TB challenges in hard-to-reach populations and children Addressing TB control in Europe & imaging paediatric TB in Africa

In the first part of this thesis we discuss methods for TB identification and management of hard-to-reach populations (migrants, homeless people, drug users and sex workers) in low-incidence settings, like the European Union. We found that stigma and access to health care are the main barriers for TB services uptake. In the contrary, chest X-ray (CXR) screening by mobile clinic, active referral and involvement of community health workers improve TB identification and treatment completion.
In the second part we focus on chest ultrasound as a diagnostic tool for pulmonary tuberculosis in children and other respiratory diseases. We found that the occurrence of pleural effusion on chest ultrasound, in an older child in a TB-endemic setting, is associated with confirmed pulmonary TB. Additionally, we found that consolidations resolve less quickly in children with confirmed TB compared to children with other respiratory diseases and that enlarged mediastinal lymph nodes were larger in children with confirmed TB. We compared chest ultrasound with CXR and found that chest ultrasound picks up abnormal findings more often than CXR and has a higher interreader agreement. Additionally we showed that chest ultrasound has a high diagnostic accuracy in diagnosing childhood pneumonia and could be a useful tool for the diagnosis of other respiratory diseases in children.
Chest ultrasound is a promising tool to diagnose pulmonary TB, and in settings were other imaging techniques are lacking, chest ultrasound should be considered for the diagnosis of pulmonary TB and other respiratory diseases.