Introduction

The Pan American Health Organization in conjunction with the Migrant Clinicians Network and the U.S.- Mexico Border Health Association has established the Binational Migrant Tuberculosis Referral and Tracking Network project. The project called TB-Net is funded by the Texas Department of Health with monies from the Centers for Disease Control and Prevention (CDC).

Goal

To establish an effective binational, migrant tracking and referral network in the United States and Mexico that will facilitate information exchange on tuberculosis (TB) patients in order to prevent treatment interruption.

Objectives

• To facilitate the prompt exchange of clinical and epidemiological information between heatlh care providers in the U.S.-Mexico border region and the Midwest migrant stream.
• To provide both patients and providers with written referral information to facilitate continuation of treatment when a patient relocates;
• To provide expert binational / billingual consultation in the management of TB via a toll free number; and
• To analyze and distribute epidemiologic TB trends to appropriate public health authorities in Mexico and the United States.

Target population and region

The people to be served by TB-Net will include the mobile population along the Texas-Mexico Border region and the Midwest migrant stream.

Activities

This project includes five components

1. Portable TB health record;
2. Patient referral and follow-up;
3. Binational / migrant tuberculosis service directory;
4. Provision of expert consultation in English and Spanish; and
5. Data gathering and analysis.

Portable TB Health Record.

Mobile patients entering treatment along the Texas/Mexico border and Midwest migrant stream clinics will receive a wallet-size TB health record containing basic up-to-date clinical information in English and Spanish. Providers will get training in the use of the portable record. Patients will get health education from the provider on how to use the portable record.

Referral and Follow-up.

Referral may take two primary forms. First, when a provider knows that a patient is moving to a certain area s/he may use TB-Net to contact the appropriate health facility of that area to ensure that treatment is not interrupted. Second, when a patient travels to / or arrives in an area and wants to know where he or she can receive services, s/he may present the portable record to any health provider. The provider can contact TB-Net. The Network assumes responsibility for follow-up within 7 days to ensure that action was taken.

Binational / Migrant TB Services Directory.

TB-Net will provide updated services directories upon request to anyone interested and to providers in target areas. The purpose of this directory is to provide a working tool for case referral between the United States and Mexico.

Expert consultation.

Differences and similarities in the approaches to TB therapy and patient confidentiality in Mexico and the U.S. often need clarification. Therefore, a group of Mexican and U.S. TB experts working along the border will be available for consultation on case management problems.

Data gathering and analysis.

In order to document binational and migrant morbidity and mortality trends, collection of clinical and epidemiological data will be made. This data will be based on the information provided by participating health care providers that issue portable TB records.

To insure success a marketing campaign promoting TB-Net project activities will take place. Marketing will consist of on-site training and promotion of education and marketing materials. Emphasis will be placed on the importance of using and updating the portable TB record. Training will include the following areas: 1) Education about the Mexican public health system and TB treatment protocols; 2) A thorough overview of the binational / Migrant Tuberculosis Referral and Tracking Network and its usefulness; and 3) An overview of available resources in the U.S. and Mexico including educational materials and other clinical services.

Expected outcomes

Based on the development of the referral and tracking system, TB-Net will link health providers of the United States and Mexico in order to enhance the tuberculosis control and prevention activities of both countries.

After giving a patient a protable record, the providers will register the patients in the central data bank housed at the MCN office in Austin, Texas. The data bank will ensure that subsequent attempts to receive care can occur as the patient moves throughout the season.

Information

For additional information on the project, contact Todd Harlow of MCN at (512) 327-2017. Todd can be reached 24 hours a day at (888) 362-7089. Send Mail to Migrant CLinicians Network, P.O. Box 164285, Austin, Texas, 78716. Or Email mcn@onr.com Or, contact Ed Risinger, HealthData Resources, Inc. (800) 695-0873, risinger@hdata.com.