Tuberculosis Surveillance Report
Arizona, 2012

Arizona Department of Health Services
Bureau of Epidemiology and Disease Control Services
Office of Disease and Integration Services
May 2013

Executive Summary

The Arizona Department of Health Services (ADHS) TB Control Program (the Department)
conducts surveillance, data analysis, program evaluation, and consultation for Arizona’s local
health departments which provide direct patient care for TB patients. This 2012 Tuberculosis
(TB) Annual Surveillance Report provides descriptive data for TB in Arizona.
In 2012, there were 211 cases of active TB disease reported in Arizona. The 2012 TB
case rate in Arizona was 3.3 per 100,000 population compared to 3.2 per 100,000
nationally. Four of Arizona’s fifteen counties Maricopa, Pinal, Pima and Yuma
comprised 90.9% (192/211) of active TB cases reported. Maricopa County, the most
highly populated county in Arizona, reported 51.2% (108/211) of the state’s cases.
Risk factors identified for Arizona TB cases included:
o 70.6% (149/211) of the TB cases reported a country of birth other than the U.S.
o 26.5% (56/211) of the TB cases were diagnosed while a resident in a correctional
facility.
o 17.1% (36/211) of the TB cases had diabetes mellitus.
o 5.2% (11/211) of the TB cases were reported with HIV co-infection.
Drug susceptibility testing was reported for 98.2% (165/168) of the culture positive TB
cases.
o 7.9% (13/165) reported isoniazid (INH) resistance.
o No cases of multi-drug resistance TB were reported.
Completion of treatment has been a major concern of the Department. The latest year for
which completion of treatment data is available is 2010. The Department saw
improvement for completion of treatment of both correctional and non-correctional TB
cases.
o Completion of treatment within twelve months for non-correctional TB cases was
90.7% (176/194) in 2010. Overall completion of treatment for non-correctional
facility cases was 96.0% (193/201) compared to 85.3% (151/177) in 2009.
o Completion of treatment within twelve months for correctional TB cases was
59.1% (13/22) compared to 39.4% (13/33) in 2009. In 2010, there were a total of
61 correctional facility TB cases and 67.2% (41/61) were lost to follow-up due to
repatriation, transfer to a facility out of Arizona or a community release.
Continuity of care for active TB cases who return to their home country is achieved with
international referrals via CureTB and TBNet. These agencies provide assistance to TB
cases for medical follow-ups and continuation of treatment. The Department coordinates
Meet and Greets through the Ports of Entry of Nogales and San Luis for cases returning
to Mexico. These Meet and Greets are coordinated with several outside agencies as well
as the Department. In 2012, six meet and greets were arranged.

The Arizona Department of Health Services Tuberculosis Control Program
The Department has overall responsibility for surveillance, management, and evaluation of TB
activities in Arizona. The Department provides epidemiological, technical, medical, nursing, and
programmatic consultative services regarding TB prevention and control to health care providers,
local and tribal health departments (LHDs) TB control programs, and health care facilities.
Through collaboration with the Arizona State Public Health Laboratory (ASPHL), the
Department ensures appropriate laboratory testing for specimens and monitors drug-resistance
patterns in the state.
Arizona is comprised of fifteen counties and twenty-one federally recognized tribes. The LHDs
provide all direct patient care for TB control activities. The LHDs coordinate with medical
providers and correctional health staff members within their jurisdiction to provide TB control
services.
The Arizona State Public Health Laboratory provides testing services including acid-fast bacillus
(AFB) smear, culture, identification, and drug susceptibility testing for clinical mycobacterial
samples statewide. The laboratory serves as a reference laboratory for all isolates suspected to
be positive for TB and performs drug susceptibility testing for all first–time positive isolates.
The laboratory also sends isolates to the CDC contract lab in California for genotyping of all
positive culture isolates.
This report provides information about Arizona’s reported TB cases in 2012 and completion of
treatment for 2010. The latest year for completion of treatment information is available is 2010
due to length of time needed to successfully complete TB treatment.
Figure 1. TB Cases and Case Rates in Arizona and Nationally, 2002-2012
In 2012, Arizona’s LHDs reported 211 cases of active TB with a case rate of 3.3 per 100,000.
This represents an 8.2% decrease in number of cases and 17.0% decrease in case rate compared
to 2011. In the United States, a total of 9,951 TB cases were reported in 2012 with a case rate of
3.2 per 100,000. This was the lowest rate recorded in the U.S. since 1953.
Pulmonary TB disease was diagnosed in 77.7% (164/211) of the cases. Extrapulmonary disease
represented 12.8% (27/211) of the cases. The diagnosis of both pulmonary and extrapulmonary
disease was reported in 9.5% (20/211) of the cases.

