Combined prevention programs within criminal justice systems – examples from Malaysia A...
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Transcript of Combined prevention programs within criminal justice systems – examples from Malaysia A...
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– 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: Initial Findings
• 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
<80mg
100-120mgLog 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
HARAPAN-TB
• 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
• 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
ResultsHIV +ve HIV -ve Staff
Number 140 151 441
Gender 89% Male All Male 87% Male
Age 37 (23-56) 36 (21-62) 34 (21-64)
Active TB 26 n/a 4
TST + 84% 91% 77%
Previous TB 11% 2% 1%
HIV Diagnosis, Treatment & Care• 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 & Care
• 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 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 INSTITUTIONALISED rehabilitation to an open approach, OPEN ACCESS SERVICES, by setting up THE CURE AND CARE 1 MALAYSIA CLINIC or 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.
NADA MALAYSIA
2011200920082007 2010
National AntiDrugs AgencyMethadone Maintenance Program
2007 - 20011
PKAADK 11
PUSPEN 0
Klinik C&C
0
Jumlah 11
PKAADK 184
PUSPEN 0
Klinik C&C
0
Jumlah 184
PKAADK 689
PUSPEN 0
Klinik C&C
0
Jumlah 689
PKAADK 1024
PUSPEN 0
Klinik C&C
0
Jumlah 1024
PKAADK 1275
PUSPEN 21
Klinik C&C
351
Jumlah 1647
NADA MMT PROGRAM
2010 2011Target no of clients 1325 4825
Total no registered 1183 1647
No remaining on treatment
784 1275
No not on treatment 79 223
No employed 632 936
33 CCSC 8 Klinik C&C 1Malaysia 2 PUSPEN