title: Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review.
abstract: Tuberculosis is over-represented in hard-to-reach (underserved) populations in high-income countries of low tuberculosis incidence. The mainstay of tuberculosis care is early detection of active tuberculosis (case finding), contact tracing, and treatment completion. We did a systematic review with a scoping component of relevant studies published between 1990 and 2015 to update and extend previous National Institute for Health and Care Excellence (NICE) reviews on the effectiveness of interventions for identifying and managing tuberculosis in hard-to-reach populations. The analyses showed that tuberculosis screening by (mobile) chest radiography improved screening coverage and tuberculosis identification, reduced diagnostic delay, and was cost-effective among several hard-to-reach populations. Sputum culture for pre-migration screening and active referral to a tuberculosis clinic improved identification. Furthermore, monetary incentives improved tuberculosis identification and management among drug users and homeless people. Enhanced case management, good cooperation between services, and directly observed therapy improved treatment outcome and compliance. Strong conclusions cannot be drawn because of the heterogeneity of evidence with regard to study population, methodology, and quality.
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: 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: 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: 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: 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.
authors.forename: Andreas
authors.initials: A
authors.lastname: Sandgren
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: 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: D003362:Cost-Benefit Analysis; D055030:Drug Users / Q000523:psychology; D014943:Global Health; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D009042:Motivation; D014171:Transients and Migrants / Q000523:psychology; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*