US-Mexico Binational Tuberculosis Referral and Case Management Project:

An Update

Countries of Birth for Foreign-born Persons Reported with TB, US, 2002

Mexico(25%)

Philippines(11%)

Vietnam(8%)India

(7%)China

(5%)

Haiti(3%)

S. Korea(3%)

OtherCountries

(38%)

Incidence of Pulmonary TB US and Mexico Border States, 2001

* Rate = TB cases/100,000

Data source = CDC (US), DGE/SSA (MX)

National 12,768 4.5

Border 4,345 6.9

National 16,323 16.2

Border 4,780 28.1

Cases Rate*

Reason Therapy was Stopped, US, 1993-1999

Mexican-born TB patients receiving TB treatment were approximately twice as likely to have moved or be lost to follow-up than US-born TB patients (P<0.001)

Goals of the US-Mexico Binational TB Referral and Case Management Project

Ensure continuity of care and completion of therapy

Reduce TB incidence and prevent drug resistance

Coordinate referral of patients between health systems

Provide model for other diseases

Unique identification number

Location where card was issued

Treatment initiation date

Date of last dose TB treatment

Treatment regimen

DOT (yes/no)

Bilingual

Toll-free telephone numbers in the US and Mexico

Binational Health Card – Data Elements

TB Patients - Eligibility US Active TB

Mexican-born, and/or Mexico-bound

Examples: Recently arrived to the US from MX Migrant worker Close or immediate family lives in MX Works in the US and lives in MX Lives in the US and receives medical care in MX

Mexico Active TB

Pilot Sites US-Mexico border sister cities/states

San Diego - Tijuana El Paso/Las Cruces - Ciudad Juarez Webb/Cameron Counties - Matamoros Arizona - Sonora

INS / ICE Detention Centers Texas, California, Arizona

Mexican states (interior) Coahuila, Nuevo Leon, Michoacan, Jalisco,

Veracruz, Oaxaca

Project Launch: March 27, 2003

Card Distribution and Patient MovementAs of November, 2003

USAEl Paso, TX / Las Cruces, NM

39 Cards distributed 19 patients to Mexico 0 patients from Mexico

San Diego, CA 92 Cards distributed

6 patients to Mexico 1 patient from Mexico

Arizona 5 Cards distributed

1 patient to Mexico (deported) 0 patients from Mexico

Tennessee/Chicago/Webb/Cameron Implementation in December 2003

MEXICOCiudad Juarez

42 Cards distributed 0 patients to USA 11 patients from USA

Matamoros 245 Cards distributed

4 patients to USA 0 patients from USA

Tijuana 267 Cards distributed

1 patient to USA 2 patients from USA

Project Evaluation Is the binational referral system facilitating

completion of therapy for patients traveling across the US-Mexico border?

Can we improve project efficiency?

How much does it cost?

Is the model sufficiently effective and feasible to warrant replication in other sites and/or for other diseases?

Project Evaluation

Site visits May 2003 - El Paso, San Diego, USA July 2003 - Mexican National TB Program, MX November 2003 - Mexican border sites December 2003 - US and Mexican interior sites

All Partners Evaluation/ Progress meeting planned January 22-23, 2004 - Mexico City, MX

Project Partners National TB Program of Mexico Mexican Ministry of Health Mexican National Center for

Epidemiological Surveillance National Institute of Diagnostic and

Epidemiological Laboratory Centers for Disease Control and

Prevention US-Mexico Border Health Commission California Department of Health Services San Diego County Health and Human

Services Agency and its CureTB program

Texas Department of Health, TB Elimination Division

El Paso City-County Health Department Migrant Clinicians Network and its

TBNet program The Binational TB Prevention and

Control Project, “JUNTOS” La Fe Community Health Center Institute of Health Services of Baja

California

State of New Mexico Department of Health

Secretary of Health of Chihuahua, Tamaulipas, Sonora, Coahuila. Nuevo Leon

Secretary of Health of Jalisco, Michoacan, Vera Cruz, Oaxaca

Ciudad Juarez Secretary of Health US Agency for International

Development (USAID) US Department of Health and Human

Services (HHS) US Department of Homeland Security US Department of Health Resources and

Services Administration (HRSA) US Department of Immigration and

Naturalization Services (INS)/ICE Ten Against TB American Lung Association American Lung Association of Texas

(ALAT) Pan American Health Organization

(PAHO)

Project Summary

Responds to identified TB needs in the region

Represents consensus for binational collaboration

Improve treatment outcomes

Provides model for other similar settings or for other diseases in this setting

Thank You

Gracias

EXTRA

Data Flow/ManagementACTION

Registers patient Educates/issues card Notifies Referral System when patient MOVES

Registers patient Notifies TB provider in destination location Reports final outcome to both US/MX

Notifies Referral System on other side of border Provides information

US-MEXICO BORDER

REFERRAL SYSTEM

REFERRAL SYSTEM

TB PROVIDER

Patient MOVES