Post on 06-Jan-2018
description
CureTB and other border initiatives
Kathleen Moser, MDTB and Refugee Health BranchSan Diego County Health and Human Services Agency
CureTB is part of the San Diego TB Control Program
TB Clinic
Field Case Management
North TeamSouth Team
Refugee Health
Epidemiology andSurveillance
Health Education
Binational Unit - CureTB
San Diego County Health and Human Services Agency
TB Control and Refugee Health Branch
San Diego’s binational activities are supported by
state and federal categorical TB funds
• 2006 State of California: $132,000
• 2006 COAG funds: $120,000
San Diego County TB COAG funds
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000
2,200,000
2,400,000
2,600,000
2004 2005 2006 2007
Year
$
- $429,192Targeted Testing & Rescission
-$106,256Lab reduction & Rescission
-$80,000Rescission
?
Cure-TB Mexican National TB Program
US medical provider
I’ll send information to the health dept. in
Mexico . Thank you.Gracias por su
information. Yo la enviare a la jurisdiccion. Adios.
Mexican medical provider
CureTB
• Has been operating since ~ 1997 (when State funding began).
• Has been using a “card” since ~1999:
• Has been building relationships, improving operations, and collecting outcomes for over 10 years.
Binational Card Project Launch: March 27, 2003
2004 CureTB Outcomes
2%
25%
14%9%
46%
Completed LostRefused Insufficient initial infoDied ReturnedNot recommended
3%7%
12%
7%
65%
Completed Returned Lost
Refused Died Insufficient Info
Continues
58 ICE cases 91 non-ICE cases
CureTB Staff
March 2007
Miguel, Rafael, Alberto, Florencia y Francisco
Recommendation: Support CureTB with funds outside of the San Diego COAG. ~$200,000
Recommendation: Technical assistance to develop or access a secure data system to transmit clinical information. Possible access to Plataforma Unica
Non-ICE detainees• 22 year old male being smuggled into the US• Detained in Border Patrol custody (part of Customs and Border Protection) as a
material witness• Found to have smear positive, pulmonary TB• Smuggler pled guilty and pt no longer needed as a material witness• CBP options: CBP escorted immediate voluntary return, agree to voluntarily
return on own, or resident address release to TB Program.
• Dilemma for TB Control – If locals assume care:
• Responsible for cost of treatment, housing, etc.• Security risk• Flight risk
– If return to Mexico• Transmission in sister city• Likely return to US• Can US jurisdiction count? Lots of work to arrange continuity and follow care ‘til deported.
Recommendation: Binational “Adherence Workgroup” to develop patient-centered solutions and funding estimates
Mycobacterium bovisSan Diego County, 2004-2006
87 (11%) of 782 culture-proven TB cases
• 85 (98%) were Hispanic• 51 (59%) born outside
US (all Mexico)• 17 (20%) coinfected
with HIV• 22 (25%) were children
less than 15 years old• 39 (45%) had only
extrapulmonary site
Recommendation: Binational Working Group to review the economic and health issues of the “fresh cheese” industry.
62 yo resistant to INH, Rif, Ethamb, PZA, Strep and ethionamide
22 yo resistant to INH, Rif, Ethamb, PZA, Strep and Levo
26 yo resistant to INH, Rif, Ethamb, PZA, Strep
40 yo DM, meth user, resistant to…
Puentes de Esperanza
48 yo resistant to INH, Rif, PZA but has been on Emb x 1 year.
Recommendation:Support DOT in Mexico