[Tuberculosis control in homeless persons in European Union: more than words alone].

In Europe, in countries with a low incidence of tuberculosis (TB), disease is concentrated in certain subgroups of the metropolitan population, often socially excluded, such as homeless persons, illicit drug users and alcohol addicts, street dwellers with psychiatric comorbidities and ex-prisoners. The prevention and control of TB among these risk groups is complicated by delayed diagnosis, onward transmission and poor treatment adherence leading to the development of drug resistant forms of TB. In 2008, ECDC (European Center for Disease Control) published a Framework Action plan to fight TB in European Union (EU), which recognises the concentration of TB in "hard to find" and "hard to treat" populations as a major challenge to TB control efforts across the EU and encourages EU institutions in collaboration with partners to identify and disseminate good practice models in TB control. As an example, the DutchTB control model is described, based on close collaboration between hospitals, municipal public health TB clinics and complemented by two tertiary in-patient TB treatment centres. There is an urgent need to develop the knowledge base on optimal strategies for effective early diagnosis and completion of treatment of "hard to reach" groups and more EU supported collaboration of partner organisations across member states is needed to provide leadership and strategic direction, the evidence to inform policy and practice, and advocacy and support for those most at risk from TB today.