Continuity of Care for Patients with Tuberculosis Relocating to Other Countries - CureTB Program, 2016-2023

Patients who have received a diagnosis of tuberculosis (TB) disease face barriers to continuing and completing TB treatment when they relocate between countries, potentially resulting in lower treatment completion rates. Treatment for TB disease can range from 6 months to more than 2 years in duration; failure to complete treatment increases the risk for TB transmission and emergence of drug resistance. CDC's CureTB program makes follow-up TB care referrals for persons relocating to or from the United States, either as temporary visitors or when returning to their home countries, by providing information directly to public health authorities at patients' destinations. To evaluate program performance, public health officials examined 2016-2023 CureTB referral outcomes and treatment completion rates. Among 6,944 referral requests received from U.S. or foreign authorities during 2016-2023, approximately one half (3,912; 56%) were for patients with suspected TB, and approximately one third (2,404; 35%) were for patients with confirmed TB. Among patients who had received a diagnosis of TB for whom a request for a referral was made, CureTB made referrals for 1,741 (72%), including 1,622 (93%) persons relocating to other countries and 119 (7%) relocating to U.S. destinations. Referrals were not required for 522 (22%) persons, and referrals could not be completed for 141 (6%) because information needed to contact the patient was insufficient. Overall, within 12 months of referral, 1,379 (79%) of 1,741 referred patients completed treatment. Among 1,287 (74%) referred patients for whom data on timing of initiation of care were available, treatment completion rates were highest (91%) for 637 patients linked to treatment ≤30 days after departure, followed by 89% for 505 patients linked within 1-3 months, and 85% for 145 linked within 3-12 months. Timely initiation of care can facilitate continuity of care and support completion of TB treatment. CureTB supports the global goals of reducing TB transmission, improving treatment completion rates, and enhancing progress toward TB elimination in the United States; the program can serve as a model for other countries.