Effectiveness of interventions aiming at identifying and managing tuberculosis among hard-to-reach populations: A systematic review
Tuberculosis (TB) is over-represented in hard-to-reach (under-served) populations in high income, low TB incidence countries. The mainstay of TB care is reliant on early detection of active TB patients (case finding), contact tracing and treatment completion. We performed a systematic review of interventions with a scoping component of relevant studies published between 1990-2015 to update and extend previous NICE reviews on the effectiveness of interventions aimed at identifying and managing TB in hard-to-reach populations. We identified an additional 19 studies to the 26 studies included in the NICE reviews. The analyses showed that TB screening by (mobile) chest X-ray improved screening coverage and TB identification, reduced diagnostic delay and was cost-effective among several hard-to-reach populations. Sputum culture in pre-migration screening and active referral to a TB clinic improved identification rates. Monetary incentives improved TB 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 due to heterogeneity of evidence with regard to study population, methodology, and quality.