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NewslettersReaching the End TB Goals: The Role of Strong Diagnostic Networks

Reaching the End TB Goals: The Role of Strong Diagnostic Networks

Estimated number of people who developed MDR/RR-TB

Each year on March 24th, World TB Day serves as an important reminder that tuberculosis (TB) remains a significant public health challenge. Despite being an ancient disease, TB continues to affect 10 million people annually, with South-East Asia and Africa accounting for nearly 70% of global cases. Alarmingly, an estimated 2 million people with TB go undiagnosed or untreated each year, and only 44% of the estimated 400,000 individuals with drug-resistant TB are diagnosed and treated. Access to diagnosis, a central pillar of the End TB Strategy, remains one of the biggest barriers in the fight against TB.

Estimated number of people who developed MDR/RR-TB (incident cases) in 2023, for countries with at least 1000 incident cases

For years, sputum smear microscopy has been the go-to diagnostic method for TB, despite its low sensitivity, especially for people with HIV. When the World Health Organization (WHO) first endorsed a rapid molecular test that could detect TB and rifampicin resistance within 90 minutes, it raised hopes for a breakthrough in TB diagnosis. Additional recommendations for rapid molecular tests provided options for faster and more reliable detection of TB and drug-resistant TB. However, access to these WHO-recommended rapid diagnostics (WRDs) remains limited. Currently, just over 20% of national TB testing sites have WRDs available on-site or through referral. As a result, only 48% of people diagnosed with TB are initially tested with a WRD.

This limited access to rapid diagnostics has significant consequences. Rifampicin-resistant TB has recently been classified as a critical pathogen, and drug-resistant TB is a major driver of antimicrobial resistance (AMR) deaths. Without universal access to testing, drug-resistant TB will continue to pose a serious threat to both TB control and global health security. Expanding access to WRDs at all levels of the health system is essential to ensuring early diagnosis, timely treatment, and better patient outcomes.

While challenges remain, progress is evident. Several African countries have prioritized increasing access to WRDs, and three of them are on track to meet the End TB Strategy’s incidence target, while six are on track to meet the mortality target. Furthermore, the research and development pipeline is showing promise, offering renewed hope for ending TB. Non-sputum-based tests could increase access and early detection in children, and a new TB vaccine may be available within the next five years.

Overview of the progress towards reaching Global UN targets to end TB

However, these innovations will be meaningless unless existing tools are fully scaled up. Every person with TB must be diagnosed and treated without delay.

The key to ending TB is in our hands. To make this a reality, we call on policymakers to:

  • Commit to sustainable funding to strengthen primary health care
  • Invest in laboratory infrastructure and new diagnostic technologies
  • Deliver on the promise of universal, equitable access to diagnosis, treatment, and care for all people with TB
infographic of Drug Resistant Tuberculosis (TB)

At the African Society for Laboratory Medicine, we are working with national programs to accelerate uptake, access and use of innovative TB diagnostics and improve patient outcomes by:

  • Supporting the implementation of WHO diagnostic standard – We help countries measure their progress by creating scorecards to track key targets and conducting in-country reviews to guide improvements.
  • Strengthening laboratory systems – We assist national programs to develop national laboratory strategic plans and national essential diagnostic lists, ensuring that rapid TB tests are prioritized and that lab networks align with End TB goals.
  • Optimizing diagnostic networks – Through lab mapping and network optimization, we help ensure that rapid molecular tests are placed where they are needed most, improving timely diagnosis and treatment.
  • Enhancing data-driven decision making – We work with countries to maintain updated master facility and equipment lists, enabling better planning, procurement and integration of new technologies to strengthen TB diagnostic services.
  • Fostering knowledge-sharing – We facilitate collaborations and south-south learning, enabling the identification and sharing of best practices to scale up rapid TB testing, and engagement of the private sector to strengthen diagnostic networks.

By working together, we can ensure that every patient has timely access to diagnosis. Ending TB is possible – but only if we act now.