HIV-infected inmates receive ADAP funds
The Hampden County Correctional Center in Ludlow, MA, has all HIV-infected inmates register with the AIDS Drugs Assistance Program (ADAP), which reimburses the county for all HIV medications given to the inmates. ADAP pays for 32 AIDS-related medications, including interferon for the 80% of inmates who are infected with both HIV and hepatitis C.
HIV-infected patients are encouraged to develop a relationship with their physician and the medical team, as well as to learn about their medications and why it’s important that they adhere to the prescribed regimens. Inmates also can easily obtain over-the-counter medications by using one of the facility’s vending machines. That way, they don’t have to ask a nurse for help every time they have a headache.
The result has been that inmates feel very confident about their medical care, says Tom Conklin, MD, director of health services. The Hampden County HIV care program includes three parts:
1. Education. "If inmates understand their illnesses and the treatment plan, then they’re far more compliant and cooperative than if they’re just told to take a pill," Conklin says. "Also, many of the diseases we identify here are communicable diseases, and we want inmates to understand their illness and how they can pass it on to others."
Inmates as a group tend to engage in many high-risk behaviors, such as injection drug use, and jail officials have a good opportunity to educate them about how these behaviors can lead to their becoming infected with HIV or other diseases.
Hampden County’s corrections system has three full-time educators. Everyone who is in the jail for 24 hours or longer receives some basic medical education, Conklin says. An educational course is held each day for 30 minutes, covering HIV, STDs, tuberculosis, and hepatitis.
Peer sessions
The system encourages inmates to attend a peer educational program two hours a day for three days. Any inmate who completes the course is entitled to 1.5 days off his or her sentence. "This is a great inducement to having people participate," Conklin says. "We find that a lot of people sign up for HIV testing afterwards."
Inmates awaiting trials have to attend weekly mandatory health care meetings in which illnesses are discussed. Inmates are expected to participate in the meetings and other activities that will accelerate their rehabilitation, Conklin says.
If inmates stay in bed or otherwise fail to participate, they are sent to another unit, called the accountability unit, where there cannot watch television and have to go to bed earlier. They’ll also be inspected on a daily instead of weekly basis, and they’ll receive daily health care education.
Finally, the corrections system provides personal education based on a primary nursing model to inmates who have specific health concerns and diseases.
2. Prevention. "Prevention is the greatest treatment ever devised," Conklin says. "There’s no treatment as good as prevention."
The system’s prevention work includes helping inmates quit smoking. "We have a smoke-free facility, and no one can be on the grounds with any kind of cigarettes," he says. "We put out celery sticks and carrot sticks for people at first, and the inmates said they didn’t need that."
Inmates can take smoking cessation classes. The jail system is so tight on cigarette smuggling that a pack of cigarettes as contraband will cost an inmate $200, he adds.
The system also provides a great deal of HIV prevention information, followed by HIV testing and counseling.
3. Continuity of care. The corrections system is unique in a number of ways. For one thing, it has community-based physicians providing health care to inmates. "We have four health centers in greater Springfield, covering 90% of the people who come into our facility," Conklin says. "We proposed contracts with their physicians and case managers, and they were delighted to do this because they saw it as an extension of their own mission of taking care of patients."
The physicians spend eight to 12 hours a week at the jail and the rest of their time at the health centers. When inmates are admitted, they are divided according to their zip code and assigned to one of four center areas. This determines which team will provide their health care. The team includes a primary care nurse, a full-time nurse practitioner, a case manager, and physicians.
When the inmate is released, the case manager, nurse practitioner, and physician continue to be the inmate’s health care providers, so they can continue those relationships. "Ninety percent of our patients keep their appointments in the community, and those with HIV keep 100% of their appointments," Conklin says. This rate is three to four times better than the national rate of inmates keeping community health care appointments.
Another unique aspect of the care continuum is that when HIV-infected inmates are released, they can take the same ADAP number they used in prison to the local drugstore, where they can continue their antiretroviral prescriptions.
All of those efforts benefit the community, as well as inmates, Conklin says. "There are six to 10 million people moving in and out of jail systems in this country each year, and that’s a lot of disease moving in and out of jail and infecting our communities."
By educating inmates on how to prevent becoming infected with HIV, hepatitis, and STDs, the jail system saves the community tens of thousands of dollars each year, Conklin says. "We know that by early detection, prompt treatment, nipping problems in the bud by diagnosing early, and by continuing care in the community, we will save the community big bucks," he explains.
The community also benefits from enhanced public safety. Inmates who have learned to take better care of their health are less likely to return to jail or prison, Conklin says. "We have a low recidivism rate, and we think health care plays a role in that because a healthy body leads to healthier behavior."
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