Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature

Sophia G. de Vries, Anne L. Cremers, Charlotte C. Heuvelings, Patrick F. Greve, Benjamin J. Visser, Sabine Belard, Saskia Janssen, Rene Spijker, Beth Shaw, Ruaraidh A. Hill, Alimuddin Zumla, Marieke J. van der Werf, Andreas Sandgren, Martin P. Grobusch

Research output: Contribution to journalReviewpeer-review

Abstract

Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.

Original languageEnglish
JournalLancet Infectious Diseases
Volume17
Issue number5
Pages (from-to)E128-E143
Number of pages16
ISSN1473-3099
DOIs
Publication statusPublished - May-2017

Keywords

  • DIRECTLY OBSERVED THERAPY
  • RISK-FACTORS
  • PRIMARY-CARE
  • DRUG-USE
  • HEALTH
  • HOMELESS
  • HIV
  • EXPERIENCES
  • IMMIGRANTS
  • ADHERENCE

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