Puentes de Esperanza: Binational Alliance for
the Treatment of Multi-Drug Resistant
Tuberculosis (MDR-TB) in the Californias
Authors: Kathleen Moser, MD, MPH; Guadalupe Felix, MD; Rafael
Laborin-Laniado, MD, MPH; Raquel Castañeda, MD; Alberto Colorado, BS;
José Luis Burgos, MD, AAHIVS; Sundari Mase, MD, MPH; Miguel Salazar, MD.
Background: The spread of MDR-TB across international boundaries
has pushed all nations to recognize this disease as a looming global public
health crisis. In 2003, 75% of MDR-TB cases (86/114) in the US were
foreign-born.  Mexico was the top country of origin contributing 21%(18/86) of
these cases.  From 1994-2002, 24% of the 374 MDR-TB cases in California
were born in Mexico.  In a recent study, MDR-TB in Baja California
comprised 22% of cases occurring in previously treated patients.

Methods: Puentes de Esperanza is a three-year project funded by the US
Agency for International Development and developed through US-Mexico
collaborative planning.  The project will enhance activities underway in Baja
California to control the spread of resistant strains of TB. Essential
elements of the initiative include:
A binational consultation system linking experts from the U.S and Mexico.  
The partners will confer and monitor patient clinical progress and outcomes
regularly through teleconferences and in-person case conferences.
Assurance of a steady supply of second-line medications. Laboratory
support. Treatment of 10-20 MDR-TB patients in existing TB specialty clinics
in Baja California under fully supervised therapy. Education of community
health professionals.  

Results: Several binational planning meetings have been done between
Project partners. First Binational Case conference was successfully
implemented on January 20, 2006 and continue quarterly.  Policies,
Protocols and  Training curricula are under development.  First MDR
patients has been identified and is in the process to be enroll in the project.
A website to link  partner health care providers and program managers is in

Conclusions: Puentes de Esperanza is envisioned as a three-year
project culminating in a sustainable infrastructure to treat MDR-TB in
northern Baja California. To this end, each activity will be developed with
sustainability as an explicit goal.  A cost analysis is planned to identify the
initial investment and ongoing resources required for project maintenance.   
Puentes de Esperanza

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