Global coverage of interventions to prevent and manage injecting drug use related harms in prisons: a systematic review

Background: In this global review, we expand the scope of our Lancet series, which has systematically reviewed the global coverage of interventions to prevent and manage drug-related harms among people who inject drugs (PWID) since 2016. Using a similar methodology, we systematically review the availability of interventions for harms related to injecting drug use, including blood-borne viruses, for all individuals in prison environments as part of a global collaboration with the World Health Organisation and the United Nations Office of Drugs & Crime.

Methods: We searched for publications in relevant databases and previous systematic reviews (e.g., PubMed, Embase, PsycINFO, etc.), grey literature, and contacted global experts for unpublished materials that reported data on any of the relevant interventions including HIV and hepatitis (HCV) testing and treatment, condom provision, opioid agonist treatment (OAT), needle and syringe programs (NSPs), and naloxone in prison environments. For each intervention, we collected programmatic data on the availability, number and type of carceral facilities, number of people accessing services, and the number and type of medication or equipment distributed by country. We also extracted data relevant to key subpopulations of people who are incarcerated (e.g., PWID, sex). Our final analyses will include a comparison coverage of each intervention to findings from our concurrent review on the prevalence of injecting drug use and related-harms among people who are incarcerated. 

Results: We identified 515 studies and reports that documented coverage data on interventions that prevent or treat harms related to injecting drug use, including blood-borne viruses, within prisons globally. The majority of studies are from North America (34%, 173 studies), Western Europe (27%, 137 studies), and Eastern Europe (14%, 70 studies). The number of studies has increased dramatically over time with 11% (57 studies) from 2000-2005, 11% (56 studies) from 2006-2010, 24% (124 studies) from 2011-2015, 35% (180 studies) from 2016-2020, and 17% (89 studies) from 2021-present. Our preliminary findings indicate that coverage of major harm reduction and treatment interventions for harms related to injecting drug use is extremely low in prison environments. More detailed results will be available for the presentation.

Conclusions: Initial findings from our comprehensive review indicate a significant global shortfall in harm reduction and treatment services for harms related to injecting drug use, including blood-borne viruses, in prison environments. Our study's findings will be crucial for developing targeted policy interventions to enhance harm reduction and treatment services in prisons, and to improve the health of people who are incarcerated globally, especially PWIDs. Bridging these service gaps is vital for improving health outcomes for all incarcerated individuals and aligns with global public health and human rights objectives.