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CureTB and other border initiatives

CureTB and other border initiatives. Kathleen Moser, MD TB and Refugee Health Branch San Diego County Health and Human Services Agency. CureTB is part of the San Diego TB Control Program. San Diego County Health and Human Services Agency TB Control and Refugee Health Branch.

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CureTB and other border initiatives

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  1. CureTB and other border initiatives Kathleen Moser, MD TB and Refugee Health Branch San Diego County Health and Human Services Agency

  2. CureTB is part of the San Diego TB Control Program San Diego County Health and Human Services Agency TB Control and Refugee Health Branch Epidemiology and Surveillance Health Education TB Clinic Refugee Health Field Case Management Binational Unit - CureTB South Team North Team

  3. 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

  4. San Diego County TB COAG funds - $429,192 Targeted Testing & Rescission -$106,256 Lab reduction & Rescission ? -$80,000 Rescission

  5. US medical provider Mexican 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. Cure-TBMexican National TB Program

  6. 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.

  7. Binational Card Project Launch: March 27, 2003

  8. 2004 CureTB Outcomes 58 ICE cases 91 non-ICE cases

  9. CureTB Staff March 2007 Miguel, Rafael, Alberto, Florencia y Francisco Recommendation: Support CureTB with funds outside of the San Diego COAG. ~$200,000

  10. Recommendation: Technical assistance to develop or access a secure data system to transmit clinical information. Possible access to Plataforma Unica

  11. 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

  12. 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

  13. Recommendation: Binational Working Group to review the economic and health issues of the “fresh cheese” industry.

  14. Recommendation: Support DOT in Mexico 26 yo resistant to INH, Rif, Ethamb, PZA, Strep 62 yo resistant to INH, Rif, Ethamb, PZA, Strep and ethionamide Puentes de Esperanza 48 yo resistant to INH, Rif, PZA but has been on Emb x 1 year. 22 yo resistant to INH, Rif, Ethamb, PZA, Strep and Levo 40 yo DM, meth user, resistant to…

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