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 TB Clinic Field Case Management North Team South Team Refugee Health Epidemiology and Surveillance Health Education Binational Unit - CureTB San Diego County Health and Human Services Agency TB Control and Refugee Health Branch

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

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

9. 2004 CureTB Outcomes 58 ICE cases 91 non-ICE cases

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

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

12. 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

13. Mycobacterium bovis San 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

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

15. 62 yo resistant to INH, Rif, Ethamb, PZA, Strep and ethionamide 22 yo resistant to INH, Rif, Ethamb, PZA, Strep and Levo 26 yo resistant to INH, Rif, Ethamb, PZA, Strep 40 yo DM, meth user, resistant to… Puentes de Esperanza 48 yo resistant to INH, Rif, PZA but has been on Emb x 1 year. Recommendation: Support DOT in Mexico