Expert Panel: [ARCHIVED] Tuberculosis Among Migrants

When: Jan. 16, 2017 - Jan. 20, 2017 | Community: MDR-TB Treatment & Prevention  

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Panelists of Tuberculosis Among Migrants and GHDonline staff

What types of international instruments can be used to establish a continuum of care for people moving across borders? What types of policy and legal approaches are necessary to support migrant TB programs?

Posted: 18 Jan, 2017   Recommendations: 2   Replies: 12

Friends
I would like to hear from you about establishing continuity of care for people moving across borders. At Migrant Clinicians Network we have been engaged in providing continuity of care services to individuals leaving the US, both voluntarily and involuntarily, for 20 years through a program called Health Network. What we have learned over time is that while the person’s documentation status is of critical importance to some, what are essential for our work are a robust relationship with the national TB programs in the receiving countries and a clear trust relationship with the person moving while under treatment for TB disease. We have supported individuals returning to 111 countries and have developed memoranda of understanding with some programs with whom we have worked for many years, while relying on signed informed consent from the individual returning as entrée to countries unfamiliar with Health Network.

What has been your experience in providing continuity of care to people moving across borders?

Replies

 

Masoud Dara, MD Panelist Replied at 4:31 PM, 18 Jan 2017

Thank you very much Delia,

Continuum of care is extremely important. In the WHO European Region, with the inputs of national programmes, we developed a consensus paper on minimum package for cross border control and care, see enclosed. This document served both as an advocacy and operational tool.

One of the main challenges is funding, particularly if it involves a patient with drug resistant TB. I am familiar with your excellent work. While waiting to hear from the community members and taking into account the time difference we have, it would be very useful to hear more about your project with the innovative elements and effective approaches you have taken to ensure services across borders.

All the best,
Masoud

Attached resources:

Deliana Garcia Panelist Replied at 5:25 PM, 18 Jan 2017

I appreciate your kind remarks about our work, Masoud. Our design is premised on the understanding that mobility need not be impediment to health care access; however, you are quite correct about funding. What has helped us both support the program and improve our work is that while TB has been central to the development of our work it has not been the singular focus. As we began to provide continuity of care for individuals with TB and co-morbidities such as HIV, DM and Hep C we learned that the process of patient navigation was the same even as the important partners for successful continuity changed. Some situations are much more complicated than others but establishing and maintaining a network of health care providers around the world has allowed us to more quickly connect a migrant in need of care with a new source for that care. We have also seen that the development of strong programs in different countries staffed by individuals committed to TB control means that migrants are better able with navigation support to continue and finish treatment. I am attaching a case student so that you might see what is required for some cases and have an example of our success.

Attached resources:

Leo Li Replied at 7:26 PM, 18 Jan 2017

This is a big issue.
Compliance is always a huge problem for the TB patients, especially for those who usually moved across different contries. I am thinking as the technology is getting smarter, can we communicate with the patients through an APP which is established for the follow-up of TB patients who are moving to another place or country?
Best regards
Leo

2017-01-19

doublly0103



发件人:Deliana Garcia via GHDonline <>
发送时间:2017-01-19 03:18
主题:What types of international instruments can be used to establish a continuum of care for people moving across borders? What types of policy and legal approaches are necessary to support migrant TB programs?
收件人:"Leo
抄送:

Deliana Garcia started a discussion
Friends
I would like to hear from you about establishing continuity of care for people moving across borders. At Migrant Clinicians Network we have been engaged in providing continuity of care services to individuals leaving the US, both voluntarily and involuntarily, for 20 years through a program called Health Network. What we have learned over time is that while the person’s documentation status is of critical importance to some, what are essential for our work are a robust relationship with the national TB programs in the receiving countries and a clear trust relationship with the person moving while under treatment for TB disease. We have supported individuals returning to 111 countries and have developed memoranda of understanding with some programs with whom we have worked for many years, while relying on signed informed consent from the individual returning as entrée to countries unfamiliar with Health Network.
What has been your experience in providing continuity of care to people moving across borders?
--
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Deliana Garcia Panelist Replied at 7:59 PM, 18 Jan 2017

