When doctors come to prison – a pilot project for better HIV care in correctional facilities

Recent rearrangements in national policies regarding follow‐up of HIV‐infected inmates have determined that hospitals closest to the prison facility be responsible for their care. Our HIV Unit and the two prison facilities in the area have established a clinical protocol whereby a clinical team goes to the prisons for blood collecting and visits instead of having the inmates transported to the hospital. The purpose of the protocol, from a clinical point of view, was to: (i) promote adherence to blood tests and clinical visits; (ii) promote adherence to antiretroviral (ARV) therapy; (iii) facilitate ARV administration by promoting once‐daily‐dosing. This retrospective review looks back at the first year of protocol implementation between the HIV Unit of HPP Cascais Hospital and the prisons of Tires and Linhó. The purpose of this study is to characterize the demographics of our inmate population; assess the number of inmates on ARV and describe the regimens as PI‐ or NNRTI‐based and as once‐ or twice‐daily dosed; evaluate ARV efficacy by HIV viral load undetectability; and assess opportunity for ARV switch from twice‐ to once‐daily dosing. From April 2011 until June 2012 a total of 53 inmates were included in this protocol. The majority of patients were female (55%) as one of the prisons is mainly for female inmates. The median age is 36 years (from 23–59). The average time of follow‐up was 11 months (15 months maximum). From the total of 53 patients under study, 40 are currently under care, the other 13 having been released or transferred to other prison facilities. The majority of these patients are on ARV therapy (83%). By the end of follow‐up time 88% of patients were on a once‐daily dosed regimen; these are PI‐based in 69% and NNRTI‐based in 31%. At their last evaluation, 32/33 patients on therapy had undetectable HIV viremia (97%). As a conclusion, we assess that this protocol implementation has benefitted all parts: patients assure regular laboratory and clinical follow‐up, and avoid constraintful displacements to the hospital; prisons guarantee regular specialized medical assistance to inmates and save on multiple trips to the hospital; finally, the clinical team is rewarded with 100% adherence to visits and therapy, which is evident by 97% viral load undetectability. The major constraint found in this protocol was the difficulty in providing adequate discharge planning and linkage to care in the community due to frequent unannounced release of inmates.