1 Role of the Binational TB Card for U.S. Immigration and Customs Enforcement Detainees U.S.-Mexico Binational TB Case Management and Referral Program Meeting April 4, 2005 El Paso, TX Division of Immigration Health Services

2 Division of Immigration Health Services Mission We protect America by providing health care and public health services in support of immigration law enforcement.

3 Program Objective Facilitate continuity of tuberculosis (TB) therapy for U.S. Immigration and Customs Enforcement (ICE) detainees following custody

4 Queens, NY Elizabeth, NJ Pearsall, TX El Paso, TX El Centro, CA San Diego, CA Florence, AZ Miami, FL Batavia, NY Aguadilla, PR San Pedro, CA L.A. Staging ICE Detention and Staging Facilities With on-site DIHS Medical Facilities Houston, TX Tacoma, WA Port Isabel, TX

5 Average Daily Total ICE Detainee Population by Year,

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7 * Source: DIHS ** Source: U.S. Centers for Disease Control and Prevention

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11 Detention-Specific Issues Frequent movement –Intake, transfers, releases, repatriations –Use of contract facilities Distrust –Providers perceived as being associated with ICE officials –Reluctance to provide contact and locating information

12 Detention-Specific Issues Medical Holds are essential Collaboration with ICE and detention authorities is essential –Medical holds – recognize in detention file as well as in medical file –Communication between medical and detention staff Language –Need for interpreters or bilingual staff –~ 150 language groups represented Significant paperwork burden / ancillary duty

13 Site-Specific Approaches Florence: detainee brought directly to medical for TB Card program enrollment following release from airborne infection isolation –Requires ICE collaboration and incorporation into local detention facility processes Enrollment of TB Suspects, treatment not initially indicated –Florence: All TB suspects given card –Tacoma: Collect locating/contact information; forward to CureTB if cultures later return positive; no card given

14 TB Suspects Smear positive, or treatment indicated –Binational TB Card given Smear negative, treatment not initially indicated –Detainees released before culture results reported to provider (any country): Active TB cases: 18/73 (24.7%) TB suspects*: 19/68 (27.9%) Non tuberculous mycobacteria: 4/17 (23.5%) * Status as of December 2004

15 Challenges Differing case definitions: U.S. and Mexico Differing criteria for initiating and continuing therapy Release/repatriation before case confirmation is available What do we do about nonadherence?

16 Acknowledgements DIHS Staff at pilot sites: Florence, AZ: Stacey Dawson, Geri Tagliaferri, Eddie Frazier, Melissa George, Elizabeth Fleming San Diego, CA: Erica Graham, Rebecca McTall, Steve Gonsalves, Dave Lusche, Joel Johnson, Gerard Bazile El Paso, TX: Gina Chacon, Angel LaSanta, Elizabeth Escalera, Diane Aker, Erik Hierholzer, Rosa Colon Port Isabel, TX: Wanda Gonzales, Dan Hankes, BuJean Jenkins, Jeri McGinnis, Luz Peredo-Berger Tacoma, WA: Michael Tartaglia, Benford Bennett, Deanna Gephart, Phil Farabaugh Director: Gene Migliaccio Deputy Director: Geralyn Johnson Medical Director: Tim Shack

17 Acknowledgements DIHS: Gene Migliaccio, Geralyn Johnson, Diana Schneider, Tim Shack, Sara Newman, Christine Williams, Steve Wacha, Denise Williams, Diane Aker, Kirsten Warwar, Andrew Hickey, Jim Sorenson ICE/DHS: Jay Brooks, Liz Herskovitz, Mark Lenox, John O’Malley, Christina Hamilton, Joan Lieberman, Michael Biggs, Mike Caltabiano, Tim Perry, Victor Cerda CDC: Ron Valdiserri, Ken Castro, Mark Lobato, Kayla Laserson, Sue Maloney, Phil LoBue, Leslie Page-Taylor, Phyllis Cruise, Stephen Waterman, many others State/local HDs: Sara Royce, Charles Wallace, Cheryl McRill, Ellen Murray, Kathy Moser, Anne Cass, Kathie Sullivan- Jenkins, David Ashkin, Alberto Colorado, Francisco Velasco, Leticia Browning, Jamie Kokko, Elena Torres, Maria Rodriguez MCN: Jeanne Laswell, Del Garcia, Ed Zuroweste, Bertha Armendariz DHHS/OGC: Jocelyn Mendelsohn, Esq.