6.0

350

5.0

300
250

4.0

200
3.0
150
2.0

100

1.0

Number of Cases

Case Rate (100,000)

Figure 1. Arizona & U.S. TB Case Rates and Arizona TB
Cases, 2002-2012

50

0.0

0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Arizona Cases
Arizona Case Rate
U.S. Case Rate

Figure 2. TB Cases Rates by Selected Population Groups, Arizona, 2012. In 2012, the TB
case rate among foreign-born individuals was 17.1 per 100,000. The case rate among U.S. –born
persons was 1.1 per 100,000. Among U.S. –born Non-Hispanic blacks, the rate was 2.2 per
100,000. TB case rates among children less than five years of age was 0.7 per 100,000.

Figure 2. TB Case Rates, Arizona 2008-2012
20

Rate per 100,000

15
10
5
0
2008

2009

U.S.-born Persons
U.S.-born Non-Hispanic Blacks
All Reported TB Cases

2010

2011

2012

Foreign-born Persons
Children <5 Years of Age

Figure 3. TB Cases by County of Residence, Arizona 2012. Four of Arizona’s fifteen
counties, Maricopa, Pima, Pinal and Yuma accounted for 90.9% (192/211) of all cases reported.
Maricopa County, the most highly populated county in Arizona, reported 51.2% (108/211) of the
state’s cases.
The TB cases reported from Pinal County accounted for 19.9% (42/211) of cases statewide with
88.1% (37/42) diagnosed in a correctional facility. There are twenty-one correctional facilities
located within Pinal County, including U.S. Immigrations and Customs Enforcement Service
Processing Centers (ICE-SPC), federal, state, local and privately managed facilities. Yuma
County reported 12.3% (26/211) of total cases and Pima County reported 7.6% (16/211). In
2012, there were no cases reported in Santa Cruz or Graham County.

Number of Cases

Figure 3. Number of TB Cases by County, Arizona, 2012
110
100
90
80
70
60
50
40
30
20
10
0

Figure 4. TB Case Rates by County, Arizona 2012. The statewide TB case rate was exceeded
in Apache, Greenlee, Pinal, Yuma and La Paz counties. Maricopa County, which reports around
50% of the states TB cases annually decreased from 3.1 per 100,000 in 2011 to 2.8 per 100,000
in 2012. This is lower than the state and national rate.
Pinal County decreased from 13.6 to 11.0 per 100,000. Yuma County decreased from 15.3 per
100,000 in 2011 to 12.9 per 100,000. Both La Paz and Greenlee counties increased from 2011 as
no cases were reported that year. In 2012, both counties reported 1 case. Both counties have very
low populations therefore their case rates are artificially elevated.

