Tuberculosis Control Laws in the U.S.-Mexico Border Region: Legal Framework in the United States
48 Pages Posted: 2 Jan 2016
Date Written: December 31, 2015
Multidrug-resistant tuberculosis (MDR TB), designated by the CDC as a serious threat within the United States, can occur when TB drugs are misused or mismanaged. Examples include when patients do not complete their full course of treatment; when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; when the supply of drugs is not available; or when the drugs are of poor quality.
In the U.S., MDR-TB rates are highest along the U.S.-México border. Populations in this region are mobile. TB patients who live on one side of the border might have their disease diagnosed or treated in the adjacent country; therefore, investigation of close contacts often involves school, work, and social settings on both sides of the border.
Laws and governmental practices can impede optimal TB case management even within the U.S., which includes prompt disease diagnosis, close monitoring of medical regimens, adherence to treatment, and identification and evaluation of close contacts. Each of these strategies becomes more difficult when case management must be coordinated among multiple health jurisdictions.
The United States-México Border Health Commission (BHC) was created in 2000 to provide international leadership to optimize health and quality of life along the U.S.-México border. Due to its impact in the border region, TB prevention and barriers to TB control are key BHC priorities. To reduce the burden of TB in binational border communities, the BHC facilitates and supports various activities intended to advance cross-border cooperation in TB surveillance, control, education, prevention, and case management.
Beginning in 2012, the BHC’s TB Consortium began discussion of legal barriers to continuity of care in the region. This draft legal guide, prepared with support from the Robert Wood Johnson Foundation, discusses legal barriers to continuity of care for TB patients. Not only does drug-resistant tuberculosis present uniquely immigration-driven challenges, it also exposes weaknesses in the U.S. public health system that concern citizens and non-citizens equally.
Repatriation of Mexican nationals by U.S. immigration authorities poses distinct issues with respect to continuity of care for bi-national tuberculosis cases. At present, U.S. repatriation policy specifies advance notification to Mexican officials along with transfer of medical records and an initial supply of medication for persons with active cases of tuberculosis. The paper examines current U.S. immigration policy for the treatment and release of such persons, along with the administrative difficulties that can impede continuity of care.
Keywords: drug-resistance, tuberculosis, immigration, Border Health Commission, public health law, quarantine and isolation, do not board list, CDC, standards of care, patient rights, repatriation, deportation, Mexico
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