International Journal of Drug Policy最新文献

{"title":"Nurse prescribing of opioid agonist treatment in Ireland: Evidence, governance, and the politics of drug policy decision-making","authors":"Peter Kelly,&nbsp;Catherine Comiskey,&nbsp;Barry Mc Brien,&nbsp;Adam R. Winstock,&nbsp;Philip James","doi":"10.1016/j.drugpo.2026.105153","DOIUrl":"10.1016/j.drugpo.2026.105153","url":null,"abstract":"<div><div>Globally, opioid agonist treatment (OAT) is recognised as a cornerstone of evidence-based responses to opioid dependence. Many countries have expanded access by enabling nurses to prescribe methadone and buprenorphine, with consistent evidence of safety, effectiveness, and improved equity of access. Despite this precedent, Ireland has not introduced nurse prescribing of OAT. Drawing on policy reviews, communications, national strategy documents, legislation, parliamentary debates, international literature and media reports, this commentary positions this issue as an important initiative which has been excluded from Irish drug-policy.</div><div>This commentary highlights a clinical and regulatory paradox: Irish nurses may prescribe controlled opioids for pain and palliative care for a person who is dependent on opioids, but are legally prohibited from prescribing the same medications for OAT. Independent reviews and government policy have recommended exploring nurse prescribing to address persistent workforce shortages. This commentary identifies how governance structures have marginalised nursing perspectives and mobilised evidence selectively, contributing to inaction. The authors propose that this case illustrates how existing approaches, varying accountability, and political framing shape policy decisions. With a new national drugs strategy in development, Ireland faces a choice: continue with non-inclusive, traditional governance or adopt inclusive, evidence-informed reform that aligns with international best practice.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105153"},"PeriodicalIF":4.4,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation, cessation and resumption of attendance at the Melbourne supervised injecting room among a cohort of people who inject drugs","authors":"Ashleigh C Stewart ,&nbsp;Kasun Rathnayake ,&nbsp;Adelina Artenie ,&nbsp;Matthew Hickman ,&nbsp;Jack Stone ,&nbsp;Daniel O’Keefe ,&nbsp;Thomas Kerr ,&nbsp;Paul Agius ,&nbsp;Amanda Roxburgh ,&nbsp;Peter Higgs ,&nbsp;Lisa Maher ,&nbsp;Nico Clark ,&nbsp;Belinda Bravo ,&nbsp;Mark Stoove ,&nbsp;Paul M Dietze","doi":"10.1016/j.drugpo.2026.105150","DOIUrl":"10.1016/j.drugpo.2026.105150","url":null,"abstract":"<div><h3>Background</h3><div>Supervised injecting facilities (SIFs) reduce drug-related harms and associated costs, but evidence is limited to a few settings. This study estimates rates of initiation, cessation, and resumption of Melbourne’s Medically Supervised Injecting Room (MSIR) use among a cohort of people who inject drugs.</div></div><div><h3>Methods</h3><div>Data were drawn from SuperMIX, an ongoing cohort study since 2008. Participants complete baseline and annual surveys, including MSIR use since its opening on 30 June 2018. We reported baseline characteristics and calculated incidence rates (IRs) of MSIR initiation, cessation, and resumption, stratified by recent homelessness and opiate agonist therapy (OAT) use, per 1000 person-years (PY).</div></div><div><h3>Results</h3><div>Of 1650 eligible participants, 685 (42%) reported MSIR use at baseline. MSIR attenders were slightly older (median 43 vs. 41 years) and less often female (28% vs. 35%) than non-attenders. Most (71%) were infrequent attenders (&lt;50% injections at MSIR). Frequent attenders (<em>n</em> = 202) injected more often (median monthly injections = 50) than infrequent (median = 30) and non-attenders (median = 20). The MSIR initiation rate was 525 per 1000 PY, similar between frequent and infrequent attenders (RR 1.10, 95% CI 0.94–1.28). The cessation rate was 264 per 1000 PY, with no difference between attendance groups (RR 1.11, 95% CI 0.60–2.04). The resumption rate was 250 per 1000 PY, also similar across infrequent and frequent attenders (RR 0.99, 95% CI 0.47–2.09).</div></div><div><h3>Conclusions</h3><div>We found high MSIR service uptake, relative to cessation. Attendance was higher among men, Aboriginal and/or Torres Strait Islander people, and those recently homeless, with frequent attenders injecting more often and those on OAT less likely to attend frequently.