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Barriers and Enablers to Implementing TB Control Strategies in EU and EEA Countries: A Systematic Review

Background: Meeting the 2035 WHO targets of reducing TB incidence by 90% requires the implementation of country-specific TB control strategies. This systematic review aims to identify factors which facilitate or impede the implementation of such strategies in EU/EEA settings. Focusing on providers of care, health system constraints and social and political factors, this review complements available evidence on the accessibility of TB services to recipients of care. 
 
Methods: We included publications that analysed empirical data on TB policies, strategies, guidelines or interventions. Databases were searched for papers published in EU/EEA countries between January 1997 and May 2017. Relevant phrases were coded and analysed using descriptive, thematic and network plot techniques. 
 
Findings: Of the 1,471 papers screened, 49 were included. The most common barrier to TB control strategies described the divergence of healthcare practices from guidelines. This often related to limited knowledge or perceived usefulness of the guideline by clinicians. Lack of appropriate human resources was another common barrier. The most commonly identified enabler to TB control strategies was the documented positive attitudes of healthcare workers towards TB programmes. 
 
Interpretation: Divergence between clinical practice and guidelines was described in most EU/EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of TB control strategies analysed. 
 
Funding Statement: This study is part of the E-DETECT TB project (ref. 709624) which has received funding from the European Union’s Health Programme (2014-2020). PROSPERO (CRD42017060100). 
 
Declaration of Interests: We declare no competing interests.