Transcript Post-Detention Continuity of TB Therapy for the Bureau

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
1
Division of Immigration Health Services
Mission
We protect America by providing health
care and public health services in
support of immigration law enforcement.
2
Program Objective
• Facilitate continuity of tuberculosis (TB)
therapy for U.S. Immigration and Customs
Enforcement (ICE) detainees following
custody
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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
Pearsall, TX
Port Isabel, TX
4
Miami, FL
Aguadilla, PR
Average Daily Total
ICE Detainee Population by Year, 1993-2004
28000
24000
20000
16000
12000
8000
4000
0
1993
5
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
U.S. Immigration and Customs Enforcement Detainees
Tuberculosis Cases with Treatment Indicated, FY 2004
80
70
Count
60
50
40
73
30
68
20
10
17
0
Confirmed active TB
Suspected active TB,
treatment indicated
Case Classification
6
Non M TB
Comparison of TB Case Rates
by Reporting Area and Reporting Period
TB Case Rate per 100,000
120
100
80
60
95.4
40
84.3
82.2
20
22.5
4.9
0
INS FY 2002,
ICE FY 2003,
ICE FY 2004,
DIHS Facilities* DIHS Facilities* DIHS Facilities*
U.S. Foreignborn CY2004**
Reporting area & period
* Source: DIHS
** Source: U.S. Centers for Disease Control and Prevention
7
U.S. Overall
CY2004**
U.S. Immigration and Customs Enforcement Detainees
Confirmed and Suspected Active TB Cases, by Release Status,
FY2004, all countries
120
100
10
Count
80
49
60
40
20
47
1 2
4
0
Deported
Voluntary
Departure
3
11
8
Released
23
USM
1 1
1
TERM
22
11
Missing or still
in custody
Release Status
Confirmed active TB
8
Suspected active TB, treatment indicated
Non M TB
U.S. Immigration and Customs Enforcement Detainees
TB Cases by Country Fiscal Year 2004
90
80
70
Count
60
50
40
30
20
10
0
I
C
S
L
A
A
N ZI INA BIA ICA BA BLI OR OR ALA AIT AS SI EA ICO PAL MA RU NE ND LIA REA AN sing
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IC
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Country of Origin
confirmed active TB
9
suspected active TB
non M TB
Removals: U.S. Immigration and Customs Enforcement Detainees by TB
Status, FY2004
70
60
40
30
20
10
U
IP
PI
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IL
BR
AZ
EN
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0
AR
G
Count
50
Country
confirmed active TB
10
suspected active TB
non M TB
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
11
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
12
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
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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
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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?
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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
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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 SullivanJenkins, 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.
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