October 1997

Grant Results

National Program

Old Disease, New Challenge: Tuberculosis in the 1990s

SUMMARY

From 1994 to 1997, the County of San Diego, Department of Health Services used a combination of improved information systems, technical assistance, training and education to overcome barriers in treating tuberculosis along the US/Mexico border in San Diego County.

The project was part of the Robert Wood Johnson Foundation (RWJF) Old Disease, New Challenge: Tuberculosis in the 1990s national program.

Key Results

  • The most important accomplishment was to encourage cooperation between health officials in the United States and in Mexico. Prior to this project, health officials responsible for TB in San Diego and in Tijuana had limited communication and no shared goals for the region. Now, officials from the two jurisdictions meet to discuss regional approaches to TB control.
  • The grantee established a bi-national TB referral system that acts as the hub for information flowing between California and Mexico. The referral system made it easier for TB patients crossing between Tijuana and San Diego to continue their treatment.
  • Supervised therapy, provided at the health clinic or at home, was well received by patients and significantly increased treatment completion rates.

Funding
RWJF supported this project through a grant of $729,808.

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THE PROBLEM

The US/Mexico border in San Diego County is the nation's most active international crossing with more than 65 million legal and one million undocumented crossings in 1992. The ongoing bi-directional flow of individuals presents special challenges to the control of tuberculosis in the San Diego-Tijuana region.

Interrupted treatment is common for patients who seek care on both sides of the border. Communication and referral between Mexican and American medical personnel is difficult because of language barriers, technical barriers, differences in standards of practice, and lack of a working knowledge of the other country's health care system.

Patients become frustrated by conflicting medical advice, perceived inaccessibility of care, and fear of intervention by health authorities, and often fail to complete treatment.

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THE PROJECT

The project had four objectives:

  • Provide continuity of treatment for people who cross the border in order to increase treatment completion rates.
  • Strengthen the diagnostic and treatment capabilities for TB patients and their contacts at targeted Tijuana Health Department centers.
  • Increase understanding among regional health care providers about TB treatment and control.
  • Provide improved TB education to patients and their families, and to targeted Tijuana and San Diego Latino community groups.

The project faced difficulties relating to Mexican laws and regulations governing the use of American dollars to employ Mexican nationals and purchase equipment. Despite these obstacles, the grantee used a combination of improved information systems, technical assistance, and training and education to pursue their objectives. Their most important accomplishment was to encourage cooperation between health officials in the United States and in Mexico.

Prior to this project, health officials responsible for TB in San Diego and in Tijuana had limited communication and no shared goals for the region. Now, officials from the two jurisdictions meet to discuss regional approaches to TB control.

Some of the grantee's other achievements included:

  • A bi-national TB referral system that acts as the hub for information flowing between California and Mexico. The referral system made it easier for TB patients crossing between Tijuana and San Diego to continue their treatment.
  • An annual TB conference held in San Diego since 1993, attracting more than 350 attendees from Mexico and the United States.
  • An x-ray machine, purchased by the project, has become part of routine care at the Tijuana Health Department. On-site diagnosis has reduced the number of patients lost to follow-up, and reduced costs to patients.

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FINDINGS

Although the project's primary goal of providing sustainable directly observed therapy for persons crossing the US/Mexico border was not fully achieved, it provided valuable information that may inform future cross-border and TB control endeavors. Findings include:

  • During 1996, high levels of drug resistance were found in Tijuana project patients. Overall, 58 percent of project patients were resistant to one or more of the first line TB medications.
  • Supervised therapy, provided at the health clinic or at home, was well received by patients and significantly increased treatment completion rates.

This project has been used as a model for an initiative launched by the Texas State Health Department called Ten Against TB. The initiative aims to unite the ten states along the US/ Mexico border (four US, six Mexican) in the bi-national control of TB.

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AFTER THE GRANT

Although the grant is completed, health officials responsible for TB control in San Diego and Tijuana have developed a formal process for discussing regional approaches to TB control. Also, the bi-national TB conference is self-supporting and there are plans to continue it annually.

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GRANT DETAILS & CONTACT INFORMATION

Project

A Model for Cooperation: US/Mexico Tuberculosis Control

Grantee

County of San Diego, Department of Health Services (San Diego,  CA)

  • Amount: $ 729,808
    Dates: January 1994 to September 1997
    ID#:  023612

Contact

Project Director: Kathleen Moser, M.D.
(619) 692-8621

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Presentations and Testimony

Moser, Kathleen S. "A Model for Cooperation: US-Mexico Tuberculosis Control." Ten Against TB meeting. Monterrey, Mexico, January 1997.

Moser, Kathleen S. "A Model for Cooperation: US-Mexico Tuberculosis Control." US-Mexico Boarder Health Association meeting, Tijuana, Baja California, June 1996.

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Report prepared by: Marie P. Lyons
Reviewed by: Marian Bass
Program Officer: Marilyn Aguirre-Molina
Evaluation Program Officer: James Knickman

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