Barriers and facilitators for the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in low- and medium-incidence countries: A systematic review of qualitative literature
Tuberculosis (TB) disproportionally affects hard-to-reach populations such as people who are homeless, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality healthcare services. To identify barriers to, and facilitators for, the uptake of TB diagnostic and treatment services by people from hard-to-reach populations in all EU, EEA, EU candidate, and OECD countries, we performed a systematic review of the qualitative literature, following PRISMA guidelines. The twelve studies included in this review focused mostly on migrants. Views on perceived susceptibility to and severity of TB varied widely and included many misconceptions. Stigma and challenges with accessing healthcare were identified as barriers for TB diagnosis and treatment uptake, whereas nurse, family, and friends’ support were facilitators to treatment adherence. Further studies are required to identify barriers and facilitators for improved identification and management of TB cases in hard-to-reach populations in order to inform recommendations for more effective TB control programs.