A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons

Purpose Opioid agonist treatment (OAT) programmes in prisons play a significant role preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both availability and coverage of prison OAT remain low. This Indonesian study explores facilitators of, barriers to, delivery methadone using social ecological model (SEM). Design/methodology/approach The used qualitative case approach comprising two with, one without, programmes. Purposive snowball sampling was to recruit participants. In total, 57 in-depth interviews were conducted with governors, health-care staff, officers prisoners. Data analysed thematically. Findings findings identified at all three levels SEM as follows: intrapersonal including misperceptions relating HIV transmission, harm reduction programmes, dependency withdrawal symptoms; interpersonal such inflexible processes wide illicit drugs and; social-structural barriers, notably general lack resources. Research limitations/implications highlight importance overlap between, organisational inter-personal, well factors. Such an is particularly important context implementation low/middle income countries, where resources so significant. Practical implications Three main strategies for improvement suggested development comprehensive education training prisoners staff; re-assessment practices methadone, review strategy prisons, that should consider prisoners’ families increase support prisoner participation; policies prisons. Social author suggests ongoing international national drug are vital continuation sustainability Originality/value contributes overall evidence base middle-income contexts.