Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mayur Desai

Second Advisor

Jeffrey Wickersham


Background: Criminalization of drug use in Malaysia has led to a concentrated epidemic of HIV and substance use disorders within prisons. In response, Malaysia introduced prison-based methadone maintenance therapy (MMT) programs to treat opioid dependence and reduce risky behaviors. Despite the introduction of this program, MMT uptake has been suboptimal in prison settings. Therefore identifying individual-level factors associated with MMT initiation is key to improving uptake.

Methods: 200 incarcerated individuals with a history of opioid use in the 12 months prior to incarceration were enrolled in a study to determine factors associated with interest in receiving MMT. All participants were 18 years of age or older, had been detained for at least 30 days, and were able to speak English or Bahasa Malaysia. Additionally, HIV-positive inmates were selectively recruited up to 50%. Logistic regression analysis was used to identify the factors associated with MMT interest.

Findings: Only 85 (43%) participants expressed an interested in receiving MMT, 18 (21%) of whom were currently enrolled in the MMT program. Age, ethnicity, religion, education, and income were unrelated to interest in MMT (p >0.05). Conversely, those that were previously married (OR=4.15), had a history of incarceration (OR=5.68), depression (OR=3.66), reported daily pre-incarceration heroin use (OR=5.53), and had the most favorable attitudes towards MMT (OR=19.82) had a greater odds of being interested in receiving MMT (p<0.05).

Conclusions: Results show that interest in MMT initiation is largely driven by social, legal and psychological problems related to drug use. Incarceration provides a unique window of opportunity to initiate MMT, and successful uptake of MMT will not be possible without first addressing the barriers towards receiving MMT in prison, and how attitudes towards methadone impairs MMT interest.


This is an Open Access Thesis.