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105150"},"PeriodicalIF":4.4,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between efficacy and ambivalence: Family perceptions of Methadone Maintenance Therapy in Malaysia","authors":"Yafizah Yahaya ,&nbsp;Fathima Begum Syed Mohideen ,&nbsp;Nizam Baharom ,&nbsp;Anu Suria Ganason ,&nbsp;Nathratul Ayeshah Zulkifli ,&nbsp;Norsiah Ali ,&nbsp;Nor Hazlin Talib ,&nbsp;Engku Aiman Engku Mohd Fauzi ,&nbsp;Nor Adam Roslan ,&nbsp;Nik Nurshaheedah Nik Mutasim ,&nbsp;Junaidi Jais","doi":"10.1016/j.drugpo.2026.105149","DOIUrl":"10.1016/j.drugpo.2026.105149","url":null,"abstract":"<div><h3>Background</h3><div>Opioid dependence remains a major health and social challenge in Malaysia. Methadone Maintenance Therapy (MMT), introduced nationally in 2005, has demonstrated effectiveness in reducing illicit opioid use, HIV transmission, and improving quality of life. This study addresses a critical gap by exploring family members' perceptions of MMT, a crucial yet understudied factor in recovery within Malaysia's collectivist culture.</div></div><div><h3>Methods</h3><div>A qualitative study using an interpretive phenomenological approach was conducted. Twenty immediate family members of MMT clients were purposively recruited from two One-Stop Centre for Addictions (OSCA) primary care clinics in Malaysia. In-depth interviews were conducted in Malay or English, audio-recorded, transcribed verbatim, and analysed thematically using NVivo 12.</div></div><div><h3>Results</h3><div>Participants’ mean age was 39.7 years. Most were spouses (60%), followed by mothers (20%), siblings (15%), and one daughter (5%), with 90% cohabiting with the MMT client. Three key themes emerged: (1) restored functionality and social reintegration, including improved emotional regulation, cessation of violence, and return to employment; (2) familial validation of MMT efficacy, with recognition of reduced cravings, absence of withdrawal symptoms, and behavioural evidence of abstinence; and (3) stigma-experience conflict, where profound ambivalence persisted due to misconceptions, safety fears, and negative social attitudes.</div></div><div><h3>Conclusion</h3><div>This study provides the first Malaysian evidence on family perceptions of MMT, highlighting its dual role in restoring family stability while facing persistent stigma. Family attitudes prove pivotal to treatment adherence and recovery outcomes, underscoring the urgent need for policy reform toward family-inclusive, stigma-reducing approaches within national harm reduction frameworks.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105149"},"PeriodicalIF":4.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The malleable logics of mandate: analysing uses of the term mandate in the context of a significant policy window","authors":"Paul Kelaita,&nbsp;Alison Ritter","doi":"10.1016/j.drugpo.2025.105120","DOIUrl":"10.1016/j.drugpo.2025.105120","url":null,"abstract":"<div><h3>Background</h3><div>Mandate is a site of political framing crucial to understanding the potential in a policy window. Yet the multiple uses of the word mandate, by government and advocates, suggests a more complex array of meanings and deployments than presumed on the surface.</div></div><div><h3>Objectives</h3><div>In this paper we sought to analyse how mandate was variously deployed by multiple policy actors in the lead up to and at a significant drug policy window (the 2024 NSW Drug Summit). We aimed to explore its uses and meanings and how these make possible or constrain policy reform.</div></div><div><h3>Methods</h3><div>Data were drawn from March 2023 to April 2025, and included political documents, media documents, and material from the drug summit itself. We analysed these data using political theories of election mandates and role mandates.</div></div><div><h3>Results</h3><div>As a concept, mandate variously referred to the privileges and responsibilities conferred by election results, the range and meaning of election promises, and the processes of policymaking during a term of government. Mandates were operationalised through their being ‘sensed’; defined through pre-election promises that direct, limit, and defer action, and constrain scope; and derived from, variously, votes, collective decision-making, and evidence. At the summit, meanings of election promises were contested: whether the mandate was confined to (merely) holding the summit, or whether the summit could deliver a mandate for future policy reform.</div></div><div><h3>Implications</h3><div>The use of mandate by politicians reveals the conditions that get set around policy change. The use of mandate by advocates suggests that expectations of policy events are different to those of government. Appreciating how mandate is multiply used and comes to have effects opens avenues for maximising the opportunity in policy windows.