Access and adherence to prevention and care for hard-to-reach groups

In this chapter, we discuss two key concepts of TB prevention and care: access and adherence. We discuss these in the context of “hard-to-reach” groups, defined as groups of people who are under-represented or underserved. By definition, these groups may experience particular difficulties in accessing TB care (including preventative, diagnostic and care services) and remaining in care once it has been accessed. As TB often affects hard-to-reach groups, healthcare services should be designed with such groups in mind, aiming for equitable and affordable access to people-centred TB care. We also describe barriers to healthcare access and adherence, and provide some solutions to overcoming these barriers, based on current evidence. Ensuring that access and adherence are addressed, with the most disadvantaged groups in mind, is a necessary step towards achieving the ambitious goals of the WHO End TB Strategy and SDGs, which aim to eliminate TB by 2030.