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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. Division of Immigration Health Services Mission.

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role of the binational tb card for u s immigration and customs enforcement detainees

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

division of immigration health services mission
Division of Immigration Health ServicesMission

We protect America by providing health care and public health services in support of immigration law enforcement.

program objective
Program Objective
  • Facilitate continuity of tuberculosis (TB) therapy for U.S. Immigration and Customs Enforcement (ICE) detainees following custody
slide4

ICE Detention and Staging Facilities

With on-site DIHS Medical Facilities

Tacoma, WA

Batavia, NY

Queens, NY

Elizabeth, NJ

San Pedro, CA

L.A. Staging

Florence, AZ

El Centro, CA

San Diego, CA

El Paso, TX

Houston, TX

Miami, FL

Pearsall, TX

Port Isabel, TX

Aguadilla, PR

slide7

* Source: DIHS

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

detention specific issues
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
detention specific issues12
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
site specific approaches
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
tb suspects
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

challenges
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?
acknowledgements
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

acknowledgements17
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.