PURPOSE: In 2006 the state of Baja California had the highest TB rate in Mexico(47.8 per 100,000). Three different surveys have reported a rate of multidrug resistant tuberculosis (MDR-TB) between 6 and 17%. Puentes de Esperanza was created as a binational USA-Mexico program to diagnose, treat and prevent MDR-TB. The program will also enhance activities already underway in Baja California including laboratory diagnosis,training of outreach workers to support patient adherence and education of community professionals at all practice levels.
METHODS: The program funded by USAID has created a binational alliance of government and nongovernment providers and organizations (including the Mexican National TB Program). It receives referrals of MDR-TB cases from Baja California's medical community; all cases are confirmed by culture and susceptibility testing. Partners confer and monitor patient clinical progress and outcomes regularly through the use of inexpensive telecomunication technology, and in-person case conferences. Individualized regimens with second line drugs are provided under strict directly observed therapy.
RESULTS: Five patients have already started treatment; three with a strain resistant to five antituberculosis drugs and two with a strain resistant to six drugs; three teleconferences have been implemented to discuss these complex MDR-TB cases with program managers and providers from Mexico and the United States.
CONCLUSION: The program has created the infrastructure needed to support early recognition of affected patients and generated outreach services to assist patients with successful adherence to treatment, creating a sustainable binational network of MDR-TB professionals.
CLINICAL IMPLICATIONS: Unable to get curative treatment, MDR patients in Baja California become increasing ill over a period of years during which they are able to spread the disease within the US-Mexico border communities. We expect that in our first year, 10-20 MDR-TB patients will receive treatment. However, the impact will be broader since transmission of this airborne disease will be curtailed. Therefore, treatment of 20 patients can prevent more than 200 new infections with MDR-TB and partnering with local providers will help reduce future misuse of antituberculosis drugs.
DISCLOSURE: Rafael Laniado-Laborin, No Financial Disclosure Information; No Product/Research Disclosure Information