1

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

2

Division of Immigration Health ServicesMission

We protect America by providing

health care and public health

services in support of immigration

law enforcement.

3

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

6

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

8

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.