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