title: 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.
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.
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Sophia G
authors.initials: SG
authors.lastname: de Vries
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Cremers
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Heuvelings
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Greve
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Visser
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bélard
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Spijker
authors.affiliation: National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Shaw
authors.affiliation: National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK; Health Services Research, University of Liverpool, Liverpool, UK.
authors.forename: Ruaraidh A
authors.initials: RA
authors.lastname: Hill
authors.affiliation: Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden. Electronic address: marieke.vanderwerf@ecdc.europa.eu.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Sandgren
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D005062:European Union; D005190:Family / Q000523:psychology; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D009656:North America; D036301:Qualitative Research; D057545:Social Stigma; D014171:Transients and Migrants / Q000523:psychology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*