Date of Award

January 2021

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Frederick L. Altice

Abstract

Background: Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of few countries in this region that offers methadone within prisons, but uptake remains suboptimal. SBIRT procedures are a recommended strategy to address substance use disorders.Methods: We conducted a modified SBIRT (mSBIRT) strategy in nine prisons and four pre-trial detention facilities (N=121) from June 1, 2017 to March 3, 2018. Survey results were analyzed to evaluate the effect of the mSBIRT strategy on interest in and initiation of opioid agonist therapy (OAT). Results: mSBIRT procedures significantly improved attitudes towards OAT, but did not have a significant effect on knowledge about OAT. There was a 51.9% increase in individuals enrolled in OAT at the time of study conclusion. Conclusion: The mSBIRT procedure employed in this study significantly improved participant attitudes, yet overall uptake of OAT remained low. Working within the Moldovan prison culture to dispel negative myths and misinformation is needed to further scale-up OAT in the country.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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