Case Rate (100,000)

Figure 4. TB Case Rate by County, Arizona, 2012
16
14
12
10
8
6
4
2
0

County Case Rate

State Case Rate

Figure 5. Number of TB cases by Race and Ethnicity and Figure 6. Case Rates by Race and
Ethnicity. Hispanic ethnicity of any race accounts for 58.3% (123/211) of all reported TB cases
annually. TB cases of Asian descent accounted for 14.2% (30/211) followed by AfricanAmerican at 11.4% (24/211), Non-Hispanic Whites 9.0% (19/211) and Native American
accounted for 7.1% (15/211) of the cases.
The highest TB case rate among racial/ethnic groups was reported for TB cases of Asian descent
with15.0 per 100,000. The rate decreased 26.8% from 20.5 per 100,000 in 2011. The rates
among Native Americans decreased 23.6% from 5.5 per 100,000 in 2011 to 4.3 per 100,000 in
2012. TB case rates among Hispanics decreased 10.7% from 7.5 per 100,000 in 2011 to 6.7 per
100,000 in 2012 The TB case rate among African-Americans increased 21.3% from 7.0 per
100,000 in 2011 to 8.9 per 100,000 in 2012.

Figure 5. TB Cases by Race & Ethnicity,
Arizona, 2008-2012
160
140
Number of Cases

120
100
80
60
40
20
0
2008

2009

2010

2011

White, non-Hispanic

African-American

Asian

Hispanic

Multi-race

Native Hawaiian

35

2012
Native American

Figure 6. TB Case Rates by Race & Ethnicity,
Arizona, 2008-2012

Rate per 100,000

30
25
20
15
10
5
0
2008
White, non-Hispanic

2009

2010

African-American

2011
Asian

2012

Native American

Hispanic

Figure 7. and 8. TB Cases by Gender, Arizona, 2012. In 2012, males accounted for 68.7%
(145/211) of active TB cases. Females accounted for 31.3% (66/211) of cases. This is consistent
with previous year’s data.

Figure 7. TB Cases by Gender, Arizona, 2012

Male
Female

Number of Cases

Figure 8. TB Cases by Gender,
Arizona, 2008-2012
200
180
160
140
120
100
80
60
40
20
0
2008

2009
Male

2010
Female

2011

2012

Figure 9. Number of TB Cases by Age Groups and Figure 10. TB Case Rates by Age
Groups. In 2012, 39.8% (84/211) of TB cases were reported in the 25 – 44 year age group.
Those in the 45 – 64 year age group accounted for 23.2% (49/211) of TB cases followed by the
65+ age group with 17.5% (37/211) and the 15 -24 age group with 14.7% (31/211). Pediatric
cases aged 5 – 14 years contributed 3.3% (7/211) and those 4 and under accounted for 1.4%
(3/211) of all cases.

In Arizona, the highest case rates occurred in the 25 - 44 year old age group (6.8 per 100,000).
The second highest occurred in those 65 years or older (4.2 per 100,000). The TB case rate
declined 11.7% for the 25 – 44 year old age group from 2011. The TB case rate decreased 40.8%
for the age group of 65 years of age and older from 2011. Also, the TB case rate declined 38.9%
from 2011 for cases aged 0 – 4 years.

Figure 9. TB Cases by Age Groups,
Arizona, 2008 - 2012
120

Number of Cases

100
80
60
40
20
0
2008
0-4

2009
5-14

2010
15-24

2011

25-44

2012

45-64

65+

Figure 10. TB Case Rates by Age Groups,
Arizona, 2008-2012

Rate per 100,000

10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
0-4

5 - 14
2008

15-24
2009

25-44
2010

45-64
2011

65+
2012

Figure 11 and 12. TB Cases by Country of Birth, Arizona 2012. Over half of all reported TB
cases reported in the United States occur among foreign-born persons. The risk of disease among
the foreign-born also appears related to chronological age and age at immigration; younger
people and those who immigrated at younger ages are at lower risk for subsequent infection with
TB. In 2012, 70.6% (149/211) of the TB cases were identified as foreign born-cases. U.S.-born
TB cases accounted for 28.4% (60/211) of total reported cases. For TB surveillance purposes, a
U.S.-born person is defined as someone born in the United States or its associated jurisdictions
or someone born in a foreign county but with at least one U.S.-citizen parent.
For country of birth besides the United States, Mexico accounted for the highest percentage with
35.1% (74/211). Guatemala has the second highest with 7.1 % (15/211) of cases considered
foreign-born. Bhutan and the Philippines accounted for 3.3% (7/211) of cases each. Somalia
accounted for 2.4% (5/211) of cases and Honduras and Vietnam contributed 1.9% (4/211) cases
each.