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105120"},"PeriodicalIF":4.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive health consequences of criminal legal involvement for women who use drugs in Taiwan","authors":"Tan-Wen Hsieh ,&nbsp;Wenmay Rei ,&nbsp;Rosetta Siew ,&nbsp;Sheng-Chang Wang ,&nbsp;Chuan-Yu Chen","doi":"10.1016/j.drugpo.2025.105135","DOIUrl":"10.1016/j.drugpo.2025.105135","url":null,"abstract":"<div><h3>Background</h3><div>Criminal legal responses to drug use may carry unintended consequences for women’s reproductive health, particularly in systems where punitive and health-oriented approaches coexist. This study explores how criminal legal involvement—both past contact and intervention stages—affects reproductive outcomes for young women who use drugs in Taiwan.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 4601 women aged 18–29 arrested for Schedule II drug use (predominantly meth/amphetamine) between 2011 and 2015. National police, health insurance, birth registration, and drug intervention datasets were linked to assess three outcomes: time to post-arrest pregnancy, pregnancy loss, and delayed initiation of prenatal care. Time-dependent Cox proportional hazard models and logistic regressions were used to estimate the associations.</div></div><div><h3>Results</h3><div>Over a three-year follow-up, nearly one-third of young women became pregnant after arrest. Among first post-arrest pregnancies (<em>n</em> = 1367), one-third ended in loss, and 9.2 % of live births lacked timely first-trimester care. Women without prior drug offenses were more likely to conceive soon after arrest (aHR = 1.25, 95 % CI: 1.10–1.43), while pregnancy hazard declined during deferred prosecution (aHR = 0.73, 95 % CI: 0.61–0.88). The incident offense was associated with a 28 % higher risk of pregnancy loss, despite reducing the odds of delayed prenatal care (aOR = 0.48, 95 % CI: 0.28–0.81).</div></div><div><h3>Discussion</h3><div>These findings reveal how the criminal legal system's involvement shapes reproductive health outcomes among women who use drugs. Early prosecutorial stages represent a pivotal window to integrate reproductive healthcare, reduce maternal risks, and support recovery.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105135"},"PeriodicalIF":4.4,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug policy and culture: A cross-national comparative study using Hofstede’s index","authors":"Shazib Altaf ,&nbsp;Jusung Lee ,&nbsp;Sugy Choi ,&nbsp;Sujeong Park","doi":"10.1016/j.drugpo.2025.105132","DOIUrl":"10.1016/j.drugpo.2025.105132","url":null,"abstract":"<div><h3>Background</h3><div>National drug policies vary widely across countries, shaped by historical, institutional, economic, and social factors. However, the role of cultural values in shaping drug policies remains underexplored. This study applies Hofstede’s cultural dimensions index to assess associations between national cultural norms and Global Drug Policy Index (GDPI) scores.</div></div><div><h3>Methods</h3><div>We conducted a cross-national comparative analysis using data from 25 countries with both GDPI scores and Hofstede’s cultural dimension scores in 2021. The dependent variable was the GDPI overall score and four sub-indices: Absence of Extreme Sentencing, Proportionality of the Criminal Justice Response, Health and Harm Reduction, and Access to Controlled Medicines. Independent variables included four Hofstede dimensions: Power Distance, Individualism, Masculinity, and Uncertainty Avoidance. Control variables included GDP per capita (log), cannabis prevalence, continent dummies, and opium/coca production status. Ordinary least squares (OLS) regressions with robust standard errors were used.</div></div><div><h3>Results</h3><div>Higher Power Distance was associated with lower overall GDPI scores (β = -0.296, <em>p</em> = 0.015), as well as with the Absence of Extreme Sentencing, and Access to Controlled Medicines indicators, suggesting that hierarchical societies tend to adopt more punitive and restrictive drug policies. Uncertainty Avoidance was positively associated with Access to Controlled Medicines (β = 0.234, <em>p</em> = 0.051). Higher cannabis prevalence showed consistent positive associations with progressive policy outcomes, while regional variation was evident, particularly in Europe and the Americas.