Tuberculosis (TB) is the second largest cause of death in the world from any single infectious disease, behind only HIV/AIDS. Each year 54 million people become infected, 6.8 million develop clinical disease, and 2.4 million people die of tuberculosis. The World Health Organization estimates that between 2000 and 2020 TB will infect 1 billion people, cause 200 million people to get sick, and kill 35 million people. After several decades of decline, TB cases in the United States have increased 20 percent between 1985 and 1992.

The treatment of TB is one of the most cost-effective interventions in the world, but complying with the 6-8 month treatment can be very difficult for many people. Some do not have access to treatment and others stop after 1-2 months of treatment. This helps to create a drug-resistance to TB. A few factors that contribute to such drug resistance include lack of access to adequate treatment and monitoring, insufficient drug supplies in public clinics, the high rate of migration in the region, and the lengthy time to complete therapy.

The incidence of TB along the US-Mexico border, and in the California-Baja California region in particular, far exceeds national incidence rates in both countries. This is in part due to migration and daily contact between residents on both sides of the border, lack of access to health care for immigrants and low-income families, and co-infection with HIV and/or diabetes.

BHI Interventions

The BHI works for tuberculosis prevention and treatment through the following activities :

• Support to the Tijuana-San Diego and the Imperial-Mexicali Binational TB Committees, which work to build the capacity of health care providers working in TB, and promote binational collaboration and coordination for TB treatment.

• Provision of grants for promotora-based Direct Observed Therapy Short-course (DOTS) programs, which prevent drug resistance and cure TB. Thanks to BHI, these programs have been implemented in Imperial, Mexicali , Tijuana , and Ensenada counties. The BHI also ensures that the promotoras (community health workers) receive training in TB prevalence, importance of early detection and treatment, outreach skills, and TB services available.

• Funding for the San Diego Health and Human Services Agency's CURE-TB program. This is a referral and case-tracking program that connects TB patients and services across Mexico and the US using a 1-800 number. CURE-TB was able to process 100% of high-priority cases during the year 2000 and staff developed curricula and training sessions for institutions wanting to become a part of the CURE-TB. Educational materials for patients and health care providers about TB-related issues and availability of referral services were also created.

• Training and updates on tuberculosis treatment (DOTS) the San Diego/Tijuana Binational TB Conference held in November 2000, for medical personnel from IMSS, ISSSTE and ISESALUD provided training and updates on tuberculosis treatment (DOTS).

• The BHI participated in the Fifth Binational TB Symposium, held in March 2000 in Tijuana , which covered issues such as DOTS strategies for Mexico , clinical and radiological evolution of a TB patient, transmission and current challenges facing TB programs. The Symposium was attended by 220 representatives from health departments, schools, and non-profit organizations in the region.

• In March 2000, the Imperial County Public Health Department, the Baja California State Health Department and the BHI organized a health fair in Calexico , California focusing on migrant farm workers. Information on TB and health services was distributed to over 500 workers and 395 workers were screened for TB.

• The BHI sponsored training on (DOTS) in Mexicali in July 2000. Held in collaboration with the Mexicali health jurisdiction, the training was attended by 43 physicians and other health providers.

• The BHI provided funds to the Baja California State Health Department to enhance community-based DOTS activities in Baja California . The sub-grant supports nine outreach workers who conducted DOTS activities among patients in Mexicali , Tijuana , Rosarito and Ensenada between October 2000 and April 2001.

For more information contact Carmen Cutter ( ccutter@projectconcern.org ) in National City at (619) 791-2604 or Enrique Gomez ( enriquegomez@uabc.mx , egomez@projectconcern.org ) in Mexicali at (011-52-686-582-3110)