates of incarceration
Global Rates of Incarceration – examples from Malaysia

Imprisonment per Capita

Malaysia

39,758 prisoners

5441 in Puspen

26,294 in jails (5th)

Ranked 53rd

Puspen 40th

Driven by war on drugs

Mandatory HIV testing

Highest HIV prevalence in SE Asia (6%)

Different from USA

Nearly 40% are foreign-borne

Nearly 40% are from rural areas


Project harapan study design
Project Harapan: Study Design – examples from Malaysia

Project Harapan


Project harapan initial findings
Project Harapan: Initial Findings – examples from Malaysia

  • Total of 121 participants enrolled

    • MMT = 38

    • MMT + HHRP = 38

    • HHRP(M) = 22

    • Control = 23

  • Rate of recidivism by MMT vs. No MMT

    • MMT = 2.6%

    • No MMT = 8.8%


Pilot study methadone dose matters
Pilot Study: – examples from MalaysiaMethadone Dose Matters

100-120mg

Log Rank (Mantel-Cox):

Χ2 = (1, 27) 7.60, p < .01

Breslow (Gen Wilcoxon):

Χ2 = (1, 27) 7.45, p < .01

Tarone-Ware:

Χ2 = (1, 27) 7.69, p < .01

<80mg


Harapan tb
HARAPAN-TB – examples from Malaysia

  • Tuberculosis is the leading cause of death in Malaysian prisons (especially HIV coinfection)

  • No standardized TB screening or treatment programs established in the prison setting

  • Patients who are ill are transferred out to government hospitals for treatment


Hiv group
HIV Group – examples from Malaysia

  • Incarceration times: 5 * (range 0-22)

  • Total previous incarceration: 67 months * (range 0-360)

  • Times since HIV diagnosis: 6 years * (range 6m-22years)

  • On HIV treatment: 6% (despite 47% requires ARV)

  • Sharing needles before incarceration: 91%

  • Previous TST: 11%

  • Previous TB disease (undocumented): 11%

  • 1 case was diagnosed with active TB through the survey

    * Mean


Results
Results – examples from Malaysia



Hiv diagnosis treatment care
HIV Diagnosis, Treatment & Care – examples from Malaysia

  • N= 100

  • 78% diagnosed in detention settings

  • Mean number of months since diagnosis: 64.8%

  • 74% have not received HIV-specific medical care since diagnosis- 34% reported ever having a CD4 - Only 18 were told their actual CD4 count

J Fu et al IHRC 2011 abstract


Hiv diagnosis treatment care1
HIV Diagnosis, Treatment & Care – examples from Malaysia

  • No access to ARVs in Puspen

  • No/limited medical personnel; completely reliant on external medical facilities for treatment of very sick inmates

  • Only 9% received HIV-specific care during this incarceration 4 forced to discontinue ART

  • Very immunosuppresed - CD4 counts: 15 - 140

J Fu et al IHRC 2011 abstract


A COMPREHENSIVE HIV/AIDS PREVENTION AND TREATMENT PROGRAMME IN DRUG REHABILITATION CENTRES IN MALAYSIA

NATIONAL ANTI-DRUGS AGENCY (NADA)

MINISTRY OF HOME AFFAIRS

MALAYSIA


Objective
OBJECTIVE IN

  • In response to the growing drug problem and its complexity and realizing that the existing strategies are not achieving the intended effects / targets, NADA has shifted its approach from INSTITUTIONALISEDrehabilitation to an open approach, OPEN ACCESS SERVICES, by setting up THE CURE AND CARE 1 MALAYSIA CLINICor better known as C&C 1MALAYSIA CLINIC.

  • This is a paradigm shift for NADA to transform its treatment and rehabilitation services to all its clients in the country.

2

NADA MALAYSIA


National AntiDrugs Agency IN

Methadone Maintenance Program

2007 - 20011

2007

2008

2009

2010

2011


NADA MMT PROGRAM IN

  • 33 CCSC

  • 8 Klinik C&C 1Malaysia

  • 2 PUSPEN



Medical evaluation
MEDICAL EVALUATION IN

NADA MALAYSIA


Challenges
Challenges IN

  • Condom and needle syringe programs prohibited

  • Lack of a health system within these organisations

  • Organisational competency

  • Community re-entry challenges

    • Homelessness and shelters (HIV & methadone)

    • Unemployment

    • Family and social disruption

    • Stigma


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