</div></div><div><h3>Conclusion</h3><div>This study highlights the role of cultural values in shaping national approaches to drug policy, with power distance and uncertainty avoidance emerging as significant factors. Higher cannabis prevalence, a reflection of the epidemiological context, was also associated with more progressive policy outcomes. Policymakers should consider cultural and public health factors when designing drug strategies, particularly in hierarchical societies, where specific reforms may be needed to limit punitive laws and expand access to essential treatments.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"148 ","pages":"Article 105132"},"PeriodicalIF":4.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Drug law is a multispecies concern” [International Journal of Drug Policy, 148 (2026) 105116]","authors":"Kate Seear","doi":"10.1016/j.drugpo.2025.105133","DOIUrl":"10.1016/j.drugpo.2025.105133","url":null,"abstract":"","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105133"},"PeriodicalIF":4.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of hepatitis C virus antibody seroconversion among people who inject drugs in Tbilisi, Georgia, 2017–2019","authors":"Nikoloz Chkhartishvili ,&nbsp;Akaki Abutidze ,&nbsp;Marine Gogia ,&nbsp;Francisco Averhoff ,&nbsp;Shaun Shadaker ,&nbsp;Senad Handanagic ,&nbsp;Tengiz Tsertsvadze","doi":"10.1016/j.drugpo.2025.105134","DOIUrl":"10.1016/j.drugpo.2025.105134","url":null,"abstract":"<div><h3>Background</h3><div>Georgia launched a hepatitis C elimination program in 2015, and prioritized reducing hepatitis C virus (HCV) infections among people who inject drugs (PWID).</div></div><div><h3>Methods</h3><div>To assess the effectiveness of the program, we established a prospective observational cohort study to estimate incidence of HCV antibody (anti-HCV) seroconversion among PWID in Tbilisi during 2017–2019. Participants were recruited using incentivized chain-referral sampling. Incidence of anti-HCV seroconversion was calculated as the number of seroconversions divided by total person-years of follow-up (PYFU). Crude estimates were adjusted using post-stratification weights. Factors associated with seroconversion were evaluated in a Cox proportional hazards regression model.</div></div><div><h3>Results</h3><div>Among 1,744 PWID enrolled, 563 (32.3%) were anti-HCV reactive at baseline and were excluded from follow-up. Among the remaining 1,181 anti-HCV nonreactive PWID, 929 (78.7%) returned for at least one visit and were followed-up for a mean of 11.7 months, contributing a total 906 PYFU. During follow-up, 7 (0.8%) persons seroconverted. After adjusting for age, sex, and sharing injection equipment, the incidence rate of new infections was 0.9 (95% confidence interval [CI]: 0.4–1.7) per 100 PYFU. In regression analysis, only history of sharing injection equipment was associated with seroconversion (hazard ratio: 50.5, 95% CI: 2.5–611.6).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the HCV elimination program in Georgia has been successful in limiting transmission among PWID, however this population remains at risk of contracting HCV. Expansion of harm reduction services and integration of HCV diagnostics and treatment may help prevent new HCV infections to promote hepatitis C elimination among PWID.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105134"},"PeriodicalIF":4.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost-effectiveness analysis of a multidisciplinary model of care on hepatitis C care among people released from provincial prison in Quebec, Canada","authors":"Charlene Weight ,&nbsp;Andrea Mambro ,&nbsp;Camille Dussault ,&nbsp;Sylvie Chalifoux ,&nbsp;Lina del Balso ,&nbsp;Apostolia Petropoulos ,&nbsp;Mona Lim ,&nbsp;Alexandros Halavrezos ,&nbsp;Bertrand Lebouche ,&nbsp;Giada Sebastiani ,&nbsp;Marina B. Klein ,&nbsp;Joseph Cox ,&nbsp;Eric Latimer ,&nbsp;Nadine Kronfli","doi":"10.1016/j.drugpo.2025.105136","DOIUrl":"10.1016/j.drugpo.2025.105136","url":null,"abstract":"<div><h3>Background</h3><div>Many individuals are released from prison with untreated hepatitis C virus (HCV) and face challenges linking to care in the community. This study evaluated the cost-effectiveness of a multidisciplinary model of care compared to standard of care (SOC) across key steps along the HCV care cascade.</div></div><div><h3>Methods</h3><div>A prospective, pre-post study was conducted among men incarcerated in Quebec’s largest provincial prison. Intervention participants received care from a nurse, social worker, and patient navigator before release and were offered appointment accompaniment post-release by the patient navigator. SOC participants were encouraged to undergo HCV screening and those with current HCV received a pre-release discharge HCV appointment. The analysis adopted a healthcare system perspective. The primary outcome was sustained virologic response (SVR) within 180 days post-release. Secondary outcomes included linkage to care within 90 days post-release, treatment initiation, and treatment completion. