Migrant TB treatment in Haiti resulting in U.S. policy change at Guantánamo Bay, Cuba.

Because of Haiti's poverty and poor health infrastructure, together with the global emergence of drug-resistant tuberculosis (TB), questions were raised about the U.S. military's practice of returning Haitian migrants with active noninfectious tuberculosis (TB) to Haiti. As a result, the pilot study reported here assessed the TB treatment completion rate of 38 Haitians (24 with TB and 14 contacts) who voluntarily requested repatriation from Guantánamo Bay (GTMO), Cuba, in November 1994. Six weeks after repatriation, four of the study subjects had been lost to follow-up, 18 had received follow-up treatment, and 16 were delinquent in receiving treatment. The reasons given for failing to get treatment varied: 7 (21% of the 34 followed) were asked to pay for clinic visits, leaving them without medication; 5 (15%) were asked to return at a later date; and 4 (11%) had not sought treatment. A second follow-up visit five months later failed to locate three additional subjects. Of the 31 followed, 17 (55%) completed chemotherapy, while the remaining 14 (45%) discontinued treatment two to three months prior to the completion date despite extensive education and a promised monetary reward. On the basis of these findings it was strongly recommended that migrants with TB remain at Guantánamo until their treatment completion date, a recommendation that was adopted.