Tuberculosis (TB) remains a major public health challenge and a leading cause of death by an infectious disease. The World Health Organization (WHO) has set targets to reduce TB deaths by 90% and to cut new TB cases by 80% between 2015 and 2030 as part of the United Nations Sustainable Development Goals. Despite advances in developing rapid molecular diagnostic technology over the last decade, only 47% of the 7.5 million cases notified in 2022 received a WHO-recommended rapid diagnostic (WRD) test as an initial test. Rapid molecular testing for TB remains out of reach in many high TB-burden areas, especially at the lower tier of the healthcare pyramid, mostly due to lack of testing capacity, human resource expertise and access to electrical power for the few available devices.

The Truenat® MTB-RIF Dx TB testing system (Molbio Diagnostics, Goa, India) is a chip-based, rapid molecular test for detection of TB and rifampicin resistance. The test is conducted on a portable system, consisting of a Trueprep® device (Molbio Diagnostics, Goa, India) for DNA extraction and a Truelab® PCR analyzer (Molbio Diagnostics, Goa, India). This system is designed to withstand high temperatures and can operate independently for up to eight hours on its power supply. The Truenat system provides an opportunity to expand access to rapid molecular testing for TB in decentralized settings. 

In this recipe, we highlight key considerations and best practices from the five countries that have implemented the Truenat system as a case scenario that can inform the broader and decentralized use of molecular diagnostic tools for TB across the continent.