At a minimum, the facility's primary care physician should evaluate asymptomatic [having no symptoms of disease] HIV-positive patients every three to four months. Between regularly scheduled visits the inmate may present to the nurse for multiple issues, including acute [new] signs or symptoms, medication issues, etc.
Adherence to complex pharmaceutical regimens has become a critical component of the nurse's role as educator and motivator. In some correctional systems the case manager may initiate adherence checks, which may be [called for] in the following instances:
Because it is common to move inmates from facility to facility, nursing case management should be established system-wide. With a system-wide approach, inmates can be incorporated into a new facility's procedures without being "lost to follow-up." The following three intensive education sessions may be used by nurse case managers with a newly diagnosed HIV-positive inmate.
Establishing community linkages is mandatory and might require face to face meetings. State Departments of Health are useful agencies for providing resource manuals of current AIDS service agencies available in the local areas.
A signed release of information form must be obtained prior to release of any information to outside community resources . . . Continuity of care is especially critical for patients receiving antiretroviral [drugs] and for those vulnerable to [opportunistic infections] due to low CD4 [T] cell counts.
Prisoners should be given medications and/or prescriptions to be filled in the community upon release. The critical issue of continuity of all antiretroviral agents should be stressed to the inmate and to the provider/organization providing post-release care. If therapy must be interrupted, it is often best to stop all antiretroviral agents. [Remember that Sustiva and Viramune must be stopped two days before the rest of the HIV medications are stopped, since it lasts longer in the body and should not be alone in your system, because you may develop resistance. -- EV]
In many correctional health care systems it is the primary care provider who decides when and if antiviral therapy will be offered. This decision, the [drugs] selected and other management decisions regarding HIV care should be based on recommendations of the DHHS or IAS-USA [see Resources for how to obtain a free copy] or other authoritative sources.
Dietitians should be available to advise inmates with HIV about nutritional aspects of wasting syndrome, lipodystrophy [high levels of triglycerides or cholesterol] and gastrointestinal intolerance of meds [such as nausea, vomiting and diarrhea].
[Housing and work] segregation may [lead people to] unscientific beliefs about HIV transmission.
The security staff, primarily the correctional officer (CO), plays an important role in case management. Many times it is the CO who recognizes early signs or symptoms of HIV disease progression. Similarly, COs learn which inmates require medications on a regular basis and can encourage inmates to be adherent. In addition, the health care staff must rely on the security staff to bring the inmate to the medical facility. The success of this depends largely on how informed the security staff is. [Editor's Note: According to the HIV Education Prison Project, in a report on mental health, "Inmates with unrecognized cognitive impairment as a result of HIV may be emotionally [unstable] and behaviorally unpredictable, inviting attacks from other inmates and punishment/retaliation from correctional officers who fail to understand the behavioral impetus. They may receive punishment for rule infractions that they were never entirely capable of understanding or remembering."]