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  • Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

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Public health
Research
Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review
  1. Charlotte C Heuvelings1,
  2. Patrick F Greve1,
  3. Sophia G de Vries1,
  4. Benjamin Jelle Visser1,
  5. Sabine Bélard1,
  6. Saskia Janssen1,
  7. Anne L Cremers1,
  8. René Spijker2,
  9. Elizabeth Shaw3,
  10. Ruaraidh A Hill4,
  11. Alimuddin Zumla5,
  12. Andreas Sandgren6,
  13. Marieke J van der Werf6,
  14. Martin Peter Grobusch1
  1. 1 Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  3. 3 National Institute for Health and Care Excellence, Manchester, UK
  4. 4 Liverpool Reviews and Implementation Group, Health Services Research, University of Liverpool, Liverpool, UK
  5. 5 Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre at UCL Hospitals, London, UK
  6. 6 European Centre for Disease Prevention and Control, Stockholm, Sweden
  1. Correspondence to Dr Marieke J van der Werf; marieke.vanderwerf{at}ecdc.europa.eu

Abstract

Objective To determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations.

Design Embase and MEDLINE (1990–2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed.

Setting European Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries.

Participants Hard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations.

Primary and secondary outcome measures Effectiveness and cost-effectiveness of the interventions.

Results From the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community.

Conclusions Although evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems.

PROSPERO registration number CRD42015017865.

  • tuberculosis
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2017-019642

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    Footnotes

    • Contributors CCH: created the protocol, performed study selection, collected the data, performed quality/risk of bias assessment, synthesised the data, interpreted the data and created the manuscript and supplementary files. PFG: performed the study selection, collected the data, performed quality/risk of bias assessment, synthesised the data, involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. SGdV: created the protocol, performed study selection, involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. BJV: created the protocol, involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. SB, SJ, ALC and AS: involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. RS: conducted the literature search, involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. ES and RAH: expert input especially on the interpretation of the NICE findings, involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. AZ: expert input, involved in interpretation of the data and contributed to and endorsed the final version of the manuscript. MJvdW: involved in the study design, data interpretation and contributed to and endorsed the final version of the manuscript. MPG: is the guarantor of this review, supervised every step in the process, commented and provided input at every stage of the review process, was involved in creating the protocol, interpretation of the data and contributed to and endorsed the final version of the manuscript.

    • Funding This study was funded by the European Centre for Disease Prevention and Control (contract reference OJ/02/05/2014-PROC/2014/014). None of the authors have received payment from a pharmaceutical company or other agency to write this article.

    • Disclaimer The funder of the study was involved in study design, data interpretation, and reporting. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.

    • Competing interests MPG reports grants from ECDC, for the conduct of part of the study. ES reports that NICE—her employing organisation—has published guidance in this area.

    • Patient consent Not required.

    • Ethics approval Ethics approval was not required for this systematic review.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data extraction forms and quality assessment forms are available from supplementary files V and VI.