Figure 11. US-Born & Foreign-Born TB Cases,
Arizona, 2008-2012
Number of TB Cases

200
150
100
50
0
U.S.-born

Foreign-born

Unknown

Number of TB Cases

Figure 12. TB Cases by Country of Birth,
Arizona, 2012
80
70
60
50
40
30
20
10
0

Figure 13. Percentage of TB cases with HIV Co-infection and % HIV Results Known,
Arizona 2008 -2012. HIV is the strongest known risk factor for TB disease. The Department
recommends all medical providers to provide HIV counseling and testing for all TB patients.
Co-infection with HIV and TB in individuals is a major concern. Immunosuppression by HIV
can negatively impact the body’s ability to fight infection. Individuals with co-infection have
high mortality rates and are more susceptible to increased drug resistance. This leads to longer
and more complex treatment regimens.
In 2012, 89.6% (189/211) of all reported cases had HIV screening results reported and with
positive results reported for 5.2% (11/211) of the cases. In TB cases within the 25 - 44 year old
age group, HIV screening results were reported for 96.4% (81/84) of TB cases with 8.4% (7/84)
reported positive results.

Figure 13. TB Cases with HIV Co-infection and TB
Cases with Known HIV Results, Arizona, 2008-2012

Percentage

100
80
60
40
20
0
2008
2009
TB/HIV Co-infection, All Ages
HIV Results Known, All Ages

2010
2011
2012
TB/HIV Co-infection, 25 - 44 years
HIV Results Known, 25-44 years

Figure 14. TB Cases diagnosed in a Correctional Facility. Arizona has consistently ranked as
one of the highest states in the nation for percentage of TB cases diagnosed while incarcerated.
In 2012, among reported cases over the age of fourteen, residence in a correctional facility at
time of diagnosis represented 27.2% (55/202) of cases. Routine evaluation of all inmates for TB
during the intake process allows for diagnosis of both latent and active TB in this population.
The Department works closely with all correctional facilities in the state and provides
correctional health staff with TB training and education to ensure facilities abide by inmate
screening requirements.

Number of Cases

60

30.0
25.0

50

20.0

40
15.0
30
10.0

20

5.0

10
0

0.0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Number of Cases

Percentage

Percentage

70

Figure 14. Number & Percentage of TB Cases
Diagnosed in Correctional Facilities, Arizona,
2003- 2012

Table 1. TB Cases by Selected Risk Factors. Risk factors associated with cases reported to the
Department in 2012 include diabetes mellitus in 17.1% (36/211) of cases, homelessness in 5.7%
(12/211), incomplete LTBI therapy in 2.4% (5/211) and contact of an infectious TB case within
the previous two years in 3.8% (8/211) of cases.
Among reported cases over the age of fourteen, risk factors included non-injecting drug use in
12.9% (26/202) of cases, injecting drug use in 4.0% (8/202), and excess alcohol use in 11.9%
(24/202) of cases. High-risk occupations for TB transmission include health care workers and
migrant farm workers. Migrant farm workers comprised 8.4% (17/211) and health care workers
represented 4.0% (8/202) of 2012 cases. The other significant risk factors include TB/HIV coinfection, residence in a correctional facility and country of birth. These risk factors were
discussed in more detail individually.
Table 1. Tuberculosis Cases by Selected Risk Factors, Arizona, 2010-2012
2010
Cases
Total Cases

