Conflicts of interest Successful treatment of MDR-TB in Baja California None to declare Rafael Laniado-Laborín MD, MPH, FCCP ISESALUD de Baja California, México Multi-drug resistant tuberculosis (MDR-TB) threatens communities across the globe It is difficult and expensive to cure, and the resources to fight these strains do not exist in many areas of the world This was the situation in Baja California, Mexico, where current resources were not adequate to ensure that all MDR patients had the opportunity for curative therapy Unable to get curative treatment, patients became increasing ill over a period of years during which they were able to spread the disease within the US-Mexico border communities and areas in the interior of both countries The state of Baja California had the highest TB rate in the country in 2010 (42.4 per 10 5 ; Mexico s rate:13.7 10 5 ) SUIVE 2009. DGE/SSA 08/03/2011 1
Project was created in 2006 as a binational USA-Mexico program to diagnose and treat MDR-TB in Baja California : A Binational Alliance for the Treatment of Multi-Drug Resistant TB in the Californias The Lash Foundation Was initially funded by a $323,816 3-year grant from the US Agency for International Development with additional support from the Lash Foundation and Rotary International Funds are administered by the Public Health Institute of California, a non-governmental US 501(c)3 organization As originally funded, the project was scheduled to end June 30, 2009 It is still running, although its funds are schedule to run out next month The San Diego TB Program has been the U.S. hub of day-to day operations. Other key partners are: o ISESALUD in Baja California Norte o Mexican National Tuberculosis Program o The Sociedad de Neumologia y Cirugia de Torax de Baja California o The Instituto Nacional de Enfermedades Respiratorias in Mexico City o Project Concern International o The Francis J. Curry National Tuberculosis Center in San Francisco o The National Jewish Medical and Research Center in Colorado o Rotary International o The State of California TB Control Branch o The Lash Foundation The program has developed a binational model for sharing professional expertise and has demonstrated success in providing access to vital services for patients with the most difficult forms of TB Project key components 2
1. TB Experts Network Partners confer and monitor patient clinical progress and outcomes regularly through teleconferences and in-person case conferences Empirical treatment How did it work? YES Suspicion of MDR-TB MDR-TB Clinic Culture and DST (1 st ) Confirmation of MDR Teleconference Severe illness Second line DST NO Wait for 2 nd line DST Regimen adjustment 2. DOT DOT through All patients are treated under strict directly observed therapy o at a health center o at home through a health promoter Health center DOT Home DOT 3. Health promoter training 4. Monthly monitoring 3
4. Monthly monitoring 5. Updated information system 6. Continuous medical training on TB 7. Real political compromise DR-TB Clinic o outpatient services Mycobacterial diagnosis o solid cultures (L-J) o liquid cultures (MGIT 960) DST first line drugs Quantiferon-Gold in tube o contact LTBI screening 4
To date 48 patients treated by 34 discharged as cured after 18-24 months of treatment 10 still under treatment (9 culture-negative) 3 patients (6.25%) died 1 abandoned treatment (2.08%) after 9 months (culture negative) Future challenges Uninterrupted supply of MGIT reagents Second line susceptibility testing Enough promotores to enforce DOT Binational project personnel JM Alcantar-Schramm MPSS F Batiz-Armenta MPSS Rebeca Cázares-Adame MPSS Carolina del Portillo MPSS E Dueñez MD J Estrada-Guzman MD V Esparza MD R Laniado-Laborín MD, MPH, FCCP K Moser MD, MPH S Ruvalcaba, TB Lab C García, TB Lab 5