Leo I hold out great hope for every technological advancement that comes about. What we have learned is that we must try and marshal as much technology as possible while remembering that we are working with patients and care sites in very remote and under resources locations. It became important to work with the entire continuum of technology from the fax machine through our database portal and communications platforms like Whatsapp. People are so resourceful when it comes to communication but what remains true is that they often still need someone to "translate" the system for them or assist with a warm hand off from one site to another. Many migrants share a cell phone and work where there is no internet access so a text from us with the directions to the health center and the time and day of their appointment means that they have a written record of what they need without having to lose work time answering the phone and talking to a case worker.

Have you worked with an app that you believe will be effective with patients across international borders? I would love to hear what is out there and working well.

Dylan Tierney Replied at 9:29 PM, 18 Jan 2017

We’ve been talking primarily about national and international agencies leading the implementation of policies that can help to provide care for migrants with tuberculosis. I wonder, however, whether the private sector could also play a significant role, especially for people who migrate for employment. I could imagine that a mining or agricultural corporation that employs migrants would have an interest in keeping its workers healthy. Has there been any precedent for these groups playing a role in supporting migrant TB control?

Paul Douglas Panelist Replied at 9:50 PM, 18 Jan 2017

I agree Dylan. We should also look to the educational sector which is such a massive market, people of the right age and the real risk of harming other students!! There are models where we see employers or education having insurance schemes to cover health but I am not aware of health screening programmes to support these groups.

We have seen the private sector play a role in capacity building and support to National TB programmes through the immigration screening processes but what you suggest is another complete leap forward.

Paul

Leo Li Replied at 10:09 PM, 18 Jan 2017

Thank you for your information.
Nowadays, in China Wechat app is very popular for communication wherever you are, even you are in abroad. As I knew, many doctors were using this app to communicate with patients and follow up them interactively.
unfortunately facebook, twtter and any other app available abroad do not work in China, which leads to negative impact on communication with patients who would like to go abroad or would like to live abroad.
Hopefully your experience will do us a huge favor in management of TB patients.
Best regards
Leo

2017-01-19

doublly0103



发件人:Deliana Garcia via GHDonline <>
发送时间:2017-01-19 09:10
主题:Re: What types of international instruments can be used to establish a continuum of care for people moving across borders? What types of policy and legal approaches are necessary to support migrant TB programs?
收件人:"Leo
抄送:

Deliana Garcia replied to a discussion in Tuberculosis Among Migrants:
Leo I hold out great hope for every technological advancement that comes about. What we have learned is that we must try and marshal as much technology as possible while remembering that we are working with patients and care sites in very remote and under resources locations. It became important to work with the entire continuum of technology from the fax machine through our database portal and communications platforms like Whatsapp. People are so resourceful when it comes to communication but what remains true is that they often still need someone to "translate" the system for them or assist with a warm hand off from one site to another. Many migrants share a cell phone and work where there is no internet access so a text from us with the directions to the health center and the time and day of their appointment means that they have a written record of what they need without having to lose work time answering the phone and talking to a case worker.
Have you worked with an app that you believe will be effective with patients across international borders? I would love to hear what is out there and working well.
--
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Dylan Tierney Replied at 10:24 PM, 18 Jan 2017

As a TB specialist at a teaching hospital in Boston, a large number of my patients are immigrants. It strikes me that the hospital acts as one of these private sector entities that has a built in TB control program for migrants. While it’s probably not an intentional goal of the TB screening policy at the hospital, it is an efficient way to identify and treat people coming from outside the country for employment since screening, diagnosis and management are all contained under the employer’s one roof and there is an interest on the side of the employer and employee to provide and adhere to high quality care.

