Tuberculosis (TB) disproportionally affects hard-to-reach populations,, such as the homeless, migrants, refugees, prisoners, substance misuers, people living with HIV. These people face important challenges in accessing and receiving quality health care services. To identify barriers to, and facilitators for, the uptake of TB diagnosis and treatment services by people from those hard-to-reach populations we performed a systematic reviewed of the qualitative literature following PRISMA guidelines, . Twelve studies were included in this review; most focussed on migrants. Views on perceived susceptibility to and severity of TB varied widely and included misconceptions. Stigma and challenges with accessing health care were identified as barriers for TB diagnosis and treatment uptake whereas nurse, family, and friends' support were facilitators to treatment compliance. Addressing barriers and facilitators may improve identification of potential TB cases and treatment in hard-to-reach populations. PROSPERO registration number: CRD420150194503

A wide variety of data was identified. Prevalence rates vary throughout the continent and more research, especially in humans, is needed to reliably gauge the extent of the problem. Preventive measures need to be reconsidered to control outbreaks in the future.

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.