Theme: Models of Care Year: 2024
Introduction: HIV and substance use disorders are common comorbidities among criminal justice involved individuals. The availability and uptake of opioid use disorder (OUD) and HIV services pre- and post-release are critical to improving health outcomes. We sought to describe the use of and barriers to OUD service uptake among recently released criminal justice-involved individuals living with HIV and OUD when offered low barrier access to Opioid Agonist Therapy.
Methods: A sequential explanatory mixed-method cohort study was conducted between September 2021 to September 2022 with formerly incarcerated individuals living with HIV and self-reported opioid use. Descriptive statistics were used to calculate quantitative data, and qualitative data were analysed thematically, using deductive and inductive coding.
Results: Twenty three participants were eligible for receiving post-release services. The median age was 32 years; nineteen (83%) self-identified as men and 20 (87%) were Black/African. All participants reported two or more incarceration episodes. All participants underwent an initial harm reduction assessment. Eight (35%) were initiated on medication for opioid use disorder (MOUD) with methadone; 7 (88%) were retained on MOUD. Verified linkage to HIV treatment was 57% (n= 13). Reasons for low uptake of MOUD included: (1) a perceived ineffectiveness of MOUD for achieving substance use cessation, (2) a preference for in-patient detoxification-type rehabilitation, (3) challenges reaching MOUD sites, and (4) a lack of readiness for MOUD as reasons for not engaging in MOUD and harm reduction services.
Conclusions: The results of this small study indicate low uptake of MOUD and harm reduction services after release from incarceration. We identified specific structural and individual barriers to OUD services uptake and implementation. The findings suggest that dedicated resources and participatory design that includes all stakeholders, including criminal justice involved individuals, are key to advancing OUD and HIV care outcomes while potentially reducing recidivism.