Bakhtiyar Babamuradov Replied at 2:36 AM, 19 Jan 2017

Dear Masoud, Colleagues,
Greetings from Kazakhstan and thank you very much for discussion of important topic. Since December 2014 Project HOPE in cooperation with the National Center for Tuberculosis Problems started the project "Address TB, M/XDR-TB and TB/HIV among labor migrants ", based on the consensus paper on minimum package for cross border control and care for WHO European region.
The project's objective - development and implementation of highly effective TB control measures, the M / XDR-TB and TB / HIV among migrants. Therefore, the proposed rationale is prioritizing implementation of interventions that are focused on: a) removing legal barriers to access to care for internal and external migrants; b) assuring TB prevention and care for migrants; c) strengthening community systems and increasing role of civil society.
In seven pilot sites rapid situation assessment and mapping of districts with highest concentration of migrants will be conducted at the beginning of the program to get reliable information about number of migrants, key barriers for accessing TB services, links within migrant community and with civil society groups. Initial activities will also include establishment of a cross-sector working group on TB and migration supported by national and international technical experts. The working group and consultants will focus on four key components: governance, service delivery, monitoring and surveillance, supporting environment
The target groups for the project are determined by priority: external and internal migrants and their family members (healthy, with suspected tuberculosis, TB patients and drug-resistant tuberculosis)
And it is important to establish data exchange and cooperation between countries for continuum of care, especially for MDR TB cases, so have organized dialog between countries of Central Asia through regular meetings and countries come to decision to have bi and multi-lateral agreement on cross border control of TB.
We also very interested to learn experience and implement innovative approaches related tuberculosis control among migrants.

Cynthia Tschampl Replied at 10:12 AM, 19 Jan 2017

I'm really enjoying this panel so far, thank you to all contributors! I led a study that attempted to quantify the issue of TB crossing the US border and then estimated what percent was already being addressed via cross-border care coordination programs, such as MCN's.

Attached resource:

Deliana Garcia Panelist Replied at 11:07 AM, 19 Jan 2017

Dylan, you raise an important point. I agree with Paul that there are examples from the private sector of efforts to address TB among employees or participants in the case of schools. I believe that labor sectors where employees are drawn from migrants without immigration authorization and therefor few protections have shown less interest in similar efforts. In the USA efforts have been made to engage employers in insurance schemes similar to the one Paul described with limited success. If the insurance required that the worker pay in prior to use few workers were willing to invest their limited resources for potential future need. When employers were asked to provide health care coverage, few felt that their profit margin allowed for that investment even if they understood the benefit of maintaining a health work force. Unfortunately what we have seen here is that the presences of a consistent pool of eager young workers wanting only to work so as to remit money to families and communities means that frequently employers have no need to address the health of any or all of their workers.

I would like to hear from colleagues that have examples of a helpful response from the private sector.

Deliana Garcia Panelist Replied at 11:23 AM, 19 Jan 2017

Dear Bakhtiyar, thank you for your contribution to this discussion. The work of Project HOPE in Central Asia is a model for interregional work. The focus on the three elements you describe: a) removing legal barriers to access to care for internal and external migrants; b) assuring TB prevention and care for migrants; c) strengthening community systems and increasing role of civil society, is critical. Addressing these three interventions simultaneously can be difficult to achieve and sustain. The act of removing legal barriers to access has stymied many efforts. Your attention to strengthening community systems and increasing the role of civil society will go a long way to the removal of access barriers. As civil society finds its voice and calls for the care of migrants, the public and the private sectors will be less able to ignore the need to undertake change.
It would be important to hear about efforts to address stigma as assuring TB prevention and care requires the engagement of health care workers and others who may feel that more must be done for those from within the community before addressing the needs of new comers.
Are there examples of this work that anyone would like to share?
Thank you to all for your contributions!

This Expert Panel is Archived.

While this Expert Panel is no longer active, we invite you to review and recommend past replies and resources. Membership for this Expert Panel is closed, but we hope you'll join us in one of the many communities on GHDonline.

Panelists of Tuberculosis Among Migrants and GHDonline staff