Tuberculosis in the San Diego-Tijuana Border Region: Time for Bi-National Community-Based Solutions (original) (raw)
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We evaluated the use of federal public health intervention tools known as the Do Not Board and Border Lookout (BL) for detecting and referring infectious or potentially infectious land border travelers with tuberculosis (TB) back to treatment. We used data about the issuance of BL from April 2007 to September 2013 to examine demographics and TB laboratory results for persons on the list (N = 66) and time on the list before being located and achieving noninfectious status. The majority of case-patients were Hispanic and male, with a median age of 39 years. Most were citizens of the United States or Mexico, and 30.3% were undocumented migrants. One-fifth had multidrug-resistant TB. Nearly two-thirds of case-patients were located and treated as a result of being placed on the list. However, 25.8% of case patients, primarily undocumented migrants, remain lost to follow-up and remain on the list. For this highly mobile patient population, the use of this novel federal travel intervention...
American Journal of Public Health, 2013
Tuberculosis (TB) is an important health concern along the 1950-mile international border shared by Mexico and the United States. The neighboring states of Baja California, Mexico, and California, United States, have TB incidence rates that far exceed those of their respective countries. In 2008, the incidence rate for TB in Baja California was 50.9 per 100 000, versus 17.1 per 100 000 nationally in Mexico. 1 In California, the incidence of TB that same year was 7.4 per 100 000, compared with 4.2 cases per 100 000 persons in the United States. 2 Multidrug-resistant tuberculosis (MDR-TB) is TB disease associated with Mycobacterium tuberculosis strains that are resistant to isoniazid and rifampin, the 2 most effective TB medications available. 3 MDR-TB is found in Mexico and California, and significantly increases treatment and societal costs of TB, with case fatality rates ranging from 12% in HIVnegative to 90% in HIV coinfected persons. 3 Although TB control efforts worldwide are starting to decrease TB incidence and mortality, 4,5 the emergence of MDR-TB is "threatening to destabilize global TB control," 6(p261) and could rapidly turn TB into an untreatable disease, even in high-income countries. 7 California had an average of 41 MDR-TB cases per year from 1994 to 2003-the highest incidence of MDR-TB in the United States. 8 More than 85% of the incident MDR-TB cases in California from 1993 to 2006 were among foreign-born individuals, 28% of whom were born in Mexico. 7 In Mexico, although some studies of MDR-TB prevalence in specific populations have been conducted, 9-12 there is no routine surveillance data on MDR-TB for comparison. California and Baja California share a strong migratory dynamic. Translocation and contact between inhabitants of both sides of the border are frequent, and familial and other social relations extend across the border. 13 This
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Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
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Frontiers in Public Health
Background: Tuberculosis (TB) remains a salient public health issue along the U.S./ Mexico border. This study seeks to identify the social and structural factors, which are associated with TB disease burden in the binational geographic region. Identification of barriers of treatment completion provides the necessary framework for developing evidence-based interventions that are culturally relevant and context specific for the U.S./Mexico border region. Methods: Retrospective study of data extracted from medical charts (n = 439) from Yuma County Health Department (YCHD) (n = 160) and Centro de Salud San Luis Río Colorado (n = 279). Patients currently accessing TB treatment at either facility were excluded from the study. Chi-square, unadjusted odds ratios, and logistic regression were utilized to identify characteristics associated with successful TB treatment in this population. Findings: The study population was predominantly male (n = 327). Females were more likely to complete TB treatment (OR = 3.71). The absence of drug use and/or the absence of an HIV positive diagnosis were found to be predictors of TB treatment completion across both clinical sites. Forty-four percent (43.59%) (n = 85) TB patients treated at CDS San Luis did not complete treatment versus 40.35% (n = 49) of TB patients who did not complete treatment at YCHD. Moving from the area or being deported was the highest category (20.78%) for incomplete TB treatment in the population (n = 64) across both clinical sites.
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Journal of Immigrant …, 2011
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