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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
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Division of Immigration Health ServicesMission
We protect America by providing
health care and public health
services in support of immigration
law enforcement.
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Program Objective
• Facilitate continuity of tuberculosis (TB) therapy for U.S. Immigration and Customs Enforcement (ICE) detainees following custody
4
Queens, NYElizabeth, NJ
Pearsall, TX
El Paso, TX
El Centro, CASan Diego, CA
Florence, AZ
Miami, FL
Batavia, NY
Aguadilla, PR
San Pedro, CAL.A. Staging
ICE Detention and Staging FacilitiesICE Detention and Staging FacilitiesWith on-site DIHS Medical FacilitiesWith on-site DIHS Medical Facilities
Houston, TX
Tacoma, WA
Port Isabel, TX
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Average Daily Total ICE Detainee Population by Year, 1993-
2004
0
4000
8000
12000
16000
20000
24000
28000
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
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U.S. Immigration and Customs Enforcement DetaineesTuberculosis Cases with Treatment Indicated, FY 2004
73 68
17
0
10
20
30
40
50
60
70
80
Confirmed active TB Suspected active TB,treatment indicated
Non M TB
Case Classification
Co
un
t
7
Comparison of TB Case Ratesby Reporting Area and Reporting Period
84.3 82.2
22.54.9
95.4
0
20
40
60
80
100
120
INS FY 2002,DIHS Facilities*
ICE FY 2003,DIHS Facilities*
ICE FY 2004,DIHS Facilities*
U.S. Foreign-born CY2004**
U.S. OverallCY2004**
Reporting area & period
TB
Cas
e R
ate
per 1
00,0
00
* Source: DIHS** Source: U.S. Centers for Disease Control and Prevention
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U.S. Immigration and Customs Enforcement DetaineesConfirmed and Suspected Active TB Cases, by Release Status,
FY2004, all countries
47
4 8 2 111
49
11
10
3
3
212
2
11
0
20
40
60
80
100
120
Deported VoluntaryDeparture
Released USM TERM Missing or stillin custody
Release Status
Cou
nt
Confirmed active TB Suspected active TB, treatment indicated Non M TB
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U.S. Immigration and Customs Enforcement DetaineesTB Cases by Country Fiscal Year 2004
0
10
20
30
40
50
60
70
80
90
ARGENTIN
A
BRAZIL
CHINA
COLOM
BIA
COSTA R
ICA
CUBA
DOMIN
ICAN R
EPUBLIC
ECUADOR
EL SALV
ADOR
GUATEM
ALAHAIT
I
HONDURAS
INDONESIA
KOREA
MEXIC
O
NEPAL
PANAMA
PERU
PHILIP
PINES
POLAND
SOMALI
A
SOUTH K
OREA
TAIWAN
Miss
ing
Country of Origin
Co
un
t
confirmed active TB suspected active TB non M TB
10
Removals: U.S. Immigration and Customs Enforcement Detainees by TB Status, FY2004
0
10
20
30
40
50
60
70
ARGENTIN
A
BRAZIL
CHINA
COSTA R
ICA
CUBA
DOMIN
ICAN R
EPUBLIC
ECUADOR
EL SALV
ADOR
GUATEM
ALAHAIT
I
HONDURAS
MEXIC
O
PANAMA
PERU
PHILIP
PINES
SOUTH K
OREA
TAIWAN
Country
Co
un
t
confirmed active TB suspected active TB non M TB
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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
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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
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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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AcknowledgementsDIHS Staff at pilot sites:Florence, AZ: Stacey Dawson, Geri Tagliaferri, Eddie
Frazier, Melissa George, Elizabeth FlemingSan Diego, CA: Erica Graham, Rebecca McTall, Steve
Gonsalves, Dave Lusche, Joel Johnson, Gerard BazileEl Paso, TX: Gina Chacon, Angel LaSanta, Elizabeth
Escalera, Diane Aker, Erik Hierholzer, Rosa ColonPort Isabel, TX: Wanda Gonzales, Dan Hankes, BuJean
Jenkins, Jeri McGinnis, Luz Peredo-BergerTacoma, WA: Michael Tartaglia, Benford Bennett, Deanna
Gephart, Phil FarabaughDirector: Gene MigliaccioDeputy Director: Geralyn JohnsonMedical 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 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.