2011
%

282

Cases

2012
%

255

Cases

%

211

Occupation
Health Care Worker >15 years

4

1.5

10

4.1

8

4.0

Migrant Farm Worker >15 years

8

3.0

19

7.9

17

8.4

8

3.0

8

3.3

8

4.0

16

6.1

25

10.3

26

12.9

27

10.2

34

14.1

24

11.9

6

1.8

8

3.1

2

1.0

24

8.5

15

5.9

12

5.7

31

11.0

31

12.2

36

17.1

Reported Behaviors
a

Injecting Drug Use

>15 years
a

Non-injecting Drug Use >15 years
a

Excess Alcohol Use >15 years
Type of Residence
Long Term Care Facility
Homeless

b

a

Comorbidity
Diabetes Mellitus

c

Immunosuppression (Not HIV/AIDS)

c

9

3.2

6

2.3

4

1.9

Incomplete LTBI Therapy

10

3.5

6

2.4

5

2.4

Contact of infectious TB case (2 years
c
or less)

15

5.3

15

5.9

8

3.8

c

a

Within one year prior to diagnosis of tuberculosis.

b

Residence at time of diagnosis.

Table 2. TB Cases Reported with Drug Sensitivity and Drug Resistance. In 2012, 79.6%
(168/211) of the TB cases reported had positive culture results. Of these cases, 98.2% (165/168)
reported drug sensitivity results. Isoniazid (INH) resistance remained consistent from 2011 at
7.9% (13/211) of cases. No cases of multi-drug resistance TB was reported in 2012.

Tuberculosis Cases Resistant to INH and Other Anti-TB Drugs, Arizona, 2006 - 2012
Year

Cases

Culture
Confirmed

Drug
Sensitivity
Testing

INH
a
Resistant

No.

(%)

No.

(%)

No.

Other
c
Resistance

Total
d
Resistance

(%)

No.

(%)

No.

(%)

MDR

b

2006
2007
2008
2009
2010
2011

313
302
227
232
282
256

228
222
152
181
202
192

210
218
146
178
196
189

(92.1)
(98.2)
(96.1)
(98.3)
(97.0)
(98.4)

17
18
6
13
15
15

(8.1)
(8.3)
(4.1)
(7.3)
(7.7)
(7.9)

2
3
0
0
0
1

(1.0)
(1.4)
(0.0)
(0.0)
(0.0)
(0.5)

10
14
6
23
14
13

(4.8)
(6.4)
(4.1)
(12.9)
(7.1)
(6.9)

29

29

(13.8)
(16.1)
(8.2)
(20.2)
(14.8)
(15.3)

2012

211

168

165 (98.2)

13

(7.9)

0

(0.0)

8

(4.8)

21

(12.7)

a

Isolates may also be resistant to other drugs, including rifampin, includes initial and final susceptibility results
Resistant to at least isoniazid and rifampin, includes initial and final susceptibility results.
Other patterns of drug resistance excluding INH resistance
d
Isolates with resistance to any first or second line TB drug
b
c

35
12
36
29

Figure 15. Directly Observed Therapy, Arizona, 2001-2010. Directly observed therapy (DOT)
is the standard of care for administering TB medications to active cases. In DOT, health care
workers observe the individual take his/her medications to ensure compliance with the treatment
regimen. All LHDs are encouraged to provide DOT for community cases. DOT can be difficult
for some of Arizona’s LHDs as most of the rural counties are large and require traveling long
distances to provide this service. Several LHDs also provide DOT for correctional facilities
within their jurisdictions.
In 2010, 92.6% (249/269) of the TB cases who started treatment received directly observed
therapy or a combination of directly observed therapy and self-administered therapy. Selfadministered therapy only was reported for 5.2% (14/269) of cases.

Figure 15. Directly Observed Therapy,
Arizona, 2001-2010
100

Percentage

80
60
40
20
0
2001

2002

2003

Self Administered Only

2004

2005
Unknown

2006

2007

2008

2009

2010

DOT or DOT & Self Administered

Figure 16. Completion of Treatment, Arizona, 2001-2010. Completion of treatment for TB
cases is a continuing focus for the Department. The overall goals for treatment of TB are to cure
the individual patient and limit the transmission of TB to other people. Thus, successful
treatment of each individual TB patient benefits the individual and the community. The
Department conducted cohort reviews and collaborated with LHDs which improved completion
of treatment in Arizona. Also, the Department utilizes international referrals to provide
completion of treatment information for TB cases that have left the U.S. and returned to their
country of origin. In 2010, 87.5% (189/216) of the eligible cases completed treatment within
twelve months. Overall, 92.4% (206/223) of the cases completed therapy regardless of the time
frame.

