This guidance aims to improve the way tuberculosis (TB) among hard-to-reach groups is identified and managed. It is for commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups.

The main groups considered were:
• people who are homeless
• substance misusers
• prisoners
• vulnerable migrants.

The recommendations cover:
• strategic oversight and commissioning of TB prevention and control activities
• raising and sustaining awareness of TB among health professionals and those working with hard-to-reach groups – and among the hard-to-reach groups themselves
• local needs assessment
• cohort review
• commissioning multidisciplinary TB support
• identifying and managing TB (including contact investigations)
• rapid-access TB services and enhanced case management
• the provision of accommodation during treatment.