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Fulltext Implementing methadone maintenance treatment in prisons in Malaysia

Wickersham JA, Marcus R, Kamarulzaman A, Zahari MM, Altice FL

Bull World Health Organ, 2013 Feb 01;91(2):124-9.
PMID: 23554524 DOI: 10.2471/BLT.12.109132

PROBLEM: In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed.
APPROACH: After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) - those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners' release.
LOCAL SETTING: Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy.
RELEVANT CHANGES: STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners' release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners.
LESSONS LEARNT: Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.
Fulltext Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia

Zahari MM, Hwan Bae W, Zainal NZ, Habil H, Kamarulzaman A, Altice FL

Am J Drug Alcohol Abuse, 2010 Jan;36(1):31-8.
PMID: 20141394 DOI: 10.3109/00952990903544828

To examine the association between HIV infection and psychiatric disorders among prisoners, where mental illness, substance abuse, and HIV are disproportionately represented.
Fulltext Adapting an Evidence-Based Intervention Targeting HIV-Infected Prisoners in Malaysia

Copenhaver MM, Tunku N, Ezeabogu I, Potrepka J, Zahari MM, Kamarulzaman A, et al.

AIDS Res Treat, 2011;2011:131045.
PMID: 21860786 DOI: 10.1155/2011/131045

HIV-infected prisoners in Malaysia represent a critical target population for secondary HIV risk reduction interventions and care. We report on the process and outcome of our formative research aimed at systematically selecting and adapting an EBI designed to reduce secondary HIV risk and improve adherence to antiretroviral therapy among soon-to-be-released HIV-infected prisoners. Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews and focus groups with key stakeholders, members of the target population, and their family members. Based on all information, we adapted the Holistic Health Recovery Program targeting people living with HIV (HHRP+), an EBI, to consist of eight 2-hour sessions that cover a range of specified topics so that participants may individually apply intervention content as needed to accommodate their particular substance abuse, HIV risk, and antiretroviral adherence issues. This study provides a complete example of the process of selecting and adapting an EBI-taking into account both empirical evidence and input from target organization stakeholders and target population members and their families-for use in real world prison settings where high-risk populations are concentrated.
Fulltext Methadone dose at the time of release from prison significantly influences retention in treatment: implications from a pilot study of HIV-infected prisoners transitioning to the community in Malaysia

Wickersham JA, Zahari MM, Azar MM, Kamarulzaman A, Altice FL

Drug Alcohol Depend, 2013 Sep 01;132(1-2):378-82.
PMID: 23414931 DOI: 10.1016/j.drugalcdep.2013.01.005

OBJECTIVE: To evaluate the impact of methadone dose on post-release retention in treatment among HIV-infected prisoners initiating methadone maintenance treatment (MMT) within prison.
METHODS: Thirty HIV-infected prisoners meeting DSM-IV pre-incarceration criteria for opioid dependence were enrolled in a prison-based, pre-release MMT program in Klang Valley, Malaysia; 3 died before release from prison leaving 27 evaluable participants. Beginning 4 months before release, standardized methadone initiation and dose escalation procedures began with 5mg daily for the first week and 5mg/daily increases weekly until 80 mg/day or craving was satisfied. Participants were followed for 12 months post-release at a MMT clinic within 25 kilometers of the prison. Kaplan-Meier survival analysis was used to evaluate the impact of methadone dose on post-release retention in treatment.
FINDINGS: Methadone dose ≥80 mg/day at the time of release was significantly associated with retention in treatment. After 12 months of release, only 21.4% of participants on <80 mg were retained at 12 months compared to 61.5% of those on ≥80 mg (Log Rank χ(2)=(1,26) 7.6, p<0.01).
CONCLUSIONS: Higher doses of MMT at time of release are associated with greater retention on MMT after release to the community. Important attention should be given to monitoring and optimizing MMT doses to address cravings and side effects prior to community re-entry from prisons.
Fulltext The Prevalence of Smoking, Determinants and Chance of Psychological Problems among Smokers in an Urban Community Housing Project in Malaysia

Abd Rashid R, Kanagasundram S, Danaee M, Abdul Majid H, Sulaiman AH, Ahmad Zahari MM, et al.

Int J Environ Res Public Health, 2019 05 18;16(10).
PMID: 31109033 DOI: 10.3390/ijerph16101762

Objective: This study was conducted to assess the prevalence, pattern of smoking and sociodemographic factors among Kerinchi residents in Kuala Lumpur, as well as to identify the association between smoking, stress, anxiety and depression. Methods: This study was carried out at four community housing projects in the Lembah Pantai area in Kuala Lumpur. Data was collected between 3 February 2012, and 29 November 2012. Data collectors made house visits and used interviewer administered questionnaires containing questions on demographic data and smoking patterns. Depression anxiety stress scale (DASS) was used to assess psychological symptoms. Alcohol smoking and substance involvement screening tool (ASSIST) scale was used to assess nicotine use. Results: Data from 1989 individuals (833 households) showed the age of respondents ranged from 18 to 89 years and the mean age was 39.12 years. There were 316 smokers indicating the prevalence of smoking was 15.85%, with 35.5% among males and 1.8% among females. Further, 86.6% of smokers were Malay and 87% were Muslims. Divorce was associated with smoking. Unemployment and housewives were less associated with smoking. Depression and anxiety were significantly associated with smoking (OR = 1.347. 95% CI: 1.042-1.741) and (OR = 1.401. 95% CI: 1.095-1.793) respectively. Conclusion: Screening for depression and anxiety should be routinely performed in the primary care setting and in population-based health screening to intervene early in patients who smoke.