Characterizing the Post-Incarceration Risk Environment in St. Petersburg, Russia

In Russia, incarceration is highly linked to bloodborne diseases and substance use. People who inject drugs in Russia are faced with numerous public health risks after being released from incarceration: relapse to drug use, opioid overdose, and complications from untreated infectious disease comorbidities. Despite representing a significant proportion of the burden of the HIV epidemic, there is a paucity of research on the reentry challenges and longer term health problems facing people who inject drugs after release in St. Petersburg, Russia. The overall goal of this dissertation is to quantitatively and qualitatively elucidate the context of the post-release public health problems facing people who inject drugs in this setting.;For the two quantitative analyses, the data originated from a large cross-sectional study conducted in St. Petersburg from September 2012 -- June 2013 (N=811). Participants were recruited by respondent driven sampling, a modified form of peer referral. The qualitative component consisted of 25 semi-structured in-depth interviews among people who inject drugs and who had been released from incarceration in the past two years from the date of their interview.;In the first analysis, we examined significant correlates of time-to-first opioid injection and utilization of a non-sterile, previously used syringe using proportional hazards regression and logistic regression respectively. Our results indicated that being unemployed and being previously diagnosed with viral hepatitis coinfection (hepatitis B and C virus) were significantly associated with an increased risk of relapsing sooner compared to people who were employed and not diagnosed with viral hepatitis coinfection at relapse. As a continuation of these findings, the qualitative analysis explored emergent themes related to reentry challenges, relapse to drug use, and overdose. Consistent with the previous analysis, we found that participants often cited problems with employment as a potential barrier to stabilization after release. Relapse to drug use was often perceived as being inevitable, however some participants expressed a strong desire to refrain from using drugs after release from prison. In the third analysis, propensity score matching was used to identify differences in patterns of alcohol and drug abuse, overdose, and utilization of health care services between participants who had been incarcerated and participants who had never been incarcerated.;Our findings consistently showed that alcohol use, receiving services from a TB doctor, and the cumulative number of health care services received, were more significantly elevated among those who had been incarcerated compared to participants who had never been incarcerated. Our results highlight the many individual level and environmental challenges facing formerly incarcerated people who inject drugs in Russia upon release. Discharge planning, such as linkage programs from an incarcerated facility to health care and social services should prioritize financial stabilization and drug/alcohol treatment. Delaying or preventing relapse to injection drug use and alcohol use could be a way to more effectively treat individuals for underlying substance use problems and link them to care for infectious disease comorbidities.