Trans-Border Migration

Cross border collaboration if assisted and supported, would enable the retrieval of patient data comprising past diagnosis/treatment; referral for treatment continuation; contact tracing, all of which would be useful to treating clinicians. Collaboration channels could also be informative for public health and reference laboratory services. The advent of whole genome sequencing has opened new applications for outbreak investigations.

It could be envisaged that cross border collaboration could work best at the operational national Consilium level for clinical queries rather than at the programmatic level which may be more useful to public health bodies and supranational entities for outbreak investigations and metrics.

Cross border collaboration would however still have challenges with regards to lack of continuity of care and information during migration, the possible differing availability, and access to different levels of health care services between countries as well as differences within the same nation (i.e. poorer provinces, conflict areas, prisons etc.).

A minimum package of cross-border (MDR) TB control could facilitate the early diagnosis or re-diagnosis of TB. If implemented with the necessary support mechanisms it could make a difference to patient care, reduce delays, ensure continuity of care between countries, including reporting of outcomes and other data. Further levels of collaboration could also offer access to certain drugs, surgery and other services that may not exist in a particular country.

 Some examples that could be given of existing cross border collaboration: The UK has sent an uncompliant British national to Holland for XDR-TB treatment, the transfer was a successful one with treatment completion. Centres in Italy and Romania collaborate and send each other patients for XDR-TB treatment and surgery. The ERS consilium offers a platform for international advice and support