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.

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China

“…Within prefecture 4871 (66.9) 16(7,32) 2(0,5) 0(0,0) 21(11,38) 2(0,5) 21 (11,38) Within province 557 (7.6) 19(5,53) 1(0,4) 0(0,0) 26(10,60) 1(0,5) 26 (10,62) Out of province 1856 (25.5) 15(3,37) 1(0,6) 0(0,0) 22(9,48) 1(0,7) 22 (9,49) Few dates missing for some patients, hence total assessed for each type of delay may not be 7284 TB tuberculosis, PTB pulmonary tuberculosis, IQR interquartile range a registered in web-based TB information management system delay is shown in Table 3. Female gender (β = 0.11, p = 0.003), and patients with sputum smear positive pulmonary TB (β = 0.33, p < 0.001) were independent predictors for longer delay.…”

“…The median (IQR) diagnosis delay was 21 (10,40) days. Final model for independent predictors for diagnosis delay is shown in Table 7.…”

“…Globally, time delays and factors associated with delays among TB patients (among migrants or local residents) has been studied extensively [9][10][11][12][13]. Migrants have many specific characteristics such as instability, low income, poor living, and working condition which could obviously influence on their health seeking behavior and cause longer delay than general population [5,[14][15][16][17][18].…”

Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: A nonrandomized controlled trial

“…Both were nurse‐led actions that addressed the independent risk factors for nonadherence that had been identified in the retrospective phase of our study (being born abroad, the existence of a language barrier and the development of toxicity) (Guix‐Comellas et al., ). Immigration‐associated cultural and social problems have been previously identified as major risk factors for nonadherence (Abubakar et al., ; Anderson et al., ; Basterrechea, Sancho, Idígoras, & Temprano, ; de Vries et al., ; Heuvelings et al., ; Klinkenberg, Manissero, Semenza, & Verver, ; Mulder, Klinkenberg, & Manissero, ; Pang et al., ; Saunders & Evans, ; Zenner et al., ). Surprisingly, specific interventions aimed to overcome these barriers have scarcely been reported in the scientific literature (Ailinger et al., ).…”

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

“…Na cidade de São Paulo foram identificados hotspots de pessoas vivendo nas ruas centrais e em áreas com grande circulação de pessoas, vasto comércio e disponibilidade de serviços sócio assistenciais (ALBUQUERQUE, 2017).Acresce-se que, nesta pesquisa, alguns casos de óbitos por TB foram incluídos nas análises tendo como endereço de residência um Abrigo Social de Pernoite no cenário de estudo. Pessoas sem moradia ou moradores de rua fazem parte de um grupo de maior vulnerabilidade em saúde, que geralmente estão associados com outros problemas sociais e de saúde, como consumo de álcool e drogas, violência e outras comorbidades, vivendo por vezes em habitações improvisadas e em condições insalubres (KATZ, 2017); são, portanto, mais propensos a adoecer por TB e considerados prioridade para o controle da doença(HEUVELINGS et al, 2017) ATKINSON et al, 2005)…”