Increasing Knowledge of Prison Health Care Providers in the Management of Drug-to-Drug Interactions in Inmates Co-infected with Human Immunodeficiency Virus and Tuberculosis

Abstract

Background: The incidence of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) co-infection is high in correctional settings relative to the general population. With advances in anti-retroviral treatment, patient survival with HIV has increased when drug regimens are used appropriately. However, when HIV and TB co-infection exists, management is more difficult due to drug-to-drug interactions (DDI). DDls can occur at any level of medication administration, including absorption, metabolism, transportation, and elimination, which makes management a major challenge for health care providers (HCPs). The purposes of this quality improvement project were to develop and present an educational session targeted at HCPs in the prison settings and to evaluate the effects of the educational program on HCP knowledge related to the management of HIV and TB co-infected inmates.

Methods: The educational session was developed based on the CDC recommendations and in collaboration with expert nurses and physicians who provide care to HIV inmates. The project evaluated the effectiveness of the educational session using a single group, pre and post-test design with 13 healthcare providers from a single correctional facility in Washington, DC. A 12-item written assessment assessed participants' knowledge of HIV and TB co-infection management, the pharmaco-dynamics and pharmaco-kinetics of HIV and TB medications administered to co-infected inmates.

Results: Correct responses to the knowledge assessment test improved from 69% before the educational session to 80% afterwards. A statistically significant increase in knowledge regarding the pharmaco-dynamics and pharmacokinetics of HIV and TB management was established (Z= -2.57, P =.01).

Conclusions: A single educational session was effective at increasing HCP knowledge in the treatment and management of HIV and TB co-infected individuals. However, the outcome of this evidence-based project suggests the need for continued reinforcement. In effect, the training session is been made available including references and websites for HCPs easy accessibility. The presentation will be modified and incorporated in the required annual refresher courses at the target correctional facility. Also in the recommendations is that the actual care of inmates should be reviewed and individualized for appropriate management with the ultimate goal of improving health outcomes.