CureTB and continuity of care for globally mobile patients

Abstract

BACKGROUND: In 2016, 3% of newly diagnosed patients with tuberculosis (TB) left the United States, of whom 24% moved to Mexico. Continuity of care for TB is important to ensure patients complete treatment and reduce TB transmission. CureTB provides continuity of care for patients with TB who move out of the United States by referring them for care at their destination.METHODS: Analysis of CureTB data collected between January 2012 to December 2015 to describe demographics and outcomes of referred patients and examine factors contributing to successful treatment outcomes.RESULTS: CureTB received 1347 referrals mostly from health departments and law enforcement agencies in the United States (92%). A total of 858 referrals were for patients with verified or possible TB (64%). Most patients moved to Mexico or other Latin American countries (96%) and completed treatment after departing (78%). Poor treatment outcomes were associated with being in custody (33%), not being interviewed by CureTB (30%), and not having diabetes (18%).CONCLUSION: CureTB successfully promoted transnational continuity of care for patients by exchanging information with international public health authorities and linking them directly with patients. This patient-centered strategy helps improve TB treatment success and reduce the global burden and transmission of TB.

Figure 1.. Referrals to CureTB, a US-based transnational referral service for patients with tuberculosis (TB), 2012–2015

¹Individual decided to remain in the United States or current country of residence or the individual left when less than 30 days of treatment were needed for completion of therapy. ²For 3 patients an original TB diagnosis was ruled out agter further diagnostic testing. ³Patients not confirmed bacteriologically or verified clinically as having active TB before leaving the United States, or for whom additional diagnostic testing was not available from the destination country and TB had not been definitively ruled out.

Figure 2.. Verified or possible tuberculosis (TB) referrals to CureTB by referring agency, 2012–2015 (n=858)

¹Immigration and Customs Enforcement detention facilities ²Bureau of Prisons, US Marshals, city/state/county corrections center ³International ministries of health and healthcare facilities or private physicians ⁴Other domestic sources (Centers for Disease Control and Prevention, Customs and Border Protection, medical centers)

Figure 3.. Referring US states and receiving jurisdictions (country or Mexican state) of verified or possible tuberculosis (TB) referrals to CureTB from US health departments, 2012–2015*

*One patient referred by a US health department moved to a country in West Africa, not shown.

Figure 4.

Referring state and receiving jurisdiction (country or Mexican state) of verified or possible tuberculosis (TB) referrals to CureTB from Immigration and Customs Enforcement or other correctional facilities in the US, 2012–2015

Figure 5.

Outcomes of CureTB referrals for patients with verified tuberculosis (TB) (n=440), by year of referral, 2012–2015

Figure 6.. Relative risk of loss to follow-up for CureTB referrals with verified tuberculosis (TB), by circumstantial factors and comorbidities, 2012–2015

¹Loss to follow-up is defined as a reported treatment outcome of lost to follow-up or having refused or abandoned treatment *Variable data was missing for 38 patients; they were excluded from analysis **Variable data was missing for 34 patients; they were excluded from analysis ***Variable data was missing for 43 patients; they were excluded from analysis Note: Brackets represent the 95% confidence intervals of the percentages