Access to Care Along the US/Mexico Border Deliana Garcia September 20, 2017 Screening for Tuberculosis Infection September 20, 2017 Harlingen, TX EXCELLENCE EXPERTISE INNOVATION Deliana Garcia has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1
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
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 TB 3. Understand the importance and availability of systems to support continuity of care for TB migrants The Recent Story of Migration A growing world economy Rapid dissemination of information Improved transportation and communication Ease of movement Increasing social inequality 3
Global Flow of People http://www.global migration.info/ Globalization 4
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. In 1990 120 million people lived outside their country of birth 5
In 2006 there were 191 million international migrants 3% 248 million international migrants in 2016 6
Pew Research Hispanic Center, May 3, 2012 Movement of Populations 1 Voluntary vs Involuntary 2 Anticipated vs Unanticipated 3Regular vs Unofficial 7
Mobility and vulnerability various phases: during transit, in destination communities, in communities of departure and return Migration presents both Vulnerabilities Opportunities 8
Migration Changing the demographics of the world Unprecedented growth in non traditional receiving areas Isolation from social networks, social service and healthcare providers Migration causes discontinuity and loss of familiarity 9
Health care policy Problematic for one government agency to pursue immigration control while another encourages unauthorized migrants to utilize health services US/Mexico Border 10
Underserved Undeserved 11
Tubeculosis occurs at the intersection of migration, poverty and health Photo Alan Pogue 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 12
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 Our vision is shaped by our own culture 13
Missed opportunities 14
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 15
Health Network Maintaining a Patient in Care Any questions? Deliana Garcia dgarcia@migrantclinician.org www.migrantclinician.org 16