100

Figure 16. Completion of Treatment for All TB Cases,
Arizona, 2001-2010

Percentage

80
60
40
20
0
2001

2002

2003

2004

2005

% Complete within 12 months

2006

2007

2008

% Overall Completion

2009

2010

Figure 17. Completion of Treatment for Non-Correctional Facility TB Cases. Residence in a
correctional facility impacts completion of treatment rates negatively. For cases of TB not
diagnosed in a correctional facility, 90.7% (176/194) of cases completed treatment within one
year. 96.0% (193/201) of non-correctional facility cases completed therapy regardless of the time
frame.

Figure 17. Completion of Treatment for Non-Correctional TB
Cases, Arizona, 2001-2010

100

Percentage

80
60
40
20
0
2001

2002

2003

2004

2005

% Complete within 12 months

2006

2007

2008

2009

2010

% Overall Completion

Figure 18. Completion of Treatment for Homeless Non-Correctional TB Cases. In 2010,
87.5% (14/16) of homeless non-correctional TB cases for whom therapy was indicated for a year
or less completed treatment. Overall completion of treatment regardless of time frame was also
87.5% (14/16).

Figure 18. Completion of Treatment for Homeless NonCorrectional TB Cases, Arizona, 2001-2010
100
Percentage

80
60
40
20
0
2001

2002

2003

2004

2005

% Complete within 12 months

2006

2007

2008

% Overall Completion

2009

2010

Figure 19. Completion of Treatment for Correctional TB Cases. In 2010, 59.1% (13/22) of
TB cases diagnosed in a correctional facility completed treatment within one year. Overall
completion of treatment regardless of time frame was also 59.1% (13/22). The low percentages
for completion of treatment in correctional facilities are likely due to the transient nature of those
incarcerated. Cases are transfer facilities multiple times or are repatriated to their home country.
Although international referrals are performed completion of treatment data is not always
known.

Figure 19. Completion of Treatment for Correctional TB
Cases, Arizona, 2001-2010
100
Percentage

80
60
40
20
0
2001

2002

2003

2004

2005

% Complete within 12 months

2006

2007

2008

2009

2010

% Overall Completion

Contact Investigations
Contact investigations identify, examine, and evauluate all persons who are at risk of infection
with TB due to recent exposure to a diagnosed infectious case. This process facilitates new case
finding which allows for early detection and treatment of new infections. In some cases, it may
even prevent disease. It is an essential component of tuberculosis control. The LHDs are
reponsible for conducting contact investigations or coordinating with responsible parties outside
local public health to ensure contact investigations are completed. The last year for which
contact information data is available is 2010 due to the length of time to complete treatment.
In 2010, contacts were identified for 75.9% (63/83) of sputum-smear positive TB cases. Among,
smear-positive cases diagnosed in a correctional facility 38.9% (7/18) identified contacts
compared to 86.2% (56/65) of community cases. Of contacts to sputum-smear positive TB cases,
67.7% (815/1203) were evaluated. Of the contacts evaulated 222 contacts were newly diagnosed
latent TB infections. 86.9 % (193/222) of these cases initiated LTBI treatment and 39.9%
(77/193) completed treatment.
Table 2. Contacts to Sputum-Smear Positive TB Cases, Arizona, 2007-2011
2007
2008
2009
No.
% No. %
No. %
Cases with Contacts
64
71 63
82 58
82
Cases without Contacts
26
14
13
Total Sputum-Smear Positive Cases
90
77
71
*Preliminary data for 2011.

