For more than four years, Champions for Health has been an active partner in TB elimination strategies in high-risk communities in San Diego County. As the non-profit arm of the San Diego County Medical Society, Champions for Health’s purpose is to address the unanswered healthcare needs of low-income and uninsured San Diego County residents. In 2019, the County of San Diego TB program (County TB) approached Champions for Health to see if they could partner to pair their TB risk assessment activities with their flu shot clinics. They agreed and ensured the County had access to their clinic schedule and the locations that would have the most impact. When the TB Elimination Alliance (TEA) started up their mini-grant program, Champions for Health volunteered to lead the creation of the CARE TB program, partnering with the County of San Diego TB Program, CDPH TB Free California, and the Asian Pacific Health Foundation. As a result of three successful TEA mini-grant awards from 2020 to 2023, CARE TB has been able to complete more than 130 needs assessments, six focus groups, and three collaborative health fairs, partnering with Asian American and Pacific Islander organizations, local universities, as well as other health care agencies serving the diverse populations of San Diego County. In August 2023, Champions for Health received TEA funding for an in-person San Diego TB Prevention Education and Community Engagement Summit that will take place on March 22, 2024, just two days before World TB Day. The Summit will bring together providers and representatives from community-based organizations to learn more about TB prevention, share practices for engaging communities at risk, and develop a community action plan.

Butte County is in Northern California about 90 miles north of Sacramento. It is semi-rural with limited healthcare providers with the expertise and knowledge to treat TB. Dr. Marytere Carrasquillo-Navarro is one of a handful of community providers specializing in internal medicine and infectious diseases. She works at several federally qualified health center (FQHC) locations, primarily managing patients diagnosed with HIV. She is a compassionate and competent provider partnering with the public health department to treat and manage patients diagnosed with TB, with or without HIV coinfection, and plays a critical role in achieving the desired outcome for each patient. To provide the best care for her patients diagnosed with TB, Dr. Marytere Carrasquillo-Navarro has been willing to participate in case discussions with public health during her lunch hours to strategize solutions to meet patient needs. In collaboration with public health, she addresses the complexities of TB care in the context of chronic co-morbidities, mental health issues, socioeconomic barriers, and other challenges. Through her patience and commitment in addressing social and health inequities that each patient faces, she is contributing to advancing health equity in our community, one patient at a time. For all these reasons, Butte County Public Health would like to acknowledge and thank her for her commitment to TB care and she deserves to be recognized as a TB Elimination Hero.

Jose has enthusiastically supported San Diego County TB outreach activities as their video producer for the past eight years. Starting with the first version of the “What is TB?” video, Jose has produced numerous videos, including TB and LTBI patient testimonials, instructional videos for clients having a chest x-ray, providing a sputum collection, and using our video DOT recording application. He has worked patiently with our native language narrators to do voice-overs and translate some of these videos into Spanish, Vietnamese, Mandarin, Tagalog, and Russian. With the support of his office, the San Diego County Communications Office, he has also been able to produce videos on behalf of other California local health jurisdictions. In addition, many of his videos have been shared at the state and national levels, including the Centers for Disease Control and Prevention. From the San Diego County TB outreach and education team’s perspective, Jose has never had a bad day. He is always happy to hear an idea pitch and provide his professional opinion on how to make it into a quality educational video. We are forever grateful for his contributions to moving our TB outreach objectives forward.

Dr. Sunita Lohiya has partnered with the Orange County Health Care Agency (OCHCA) and the California TB Control Branch on a CDC-funded, multi-site Civil Surgeon Project. The project’s main goals are: 1) to improve reporting of persons applying to adjust their immigration status (“status adjusters”) who are diagnosed with LTBI; and 2) to expand efforts to encourage status adjusters with LTBI to seek treatment for LTBI, thus preventing future cases of active TB. Dr. Lohiya has led California as one of the top three reporters of status adjusters with LTBI in the state, and reported 72% of all status adjusters with LTBI in Orange County in 2023. Her clinic, Royal Medical Group (RMG), improved reporting of treatment referral to patients with LTBI by 85% in the last six months of 2023, compared to the first six months. Dr. Lohiya has been an engaged partner in promoting LTBI treatment among status adjusters. Her clinic has adopted materials specially designed for status adjusters with LTBI, including a brochure, poster, list of low-cost clinics offering LTBI treatment, and a treatment referral form signed by Dr. Lohiya and given to the patient. Along with her clinic’s medical assistants, Lilian Trejo and Eva Garcia, Dr. Lohiya has been generous and thoughtful with her time and input to the Civil Surgeon Project, and increasing the time spent with each patient in an already busy clinic. While it is too early in the project to assess how many patients have started LTBI treatment, referral information given to patients from RMG has increased to nearly 100% as of 2023. Several treatment forms have already been returned to OCHCA from patients and their treating physicians during the project period, compared to zero prior to the project start. Dr. Lohiya is an extremely experienced and accomplished physician. She has practiced family and occupational medicine in Santa Ana for nearly 40 years, and became a civil surgeon in 1987. She has co-authored two dozen publications, many focused on hepatitis B transmission. Her clinic is very popular, with some patients traveling hundreds of miles to see her. Recently, she presented her experience as a civil surgeon encouraging LTBI treatment at a Curry International Training Center training for civil surgeons in California. She is an enthusiastic partner and leader in our work to eliminate TB in California.

Napa County is considered a rural county with comparably lower TB rates to our neighboring bay area counties. Due to lower rates, our Public Health Division is not staffed or funded for a TB clinic. Our TB control team greatly relies on support through community partners. A large portion of this partnership is through Mayra’s dedicated work at Ole. On numerous occasions she has personally taken initiative with evaluating, following, and treating patients with LTBI and active TB. Most recently she has revitalized Napa County’s only LTBI clinic, projected restart of this year.  LTBI clinic sessions lead by Mayra will be offered in both English and Spanish. At these sessions, health care providers and workers will provide TB education, complete assessments, lab draws, prescribe antibiotics, allow patients to voice their concerns, and ask questions. Having a bilingual provider to walk patients through their treatment journey is crucial and makes long lasting, positive impact for patients’ adherence to medication, follow-up, and return for future medical needs. 

Napa County’s TB Control would not be able to accomplish the work we do without the collaboration and partnership with incredible providers such as Mayra. Napa County looks forward to our continued collaboration and support of Mayra’s invaluable work. We feel it necessary her steadfast and determined TB work be recognized by the larger TB community!

Central City Community Health Center’s outreach team has partnered with the Los Angeles County TB Control Program for 10 years. The team provides mobile primary care to predominantly non-US born, undocumented immigrants experiencing homelessness and undergoing substance use treatment. Grupo settings are unlicensed, crowded, and unsanitary, and clients distrust outsiders for fear deportation. This partnership was instrumental in responding to TB outbreaks within Grupo settings, ensuring comprehensive targeted TB testing and treatment services, operating throughout the pandemic. Active surveillance has been conducted at five to eight Grupo sites since 2014; since then, 11 TB cases were identified, 4103 individuals have been evaluated, and 1806 tested with TB positivity ranging 17-27% annually.