Grant: Project Grant - Priority Announcement: HIV/AIDS and STBBI

Needle and syringe exchange programs (NSPs) are evidence-based prevention tools to reduce the transmission of HIV and viral hepatitis (hepatitis C virus; HCV) among people who inject drugs (PWID) in the community, with initial evidence suggesting similar efficacy in the 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 10 countries worldwide provide prison-based NSPs, including Canada. Despite initial optimism of Canada's introduction of prison-based NSPs in nine Canadian federal prisons, only 277 individuals have been enrolled since 2018, including 53 currently. Among people incarcerated in federal prison, 21% reported lifetime drug injection, with over half (51%) having injected in the 12 months before incarceration. Risky injection, including sharing of injection equipment, was reported by 55% of recent injectors. While modest prison-based 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-based NSPs. We aim to understand the multi-level barriers and facilitators to improve prison-based NSP adoption, scale-up, and maintenance among a diverse group of stakeholders across the nine federal prisons with NSPs. We will then use a stepped-wedge randomised study design across the nine federal prisons with NSPs to increase the number of PWID enrolled in NSPs, with the overall goal of enhancing the quality of NSP services and improving prisoner and overall public health.