Genigraphics Research Poster Template 24x48

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TBNet- TB treatment completion on a global scale
Edward L. Zuroweste, MD, Chief Medical Officer,
Ricardo Garay, Health Network Manager, Deliana
Garcia, Director International Project, Migrant
Clinicians Network
INTRODUCTION
ABSTRACT
RESULTS
CASE STUDY
A total of 1,145 active cases of TB were
referred by detention facilities that house
immigration detainees and health departments
across the United States. The destination country
did not recommend treatment for 34 cases.
treatment was recommended for 1,111 cases.
Thirteen patients died, not all from TB. Of the
remaining 1,098 patients, 112 patients were lost
to follow up and 64 refused treatment. TBNet
documented successful outcomes for 922 patients
resulting in a treatment completion rate of 84.
  Analysis of 2011 data indicates that 167 cases
were referred between January 1 and December 31.
Treatment was not recommended for 4 cases by the
destination country. Of the remaining 163 cases,
5 patients died, not all from TB, 13 were lost to
follow up and 10 refused treatment. TBNet
documented a treatment completion rate of 85.4.
Transnational tracking is critical to treatment
completion for TB among migrants. For 18 years,
Migrant Clinicians Network has provided global
case management to thousands of TB patients
traveling across the world through its project,
TBNet. This multi-national tuberculosis patient
tracking and referral program is designed to keep
mobile, underserved populations in care.
Treatment for these populations is complicated by
the fact that many, are unable to remain in a
given location long enough to complete the TB
treatment regimen. TBNets patient base includes
migrant workers, the homeless, immigration
detainees, and prison parolees Cases are managed
by trained bilingual staff with oversight by
MCNs Chief Medical Officer. Enrollment in TBNet
is free but must be initiated by a health care
provider. Once a patient is enrolled, TBNet will
establish regular contact with both the patient
and the treating clinician to document treatment
adherence. Before a case can be closed, MCNs
Chief Medical Officer reviews every record for
accuracy and completion. At the conclusion of
treatment, TBNet notifies the enrolling clinic as
well as the state or regional TB Control person
that the patient has completed treatment. Through
out its 17 years of operation TBNet has enrolled
over 5,000 patients and worked with almost 3,000
clinics in U.S. and over 70 countries. In 2010
TBNet received the 2010 Border Models of
Excellence in Tuberculosis Surveillance and
Control award from the U.S.México Border Health
Commission.
Transnational tracking is critical to treatment
completion for TB among migrants. For 18 years,
Migrant Clinicians Network has provided global
case management to thousands of TB patients
traveling across the world through its project,
TBNet. MCNs Chief Medical Officer completed an
analysis of TBNet cases enrolled from January 1,
2005 to December 31, 2011. Results from the seven
year analysis are summarized in this presentation
and show that TBNet has proven to be an
innovative approach to tuberculosis management in
migrating patients.
Male patient was screened for TB in an ICE
facility in February 2010. Had a negative smear,
RUL consolidation, TST of 20 mm, was asymptomatic
and medication was not started. He was enrolled
in TBNet prior to being deported to Central
America. In March 2010 TBNet was notified of
positive culture results. His medical records
were sent to his home country and his family was
notified. However he had already left his home
country to try to reenter the U.S. by the time
the results were available. In May, 2010 his
wife called TBNet to say that she had just had
word that her husband was being held by coyotes
in a U.S. border city and they were demanding a
ransom to free him. TBNet staff obtained the
phone number of the house where he was being held
and urged the coyotes to let him go so that he
could receive medical treatment. TBNet staff also
initiated a human trafficking report with the US
Justice Department. In June, 2010 the patient
called TBNet from an East Coast location to say
that he had been released and wanted to initiate
treatment. TBNet found a clinic and the patient
started a 4-drug regimen using DOT. In September
2010 he moved for work to a new location where
TBNet was able to find him another clinic to
assure continuity of care. The patient completed
treatment in April, 2011.
Table 2 Top Ten Nationalities of TBNet Class 3
Active TB Patients 2005-2011.
Country Total Class 3 patients (1,145 total patients-62 countries) Percent of total patients Percent Treatment Completed
Honduras 393 34.3 85
Mexico 229 20.0 78
Guatemala 179 15.6 77
El Salvador 117 10.2 90
Nicaragua 26 2.3 88
Peru 24 2.1 91
China 20 1.7 90
Ecuador 18 1.6 83
India 18 1.6 66
Haiti 10 0.9 100
METHODS AND MATERIALS
Analysis of TBNet cases enrolled from January 1,
2005 to December 31, 2011 was conducted by the
Chief Medical Officer (CMO). Final case
classification was provided by the treating
clinician or through clinical review by the CMO.
A second analysis of 2011 cases was also
conducted.
CONCLUSIONS
Table 1 Class 3 Active TB Treatment Results
2005-2011.
The World Health Organizations target for
tuberculosis treatment completion is 85 of
smear-positive cases. In 2009, the last year for
which data are available, 88 of patients
requiring treatment of less than one year
successfully completed their treatment in the
United States. Treatment success rates among
difficult-to-follow or mobile populations
typically range far below that level. Very little
data exists regarding patients who migrate
internationally. Typically, when patients cross
national borders, there is no mechanism to track
their treatment outcome.   TBNet has worked with
more than 5,000 participants. While many have
stayed in the US the majority of cases returned
to their country of origin. Whether assisting to
transfer a patient across the Texas/México border
or from the USA to one of seventy other
countries, TBNet has proven to be an innovative
approach to tuberculosis management in migrating
patients.
1,145 Class 3 Active TB Cases Referred
34 treatment not recommended by destination country
1,111 Treatment Recommended
13 deceased
1,098 Followed by TBNet for Active TB
112 lost to follow up 64 refused treatment
922 Complete Treatment 84.0
REFERENCES
CONTACT
Ed Zuroweste, MD Migrant Clinicians
Network kugelzur_at_migrantclinician.org
512-579-4540 www.migrantclinician.org
TBNet provided bridge case management services to
patients in 63 countries and 45 U.S. States from
2005-2011