The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis.

INTRODUCTION: More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES: To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS: We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS: The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS: The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS: Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

A review of HIV in prisons in Nepal.

BACKGROUND: HIV in prisons is a serious public health concern. People in prison are at risk of contracting HIV through injecting drug use, unprotected sex and tattooing. However, most countries have largely neglected HIV prevention and care in prisons. OBJECTIVES: The aim of this study is to review HIV prevention and care in Nepal's prisons MATERIALS AND METHODS: This was carried out by Systematic review of published and grey literature. RESULTS: Nepal's National HIV Strategy acknowledges the importance of prisons in broader HIV prevention efforts. However, prison conditions are poor and there is no accurate information regarding HIV prevalence or risk behaviours among prisoners. HIV prevention interventions have largely been limited to ad hoc training workshops. Antiretroviral treatment is not available to HIV infected prisoners. CONCLUSION: There is recognition in Government policy documents that prisons must be involved in efforts to stem the HIV epidemic. However, HIV prevention and care remains largely non-existent in Nepal's prisons. Efforts to obtain external funding to initiate and maintain programs such as drug dependency treatment and condom distribution are required. Attention could also be given to introducing alternatives to incarceration for less serious offenders and drug dependent offenders.