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
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 progress.

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 Project
Puentes de Esperanza

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By phone:
Mexico: (664) 973-2817
US:  (619) 819-8369