Binational Esperanza y Amistad Tuberculosis Program - Public Health Region 8

Edilia Gonzalez, LVN
Tuberculosis Binational Program Coordinator
Project Esperanza y Amistad
DSHS-Region 8
Office 830-758-4274


Project Esperanza y Amistad (Hope and Friendship) is the binational tuberculosis (TB) project for the Texas Department of State Health Services-Public Health Region 8. 



To reduce TB morbidity and mortality in the border sister cities of Eagle Pass/Piedras Negras and Del Rio/Ciudad Acuña.  


The project provides case management, treatment, and follow-up of people with tuberculosis who are considered to be binational cases or contacts to people with TB. A binational case is someone who meets one of the following criteria:

  • Patient lives in Mexico but has relatives in the U.S.
  • Patient has dual residency in the U.S. and Mexico
  • Patient has contacts on both sides of the border, in the U.S. and Mexico
  • TB patient is referred from the U.S. for treatment or follow-up in Mexico or vice versa
  • Under special circumstances, the program also accepts referrals to the program from other health agencies


Project Esperanza y Amistad was first proposed in 2009.  It was established in 2010 and an agreement between Public Health Region (PHR) 8 and the State of Coahuila was signed in 2011. The project initiated its work in February 2012 through a Binational TB Workgroup that was formed between Region 8 staff and counterparts in Mexico.  The counterparts in Mexico are representatives from the different agencies involved in the project such as the Secretariat of Health (Secretaría de Salud)) and the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social).  This workgroup meets every 2-3 months to discuss pertinent issues of the binational program and to establish guidelines to ensure patient management and functionality of the project.


Project Esperanza y Amistad acts as a supporting entity to complement the national TB program in Mexico. The project provides contracted nursing staff in Piedras Negras and Ciudad Acuña to support the Mexican TB program. The nurses are responsible for providing Directly Observed Therapy (DOT), conducting contact investigations, and providing follow-up chest x-rays and labs for binational patients.  Project Esperanza y Amistad nurses also test contacts to U.S. cases who live in Mexico. They provide tuberculosis education to a variety of groups including nurses, physicians, community health workers, non-profit health organizations, and correctional facilities. The nurses also actively support the outreach efforts of the Mexican TB program through participation in TB brigades (short trips into rural areas called ejidos) to provide TB information and education to the residents.  These brigades are coordinated by the Mexican Secretariat of Health (Secretaría de Salud). 


As of June of 2016, Project Esperanza y Amistad is now testing contacts to binational cases in Mexico using the QFT (QuantiFERON) Gold Test.  This blood test is more accurate than the TB skin test and aids in the early detection of latent TB infection and, in some cases, active TB disease.  Mexican physicians who are managing binational TB patients have agreed to offer latent TB infection treatment to those contacts who would benefit. 


For more information about Binational TB Programs in Texas, you can visit the following link:

Border Health/Binational-Tuberculosis-Program