Predicting Violent Reoffending in Individuals Released From Prison in a Lower-Middle-Income Country: A Validation of OxRec in Tajikistan.

Background: Although around 70% of the world's prison population live in low- and middle-income countries (LMICs), risk assessment tools for criminal recidivism have been developed and validated in high-income countries (HICs). Validating such tools in LMIC settings is important for the risk management of people released from prison, development of evidence-based intervention programmes, and effective allocation of limited resources. Methods: We aimed to externally validate a scalable risk assessment tool, the Oxford Risk of Recidivism (OxRec) tool, which was developed in Sweden, using data from a cohort of people released from prisons in Tajikistan. Data were collected from interviews (for predictors) and criminal records (for some predictors and main outcomes). Individuals were first interviewed in prison and then followed up over a 1-year period for post-release violent reoffending outcomes. We assessed the predictive performance of OxRec by testing discrimination (area under the receiver operating characteristic curve; AUC) and calibration (calibration statistics and plots). In addition, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for different predetermined risk thresholds. Results: The cohort included 970 individuals released from prison. During the 12-month follow-up, 144 (15%) were reincarcerated for violent crimes. The original model performed well. The discriminative ability of OxRec Tajikistan was good (AUC = 0.70; 95% CI 0.66-0.75). The calibration plot suggested an underestimation of observed risk probabilities. However, after recalibration, model performance was improved (Brier score = 0.12; calibration in the large was 1.09). At a selected risk threshold of 15%, the tool had a sensitivity of 60%, specificity of 65%, PPV 23% and NPV 90%. In addition, OxRec was feasible to use, despite challenges to risk prediction in LMICs. Conclusion: In an external validation in a LMIC, the OxRec tool demonstrated good performance in multiple measures. OxRec could be used in Tajikistan to help prioritize interventions for people who are at high-risk of violent reoffending after incarceration and screen out others who are at lower risk of violent reoffending. The use of validated risk assessment tools in LMICs could improve risk stratification and inform the development of future interventions tailored at modifiable risk factors for recidivism, such as substance use and mental health problems.