Access to Care Along the U.S. Mexico Border Webinar

Transcription

1 Access to Care Along the U.S. Mexico Border Webinar Deliana Garcia, MA June 20, 2017 EXCELLENCE EXPERTISE INNOVATION Deliana Garcia, MA has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1

2 Deliana Garcia Director International Projects and Emerging Issues Migrant Clinicians Network Disclosure and Disclaimer Faculty: Deliana Garcia Disclosure: Ihave no real or perceived vested interests that relate to this presentation nor do we have any relationships with pharmaceutical companies, biomedical device manufacturers, and/or other corporations whose products or services are related to pertinent therapeutic areas. 4 2

3 Objectives 1. Understand that mobility is not an impediment to effective treatment for infectious disease 2. Understand the role of trans border migration for increased risk for HIV and TB. 3. Understand the importance and availability of systems to support continuity of care for TB/HIV+ migrants Case Study Patient seen in health department Patient entered TX Enrolling site Patient stated that she is not caring for herself well Missed appts Patient states that she is sad, numb, and confused See therapist. Slowly improved. Entered Treatment February,

4 The Recent Story of Migration A growing world economy Rapid dissemination of information Improved transportation and communication Ease of movement Increasing social inequality Global Flow of People migration.info/ 4

5 Globalization Migrant Considerations Health care system is a patchwork of geographically static sites, with varying payment structures and eligibility guidelines. Involves increasingly diverse populations moving rapidly between locations. 5

6 In million people lived outside their country of birth In 2006 there were 191 million international migrants 3% 6

7 248 million international migrants in 2016 Pew Research Hispanic Center, May 3,

8 Movement of Populations 1 Voluntary vs Involuntary 2 Anticipated vs Unanticipated 3 Regular vs Unofficial Mobility and vulnerability various phases: during transit, in destination communities, in communities of departure and return 8

9 Migration presents both Vulnerabilities Opportunities Migration Changing the demographics of the world Unprecedented growth in non traditional receiving areas Isolation from social networks, social service and healthcare providers 9

10 Migration causes discontinuity and loss of familiarity Health care policy Problematic for one government agency to pursue immigration control while another encourages unauthorized migrants to utilize health services 10

11 US/Mexico Border 11

12 Underserved Undeserved Complexity 12

13 Unique Risks for Migrants Limited social network Substance use to combat loneliness and fear Survive as sex workers Exchanging sex for food, shelter, drugs, or money HIV Prevention Migrants are in a sociocultural context substantially different from their frame of reference. The feeling of being an alien may continuously be present. This feeling strengthened by linguistic difference to the domestic population. 13

14 HIV and Mexican Migrants Men infected while in the US and then return to Mexico % of AIDS cases in rural areas of Mexico are among men who have been in the US. The risk most frequently reported by migrant women is sexual violence 14

15 Effective risk communication With uncomfortable topics most often the provider that is the most uncomfortable! If you are professional and open with your questioning the patient will be much more forthcoming. Tubeculosis occurs at the intersection of migration, poverty and health Photo Alan Pogue 15

16 What does the intersection of TB and migration look like? Luis from Guatemala diagnosed with TB infection at age 36. Moves 4 times during the course of the last 9 month Evidence that the policy of using 3HP or 4 mos RIF needs to change everywhere for the treatment of TB infection Good News Movement to elevate TB visibility Recommendation to screen for LTBI Through US preventive services taskforce Expert opinion and evidence based methods Public health recommendation that all foreign born from endemic areas be tested and treated if found to be infected Recommendation to screen has reached the same level as cervical cancer screening 16

17 Caring for migrants Young workers tend to present infrequently Young men and young women should be screened for HIV at any opportunity Our vision is shaped by our own culture 17

18 Missed opportunities 18

19 Contacts patients on a scheduled basis (monthly for HIV patients/ dependent on travel plans) Contacts clinics monthly Assists patients in locating clinics for services and resources. Transportation/Scheduling Reports back to the enrolling clinic and notifies them of health status or outcomes 19

20 Health Network Maintaining a Patient in Care Any questions? Deliana Garcia dgarcia@migrantclinician.org 20