2010
No. %
63 76
20
83

2011*
No. %
70 77
21
91

Table 3. Evaluation of Contacts to Sputum-Smear Positive TB Cases, Arizona, 2007-2011
2007
2008
2009
2010
2011*
No. % No. % No. % No.
% No.
%
Contacts Evaluated
409 88 476 63 594 70 815 68 764 66
Contacts Not Evaluated
54
281
250
388
400
Total Contacts to Sputum-Smear Positive
463
757
844
1203
1164
Cases
*Preliminary data for 2011.

Table 4. LTBI Therapy for Newly Infected Contacts, Arizona, 2007-2011
2007
2008
2009
No. % No. % No. %
Newly Diagnosed Infected Contacts
142
164
213
Infected Contacts Started on LTBI Therapy
98 69 91 55 39 18
Infected Contacts Completing LTBI Therapy
66 67 65 71 27 69

2010
No. %
222
193 87
77 40

2011*
No. %
187
141 75
87 62

*Preliminary data for 2011.

Evaluation of Class B1/B2 Referrals
Immigrants and refugees traveling to the U.S. are evaluated for TB as part of the admission
process, and are assigned a classification according to the status of their disease. Class A
individuals have TB disease and have been granted a waiver. Class B1 includes individuals with
non-infectious pulmonary TB disease with negative acid-fast bacilli sputum smears and cultures.
Class B1 also includes extra pulmonary TB cases. Class B2 individuals have positive skin tests
but have negative evaluations for active TB disease. Class B3 individuals are recent contacts of a
known TB case.
The CDC Division of Global Migration and Quarantine notifies the Department of all Class B
individuals entering the state. The Department forwards these referrals to the LHDs where the
individual will reside. The LHDs provide medical evaluation and treatment. The transitory nature
of the immigrant and refugee population makes it difficult to initiate or complete evaluations and
treatment for these individuals. The Department is developing strategies to overcome these
barriers.
In 2012, the Department received 287 notifications for immigrants and refugees designated as
class B1, of which 40.9% (117/287) initiated medical evaluation and 39.7% (114/287) completed
medical evaluation. The Department received 207 Class B2 notifications. Of these 80.6%
(167/207) completed the evaluation and 44.9% (75/167) were started on treatment for latent TB
infection.
International Referrals and Case Management
The Department coordinates with international referral agencies to ensure continuity of care for
individuals with TB or suspected of having TB who return to their home country. CureTB
facilitates the referral process with public health officials in Mexico. TBNet facilitates the

referral process for all countries including Mexico. In 2012, 149 cases and suspect cases were
referred to these international agencies.
Border Health Activities
To ensure continuity of care for individuals being treated for TB who are repatriated to
Mexico through Nogales, Arizona, the ADHS TB Control Program coordinates “Meet and
Greets.” The Meet and Greet involves transferring these individuals from Arizona and federal
law enforcement authorities to Mexican law enforcement and public health authorities.
The Meet and Greet protocol developed in 2007 has resulted in better coordination of inmates
returning to Mexico. The protocol includes working closely with the ADHS Office of Border
Health, correctional facilities, LHDs, Sonoran partners, CureTB, and ICE authorities. In 2012,
the Department arranged six Meet and Greets through the port of Nogales. The Department has
developed a Meet and Greet protocol for the Port of San Luis, Yuma County.
.The Department is collaborating with Sonoran public health officials to improve communication
and completion of treatment for binational TB cases. MEDSIS (Medical Electronic Disease
Surveillance Intelligence System) the Arizona disease surveillance system for reporting TB cases
will soon be translated into Spanish in 2013 and be made available to Sonora Public Health
Officials to improve communication with the Department.
Conclusion
The Department continues to partner with local health departments, federal agencies,
correctional facilities, and the international community to prevent and control TB in Arizona.
The partnerships have improved treatment completion, data quality and communication between
different jurisdictions. Continuing close collaborations with local health departments and outside
partners will prevent further spread and curb the emergence of drug-resistant TB.