Inter-jurisdictional legal and policy issues associated with tuberculosis control among undocumented immigrants

The inter-jurisdictional—federal, state, and bi-national—legal framework relating to the coordination of TB control is a complicated matter that has a clear public health impact. Although the overall number of TB cases reported annually in the United States has decreased, there has been an increase in the proportion of total cases occurring in foreign-born persons. Undocumented persons, in particular, are subject to a disproportionately high incidence of TB and, due to their generally lower socioeconomic status and frequent travel, may go long periods without adequate health care and therefore may serve as significant vectors of TB and multidrug-resistant TB transmission in the U.S. and abroad. Further, removal of these individuals prior to completion of TB treatment can contribute to the emergence and spread of drug-resistant strains, which is problematic not only for the countries to which they are removed, but also for the United States when these undocumented persons—or others they have infected—return to the United States with drug-resistant forms of the disease. The public health issues associated with the inter-jurisdictional coordination of TB control are of national, and especially regional, importance. This presentation will provide an overview of the efforts that have been taken to facilitate inter-jurisdictional coordination of TB treatment for undocumented individuals and describe how the effectiveness of these programs could be improved by an enhanced legal framework.