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Directly Observed Therapy

Directly Observed Therapy. Prescribed by a physician and required by policy for all public and private patients Strategy to ensure uninterrupted TB drug therapy by a trained ORW Directly observe patient swallowing each and every dose of prescribed TB drugs Anywhere mutually agreed upon

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Directly Observed Therapy

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  1. Directly Observed Therapy • Prescribed by a physician and required by policy for all public and private patients • Strategy to ensure uninterrupted TB drug therapy by a trained ORW • Directly observepatient swallowing eachandeverydose of prescribed TB drugs • Anywhere mutually agreed upon • DOT regimes: daily, 2xW, 3xW, 5xW… Until the completion of prescribed therapy

  2. Patient being observed by D.O.T. outreach worker“El paciente que es observado por D.O.T. excede a trabajador”

  3. Contact Investigation; Screening • Investigación del contactos

  4. Screening in Jails and Prisons

  5. Mobile Unit X-ray Digitizer used in screening high risk locations

  6. Contact investigation in Brownsville, TexasInvestigacion de contactos

  7. Mask fitting for staff

  8. Improved TB lab capability

  9. Infection control and MDR treatment by consultation at South Texas Hospital

  10. Before the binational projects started: • No understanding of the other system, protocols, contact investigation, or the use of BCG or INH • “Drop-in” of dying MDR patients in WIC waiting rooms with small children • No means of referral or coordinating patients who immigrate • Communication difficult

  11. In 1993: • No information on drug resistance rates in Mexico • No information of resistance by culture on individual patients • No consistent MDR treatment nor available medications • No permits to transfer specimens to US or supplies to Mexico

  12. Binational successes and achievements • TATB: political will to consider the problem of MDR-TB and cooperation at the national level • Reynosa technical committee • DOT almost universal • Provide cultures for border cities in Tamps • Equipment for X-ray, lab, infection control • Signed agreements • USAID funding

  13. Rates by Age Groups Rate per 100,000 population 35 30 25 20 15 10 5 0 0-04 5-09 10-14 15-19 20-24 25-34 35-44 45-54 55-64 >64 Age group (years) 1999 1994

  14. Pediatric Rates Rate per 100,000 population 14 12 & $ 14 years and 10 & younger $ $ 8 & & & $ & & & $ & & $ 6 $ $ $ $ & $ 4 $ & 2 0 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Year White Hispanic African American $ &

  15. Number of TB Cases inU.S.-born vs. Foreign-born Persons United States, 1991-2001 No. of Cases

  16. TB Case Rates in U.S.-born vs. Foreign-born Persons, United States, 1991-2001 Cases per 100,000 Note: Case rates for 2000 and 2001 based on an extrapolation from the March 2000 U.S. Census Bureau Current Population Reports.

  17. Percent of Tuberculosis Cases That Are Foreign-born, Texas 1995-2001 Percent 50 43 41 39 38 40 34 32 28 30 20 10 0 1995 1996 1997 1998 1999 2000 2001 Year Reported Foreign Born in TX in 2000 14.9% Source: TB Elimination Division, TDH

  18. Estimated HIV Coinfection in Persons Reported with TBUnited States, 1993-2000 % Coinfection Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group.

  19. Primary Anti-TB Drug Resistance United States, 1993-2001 % Resistant Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

  20. Primary MDR TB United States, 1993-2001 No. of Cases Percentage Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

  21. Primary Isoniazid Resistance in U.S.-born vs. Foreign-born Persons United States, 1993-2001 Percentage Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

  22. TDH – PHR 11

  23. Border Counties – TB Cases & Rates for 2000

  24. Border Counties – TB Cases & Rates for 2001

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