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Volume 22, Number 3—March 2016

Use of Transnational Services to Prevent Treatment Interruption in Tuberculosis-Infected Persons Who Leave the United States

Cynthia A. TschamplComments to Author , Deborah W. Garnick, Edward Zuroweste, Moaven Razavi, and Donald S. Shepard
Author affiliations: Brandeis University, Waltham, Massachusetts, USA (C.A. Tschampl, D.W. Garnick, M. Razavi, D.S. Shepard); Migrant Clinicians Network, Austin, Texas, USA (E. Zuroweste)

Main Article

Table 1

Study population inclusion and exclusion criteria, data sources, and estimation equations used to determine number at risk of treatment interruption among TB-infected, authorized and unauthorized visitors to the United States, 2008-2012*

Subgroup Justification References Calculation method
Included in study
Resided in the United States with authorization†
Tourist or business travelers Left United States after <2 mo (1015) PY × (country-specific TB incidence rate)‡
Student or exchange visitors Left United States after <9 mo (1015) PY × (country-specific TB incidence rate)‡
Temporary workers Left United States after <5 mo (1015) PY × (country-specific TB incidence rate)‡
Diplomat or other representatives Left United States after <3 mo (1015) PY × (country-specific TB incidence rate)‡
Persons with all other visa types Left United States after <1 mo (1015) PY × (country-specific TB incidence rate)‡
Persons with unknown visa type Left United States after <2 mo (1015) PY × (country-specific TB incidence rate)‡
Visitors from Canada and MX 
without I-94 card Left United States after <1 mo (1015) PY × (country-specific TB incidence rate)‡
Resided in United States without authorization
Detained first and then removed 
by US officials Left United States; subgroup in this category for which most data was available (12,16,17) No. detainees × (183/365) × TB incidence rate for detainees × proportion removed§
All other removals meetinginclusion criteria Left United States (10,12,16,17) (No. nonexpedited removals × estimated no. detained before removal) × (183/365) × (country-specific TB incidence rate)¶
MX nationals leaving United 
States of own volition Left United States (10,12,16,18,19) No. MX nonexpedited removals × estimated % left voluntarily × (183/365) × (MX TB incidence rate)#
All other nationals leaving 
United States of own volition
Left United States
(Total who left voluntarily − MX left voluntarily) × (183/365) × (57/100,000 PY)**
Excluded from study
Resided in the United States with authorization
Immigrants Permanent residents; no requirement to leave United States (1215) NA
Refugees Permanent residents (1215) NA
Asylees Permanent residents (1215) NA
Resided in the United States without authorization
Currently residing in the United 
States Did not leave United States during study period (12,16,18) NA
Returnees and expedited 
removals†† Did not officially enter United States (12,16,18) NA
Detained but not removed Did not leave United States during study period (12,16,18) NA

*Study population is defined as those who were born outside the United States, had active tuberculosis while in the United States, and then left the United States before treatment completion was possible. I-94 card, the entry/exit form that all nonimmigrant visitors (except certain ones from MX and Canada) must fill out; MX, Mexico/Mexican; NA, not applicable; PY, person-years; TB, tuberculosis.
†These subgroups included family members. See Technical Appendix Table 1 for a complete list of visas for each subgroup and their corresponding mean and median length of stay.
‡Calculated for all countries, 2008–2012. PY = no. of admissions × (weighted mean length of stay in days/365). Weighted median length of stay was used for all these groups in sensitivity analyses, except those without an I-94 card, as only the mean was available. See Technical Appendix Tables 3–6 for results.
§183 d, or 6 mo, of risk was assumed as the minimum amount of time for TB to be diagnosed, treatment started, and a treatment interruption caused by leaving the United States.
¶Calculated for top 12 receiving countries by using World Health Organization country-specific TB incidence rates. All other countries grouped together and multiplied by the midpoint TB incidence rate of 57 cases/100,000 PY.
#Calculated for MX nationals; they make up the majority (assumed at 90%) of this subgroup.
**All other countries’ nationals assumed to make up 10% of this subgroup; the midpoint incidence rate of TB burden was 57 cases/100,000 PY.
††These are 2 immigration enforcement categories with specific definitions used by US Department of Homeland Security (16).

Main Article

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Main Article

1Preliminary results from this study were presented at the joint The Union–North America Region and the National Tuberculosis Controllers Association meeting, February 24–27, 2016, Denver, Colorado, USA.

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