1. US-Mexico Binational Tuberculosis Referral and Case Management Project: An Update

2. Countries of Birth for Foreign-born Persons Reported with TB, US, 2002 Mexico (25%) Philippines (11%) Vietnam (8%) India (7%) China (5%) Haiti (3%) S. Korea (3%) Other Countries (38%)

3. Incidence of Pulmonary TB US and Mexico Border States, 2001 * Rate = TB cases/100,000 Data source = CDC (US), DGE/SSA (MX) National 12,768 4.5 Border 4,345 6.9 National 16,323 16.2 Border 4,780 28.1 Cases Rate*

4. Reason Therapy was Stopped, US, 1993-1999 Mexican-born TB patients receiving TB treatment were approximately twice as likely to have moved or be lost to follow-up than US-born TB patients (P<0.001)

5. Goals of the US-Mexico Binational TB Referral and Case Management Project Ensure continuity of care and completion of therapy Reduce TB incidence and prevent drug resistance Coordinate referral of patients between health systems Provide model for other diseases

6. Unique identification number Location where card was issued Treatment initiation date Date of last dose TB treatment Treatment regimen DOT (yes/no) Bilingual Toll-free telephone numbers in the US and Mexico Binational Health Card – Data Elements

7. TB Patients - Eligibility US Active TB Mexican-born, and/or Mexico-bound Examples: Recently arrived to the US from MX Migrant worker Close or immediate family lives in MX Works in the US and lives in MX Lives in the US and receives medical care in MX Mexico Active TB

8. Pilot Sites US-Mexico border sister cities/states San Diego - Tijuana El Paso/Las Cruces - Ciudad Juarez Webb/Cameron Counties - Matamoros Arizona - Sonora INS / ICE Detention Centers Texas, California, Arizona Mexican states (interior) Coahuila, Nuevo Leon, Michoacan, Jalisco, Veracruz, Oaxaca

9. Project Launch: March 27, 2003

10. Card Distribution and Patient Movement As of November, 2003 USA El Paso, TX / Las Cruces, NM 39 Cards distributed 19 patients to Mexico 0 patients from Mexico San Diego, CA 92 Cards distributed 6 patients to Mexico 1 patient from Mexico Arizona 5 Cards distributed 1 patient to Mexico (deported) 0 patients from Mexico Tennessee/Chicago/Webb/Cameron Implementation in December 2003 MEXICO Ciudad Juarez 42 Cards distributed 0 patients to USA 11 patients from USA Matamoros 245 Cards distributed 4 patients to USA 0 patients from USA Tijuana 267 Cards distributed 1 patient to USA 2 patients from USA

11. Project Evaluation Is the binational referral system facilitating completion of therapy for patients traveling across the US-Mexico border? Can we improve project efficiency? How much does it cost? Is the model sufficiently effective and feasible to warrant replication in other sites and/or for other diseases?

12. Project Evaluation Site visits May 2003 - El Paso, San Diego, USA July 2003 - Mexican National TB Program, MX November 2003 - Mexican border sites December 2003 - US and Mexican interior sites All Partners Evaluation/ Progress meeting planned January 22-23, 2004 - Mexico City, MX

13. Project Partners National TB Program of Mexico Mexican Ministry of Health Mexican National Center for Epidemiological Surveillance National Institute of Diagnostic and Epidemiological Laboratory Centers for Disease Control and Prevention US-Mexico Border Health Commission California Department of Health Services San Diego County Health and Human Services Agency and its CureTB program Texas Department of Health, TB Elimination Division El Paso City-County Health Department Migrant Clinicians Network and its TBNet program The Binational TB Prevention and Control Project, “JUNTOS” La Fe Community Health Center Institute of Health Services of Baja California State of New Mexico Department of Health Secretary of Health of Chihuahua, Tamaulipas, Sonora, Coahuila. Nuevo Leon Secretary of Health of Jalisco, Michoacan, Vera Cruz, Oaxaca Ciudad Juarez Secretary of Health US Agency for International Development (USAID) US Department of Health and Human Services (HHS) US Department of Homeland Security US Department of Health Resources and Services Administration (HRSA) US Department of Immigration and Naturalization Services (INS)/ICE Ten Against TB American Lung Association American Lung Association of Texas (ALAT) Pan American Health Organization (PAHO)

14. Project Summary Responds to identified TB needs in the region Represents consensus for binational collaboration Improve treatment outcomes Provides model for other similar settings or for other diseases in this setting

15. Thank You Gracias

16. EXTRA

18. Data Flow/Management ACTION Registers patient Educates/issues card Notifies Referral System when patient MOVES Registers patient Notifies TB provider in destination location Reports final outcome to both US/MX Notifies Referral System on other side of border Provides information US-MEXICO BORDER REFERRAL SYSTEM TB PROVIDER Patient MOVES