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs (Canadian dollars, C$) divided by the difference in outcomes.</div></div><div><h3>Results</h3><div>Comparing 20 participants with current HCV infection (HCV RNA+) in both the intervention and the SOC arms, 16 vs. 12 were linked to care, 13 vs. 4 initiated treatment, 8 vs. 2 completed treatment, and 8 vs. 2 achieved SVR, respectively. The corresponding ICERs were C$1,242, C$10,481, C$25,577, and C$25,653 per additional person achieving the outcome.</div></div><div><h3>Conclusions</h3><div>Our multidisciplinary model of care increased the proportion of HCV RNA+ people released from prison who subsequently achieved SVR, at an additional cost of C$25,653 per additional patient. This is only C$5,653 more than the estimated cost of direct-acting antivirals, providing an economic rationale for broader implementation.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"149 ","pages":"Article 105136"},"PeriodicalIF":4.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to improve testing, linkage to care, and treatment for hepatitis C infection in prison: a systematic review and meta-analysis.","authors":"Evan B Cunningham, Alice Wheeler, Behzad Hajarizadeh, Clare E French, Rachel Roche, Monineath Roth, Alex R Willing, Hossain M S Sazzad, Alison D Marshall, Guillaume Fontaine, Anna Conway, Braulio M Valencia, Justin Presseau, John W Ward, Louisa Degenhardt, Gregory J Dore, Matthew Hickman, Peter Vickerman, Lise Lafferty, Andrew Lloyd, Yumi Sheehan, Matthew J Akiyama, Nadine Kronfli, Joaquin Cabezas, Jason Grebely","doi":"10.1016/j.drugpo.2025.105082","DOIUrl":"https://doi.org/10.1016/j.drugpo.2025.105082","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV) disproportionately affects incarcerated individuals, and effective interventions are needed to improve HCV care within prisons to achieve global elimination targets. This review aimed to identify and synthesise evidence on interventions to improve HCV testing, linkage to care, and direct-acting antiviral (DAA) treatment initiation among people in prison and post-release.</p><p><strong>Methods: </strong>We systematically searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane CENTRAL, and PsycINFO for studies assessing non-pharmaceutical interventions with a comparator or control group. Outcomes were HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. Randomised controlled trials (RCTs) and controlled non-randomised studies were included; data were extracted and risk of bias assessed in duplicate using standard tools (RoB 2 and ROBINS-I). This analysis was restricted to studies of interventions evaluated in prison settings or among people recently released from prison. Searches had no date restriction and were updated November 2024. This review is registered in PROSPERO (CRD42020178035).</p><p><strong>Findings: </strong>Of 20,643 unique records, 22 studies were included (19 non-randomised; three RCTs). Simplified testing modalities had the most evidence of impact on testing and treatment outcomes: dried blood spot (DBS) testing improved antibody testing uptake in three studies (two RCTs and one non-randomised study; OR 2.90, 95 % CI 1.43-5.86) and point-of-care RNA testing improved treatment initiation in three non-randomised studies (OR 9.60, 95 % CI 3.38-27.32). Simplified opt-out screening strategies also increased antibody testing uptake in three studies (OR 20.41, 95 % CI 1.88-221.19). Other interventions simplifying testing (e.g., reflex RNA testing, broadened testing criteria) were effective in individual studies, but pooled analyses for broadened testing criteria were not statistically significant due to high heterogeneity. Single studies also showed improvements in treatment initiation using DBS testing, nurse-led care, and no-cost coverage of HCV medications.</p><p><strong>Interpretation: </strong>Several interventions, particularly those to enhance testing, may be successful in increasing HCV testing and treatment in prisons. However, the heterogeneity of interventions, methodological limitations of included studies, and limited number of studies underscore the need for further robust research, particularly RCTs, to optimise care in this setting.</p>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":" ","pages":"105082"},"PeriodicalIF":4.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}