Cross border Continuity of TB Care

Transcription

1 TB Control Program County of San Diego Cross border Continuity of TB Care CureTB US/Mexico Tuberculosis. Referral and Information Program

2 TB Control Program County of San Diego Why does this matter? Retrospective chart review of 136 of 222 verified San Diego cases from 2010 showed that 35% had >1 of the following: 1) Case had identified contacts in Mexico 2) Case had identified/suspected source/assoc case in Mexico 3) Case had tx in Mexico for TB sx in the 3 months prior to dx in the US 4) Case crossed border during TB tx or dx Of the 222 total reported cases, 21% had an identified binational connection.

3 Some barriers to continuity -Have never had TB before, don t know where to go -Language and technical barrier between systems, clinical information gap -Mexico diagnostics based on smear, generally smear negative when re-enter Mexico -May not know they have TB prior to leaving - Deportation does not enhance adherence

4 But. These problems can usually be overcome with support and information and follow-up Few people are seeking to die of TB and infect their family

5 CureTB Part of the San Diego County TB Program, Public Health Services since ~1997 Started locally to assure continuity of TB care between SD and TJ and grew based on need.to include other parts of CA and Baja CA then.grew to include all other states in the US and Mexico ~Funded by the State of CA and? by the Centers for Disease Control and Prevention

6 Categories of Patients 1. Suspect and Verified Tuberculosis Case CureTB provides preliminary outcome in 30 days, regular updates, and final outcome by 12 months. 2. Past History Request CureTB will retrieve past medical TB history. 3. Source case finding Active TB in a young child or others likely to have been recently infected for whom it is suspected that the source case is in Mexico.

7 Categories of Referrals 3. Contact notification These patients are divided in two categories: Contacts who are moving to Mexico and have been exposed to an infectious pulmonary case in the U.S. and are under 5 years of age or immunocompromised (HIV, diabetes, etc). Contact investigation notice for a smear positive pulmonary case in the U.S. who was living in Mexico while likely to have been infectious.

8 Binational Referral Form Fax: or Marjorie Lee -Data and Monitoring Lead CureTB.org

9 Make contact with patient, family, friends and providers

10 Referral Confirmation Form

11 Tool that helps keep in touch with patients and providers CureTB #

12 Follow-up with patient and providers

13 Referral Outcome Notification

14 Identify common barriers and how to resolve

15 Deportation x 4 Deported and lost in 2006, 2007, 2010 Back in ICE custody 2011 Long discussion Deported Meet and Greet set up at one port but sent to another port Needed money to get home Family was suspicious Conference call Consulate had another govt agency provide travel voucher Bus station refused voucher Consulate brokered ticket In Nayarit and completing treatment

16 Case Review with Mexican National TB Program 1. Follow up of each case with cross match of outcomes and reporting 2. MDR planning and review 3. PZA or INH monoresistance, etc 4. Smear negative cases

17 Data, data, data

18 States Sending/Receiving Class 3 and Class 5 patients

19 Total Referrals Received * Referral Category * Total US Mex US Mex US Mex Class Class Contact Notification Past History Request Source Case Finding LTBI Total *data for Jan Apr 2012

20 Class 3 Referrals from US to Mexico Received in 2010 with Outcomes* Outcome Overall Health Department (70) ICE/Other Correctional Facility (38) Interviewed before Interviewed before deported moved Yes No Yes No Cured/Completed Tx. 52 (47%) 34 (67%) 5 (25%) 10 (44%) 3 (19%) Moved Back Connected 18 (16%) 9 (18%) 4 (20%) 4 (17%) 1 (6%) to F/U Lost Insuff. Info. 18 (16%) 1 (2%) 4 (20%) 2 (9%) 11 (69%) Lost After Arrival 6 (5%) 0 2 (10%) 4 (17%) 0 Refused/Abandoned 12 (11%) 5 (10%) 3 (15%) 3 (13%) 1 (6%) Died 4 (4%) 2 (4%) 2 (10%) 0 0 Total 110(100%) 51(100%) 20 (100%) 23(100%) 16 (100%) Excluding referrals with an outcome of Died: 79% Completed or Cured or Reconnected if interviewed and 38% if no interview *Excludes 8 referrals for pts that did not move

21 Deportation follow-up Meeting in Baja CA April 20, 2012 Agreements forthcoming Representatives CureTB Baja CA State officials Local TB control and HIV programs Mexican immigration officials Social support organizations HIV, homeless, mental health

22 DSTs for verified cases: US to 223 Mexico Class 3 from US in * 195 Culture proven (87%) 192 DST results obtained (98%) 23 Resistant (12%) 11 mono PZA, 5 INH resistant, 1 Rif, 3 strep, 3 MDR 3 MDR(1.6%) *Excludes 21 Class 3 for which a referral was not required as the patient did not move to Mexico as originally intended or referral is open and patient has not yet moved

23 Resistant TB from Mexico to US 3 Class 3 from Mexico in 2011* 3 Culture proven 3 Susceptibility results obtained 2 Resistant 2 MDR *Excludes 1 Class 3 for which a referral was not required

24 Source case finding /3 children <5 yrs 1/1 child with LTBI 1/1 teen:15 yo 3/4 adults Uncle (cx+), grandmother who abandoned and sick again, HIV+ uncle (sm+) Grandmother (sm+) Uncle (sm+) treated the previous year Drug-using HIV+ friend (sm+), 76 yo mom sm+, 37 yo daughter sm+

25 Source Case Finding 17 month old US born hispanic child with L lung consolidation, mediastinal adenopathy, 14mm TST Lived in San Diego with mother, 2 uncles Babysat in Tijuana during the week with maternal grandmother, uncle, aunt and their 4 children CureTB worked with Tijuana HD to obtain CXRs of adults 37 year old uncle had no sx but LUL infiltrate. He was unable to cross the border. CBP allowed sputum to be collected at the Port of Entry.

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27 Take home We re all in this together Continuity of care across borders is possible and an important TB control strategy Acknowledgements: -The CureTB staff -All referring and receiving providers and partners along the way -The patients