Grant: Project Grant

Needle and syringe exchange programs (NSPs) are evidence-based prevention tools that reduce the transmission of HIV and viral hepatitis among people who inject drugs in the community, with evidence suggesting similar efficacy in prisons. They are recommended by the World Health Organization and the United Nations as one of fifteen essential elements of an effective HIV and viral hepatitis prevention strategy in prisons. Despite these recommendations, only nine countries worldwide provide prison NSPs, including Canada. Despite initial optimism of Canada's introduction of prison NSPs in nine Canadian federal prisons, less than 10% of people who inject drugs in Canadian federal prisons have accessed these programs. While modest prison NSP uptake has the potential to undermine program sustainability, uptake could be addressed through more proactive implementation. The Canadian federal prison system is thus ideally situated to deploy an implementation science framework to systematically scale up prison NSPs. We determined the barriers and facilitators to improve prison NSP scale-up among a diverse group of stakeholders at each of the nine federal prisons with NSPs. We now aim to address the most common barriers identified at each prison to increase the number of people who inject drugs enrolled in prison NSPs, with the overall goal of enhancing the quality of prison NSP services and improving prisoner and overall public health.