Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Lancet Infect Dis. 2017 May;17(5):e128-e143. doi: 10.1016/S1473-3099(16)30531-X. Epub 2017 Mar 11.
Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.
结核病在难以接触到的人群中发病率更高，例如无家可归者、移民、难民、囚犯或吸毒者。这些人往往在获得高质量医疗保健方面面临挑战。我们对定性文献进行了系统回顾，以确定来自欧盟所有成员国、欧洲经济区成员国、欧盟候选国和经济合作与发展组织国家的难以接触到的人群接受结核病诊断和治疗服务的障碍和促进因素。本综述包括的 12 项研究主要关注移民。对结核病易感性和严重程度的看法差异很大，包括许多误解。获得医疗保健方面的耻辱感和挑战被确定为结核病诊断和治疗的障碍，而护士、家人和朋友的支持是治疗依从性的促进因素。需要进一步研究，以确定在难以接触到的人群中改善结核病识别和管理的障碍和促进因素，为更有效的结核病控制规划提供建议。
