188146 Cross-border mobility linked to tuberculosis diagnosis and treatment interruption among injection drug users in Tijuana, Mexico

Monday, October 27, 2008: 1:05 PM

Robert Deiss, MD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Richard S. Garfein, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Maria Remedios Lozada, Dra , Patronato Pro-COMUSIDA, Tijuana, Mexico
Jose Luis Burgos, MD, MPH , Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA
Kimberly C. Brouwer, PhD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Kathleen Moser, MD, MPH , San Diego County Health and Human Services Agency, San Diego, CA
Maria Luisa Z˙˝iga, PhD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Timothy C. Rodwell, MD, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Victoria D. Ojeda, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Steffanie Strathdee, PhD , Division of Global Public Health, University of California, San Diego, La Jolla, CA
Background: In the U.S, the proportion of tuberculosis (TB) cases among foreign-born individuals is increasing. We identified correlates of lifetime diagnosis of active TB among injection drug users (IDUs) in the border city of Tijuana, Mexico and investigated the relationship between TB diagnosis and history of migration to the U.S.

Methods: From 2006-2007, IDUs in Tijuana were recruited into a prospective cohort using respondent-driven sampling. Weighted logistic regression was used to identify correlates of lifetime diagnosis of active TB.

Results: Of 1,056 participants, 103 (9.8%) reported a history of active TB, of whom 96 (93%) received anti-TB medication and 82 (80%) were diagnosed in the U.S. Treatment was prematurely stopped in 8 (8%) cases, with half of these interruptions due to deportation from the U.S. IDUs reporting a lifetime history of active TB were significantly more likely to have ever traveled to the U.S. (94% vs 76%, p<0.01) or come to Tijuana because they had been deported from the U.S. (74% vs 49%, p<0.01). History of travel to the U.S. (OR=6.6, 95%CI: 1.6, 27.8), deportation from the U.S. (OR 1.9, 95%CI 1.1, 3.2) and incarceration (OR=2.0, 95%CI: 1.0, 4.0) were independently associated with history of active TB.

Conclusion: Cross-border mobility and migration history are important in the treatment and identification of TB in the U.S.-Mexico border region. Strengthening bi-national capacity to identify, monitor and treat TB is an important public health priority, especially among IDUs who tend to fall between the cracks of health care systems.

Learning Objectives:
Session participants will identify correlates of a lifetime diagnosis of active TB among injection drug users in Tijuana, Mexico. Session participants will dentify significant factors, including mobility, deportation and treatment interruption, as important in the epidemiology of TB in the U.S.-Mexico border region. Session participants will gain understanding of the broad framework of TB control in border areas, including binational cooperation and case-finding strategies.

Keywords: Tuberculosis, Migrant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I wrote the paper and performed the analysis on which this abstract is based.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.