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Table 4 Links between key areas of safer tattooing interventions, review findings, gaps in knowledge, and recommended focus for research

From: Safer tattooing interventions in prisons: a systematic review and call to action

Key areas of safer tattooing interventions Promising strategies based on findings Gaps in knowledge Areas for further research
Approachability (information provision) Information and education materials given to all incarcerated people vs. only to tattooists and tattoo recipients. Effect of information strategies over time on populations, including prison staff. What information programs best increase awareness of both people in prison and prison staff and increase demand for safer tattooing services?
Information on safer tattooing as part of an information package on blood-borne infection prevention, treatment, and care. How to best integrate safer tattooing into a comprehensive infectious disease information package to increase demand for testing and counseling on HIV, HBV, HCV and other key infections?
Are stand-alone information programs on unsafe tattooing risks as effective as providing information combined with safe tattoo room in reducing risks of blood-borne infection transmission through tattooing?
Acceptability Supervision of a tattoo room by prison staff or by health staff. Implementation of a tattoo room in prison health clinics (where such clinics are available) vs. in prison workshops. Which implementation setting and supervision strategy are the most acceptable to people in prison, in addition to being cost-effective and feasible for the detention facility and the health services?
Implementation of a stepwise model to safer tattooing that considers available resources and acceptability thresholds. What is the effectiveness, feasibility, acceptability, and sustainability of each of the interventions outlined in a stepwise approach to safer tattooing (information, education and communication; standard precautions and effective sterilization techniques, such as bleach; sterile ink; single-use needles and safe disposal of used needles; tattoo machines; dedicated and supervised tattoo room; and vocational training)?
Availability of safer tattooing services During non-working hours. Availability limitations of the tattoo room when managed by health staff vs. prison staff. How to best professionalize safer tattooing services into an official prison vocational workshop (thus guaranteeing quality services that are available during business hours)?
Affordability Below-market costs or free-of-charge tattooing services. Influence of direct costs borne by recipients on uptake of safer tattooing. What is the willingness-to-pay of prospective recipients?
Appropriateness Provision by people in prison trained to be tattooists. Provision by trained detainee-tattooists vs. external professional tattooists vs. a combination of both? What are the feasibility, sustainability, and acceptability of a private-public partnership between the detention center and private professional tattooist?
Inclusion of other related services. In addition to safer tattooing services, what are the other services to be offered, including non-health services (e.g. skin piercing), and health services (provision of health information on blood-borne infection prevention and screening)?