Prison Telehealth Services During COVID-19

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ACCP member Melissa E. Badowski, Pharm.D., MPH, FCCP, BCIDP, BCPS, AAHIVP, Clinical Associate Professor and HIV/ID Clinical Pharmacist at the University of Illinois – Chicago (UIC) College of Pharmacy, shared her institution’s recent experience in providing care for HIV patients in the Illinois State Prison System.

Although the State of Illinois prison system has used UIC’s interdisciplinary telehealth service for the care of HIV patients for the last 10 years, clinical pharmacists and other members of the team acknowledged the risk of bringing inmates to the medical unit for routine HIV follow-up care during the COVID-19 pandemic. Therefore, the telehealth team developed a process to remotely review laboratory data and medical records of patients scheduled during the preceding week in order to identify those with urgent needs and those who could be rescheduled. The goal of this practice was to minimize movement across correctional settings and reduce patient risk of viral exposure from other inmates, correctional officers, or medical staff. In addition, the team has been educating patients on appropriate handwashing/sanitization and mask-wearing practices. Nonetheless, the major advantage of this approach is that the patients’ HIV care is not adversely affected, including uninterrupted access to antiretroviral medications.

Some prisons have experienced an outbreak and resorted to locking down an entire facility to halt all movement. However, many facilities are running as usual with heightened awareness of the need for social distancing. Of note, the State of Illinois is allowing inmates with less than a year left in their sentence and who were convicted of a non-violent crime to be eligible for immediate release. A potential disadvantage of this course of action is the number of patients (many with no health insurance coverage) who may be lost to follow-up upon release and unable to obtain life-saving antiretroviral medications and other medications for chronic disease. Patients scheduled for release in advance routinely receive from the HIV program a 30-day supply of antiretroviral therapy and a 14-day supply of all other non-HIV medications. But unfortunately, if patients are released suddenly by the parole board, they may not have access to the usual supplies of antiretrovirals and non-HIV medications. The HIV program’s case manager works directly with those individuals who are immediately released to complete the paperwork needed to secure medication coverage through the AIDS Drug Assistance Program (ADAP) and to assist with placement. Although it may take up to a week to obtain ADAP approval and an additional week for the medications to be delivered, this can reduce interruptions in therapy.