Implementing molecular tuberculosis diagnostic methods in limited-resource and high-burden countries.

Area of Science:

• Medical Diagnostics
• Infectious Diseases
• Public Health

Background:

• Tuberculosis (TB) remains a leading cause of death globally, with over a million fatalities annually.
• The World Health Organization's End TB Strategy prioritizes early diagnosis and universal drug-susceptibility testing (DST) using molecular WHO-recommended rapid diagnostic tests (mWRDs).
• Current sequencing-based mWRDs face implementation barriers in low-income countries due to infrastructure, cost, and expertise requirements.

Purpose of the Study:

• To identify challenges in implementing advanced TB diagnostic technologies in resource-limited settings.
• To propose practical solutions for overcoming these barriers and improving TB diagnosis.
• To support the World Health Organization's goals for early TB diagnosis and DST.

Main Methods:

• Review of current molecular WHO-recommended rapid diagnostic tests (mWRDs) for TB.
• Analysis of implementation constraints for sequencing-based mWRDs in low-income countries.
• Proposal of adaptive strategies for infrastructure, cost, capacity building, and resource utilization.

Main Results:

• Sequencing-based mWRDs, while effective, are hindered by high costs, specialized skill needs, and infrastructure limitations in resource-limited settings.
• Existing diagnostic methods may not meet the growing need for rapid and accurate TB detection and DST.
• Proposed solutions focus on adapting infrastructure, reducing costs, building local capacity, and leveraging open-access resources.

Conclusions:

• Innovative and accessible TB diagnostic technologies are essential for high-burden, low-income countries.
• Addressing implementation challenges requires a multi-faceted approach involving infrastructure adaptation, cost reduction, and capacity building.
• Increased use of open-access resources can facilitate the adoption of advanced TB diagnostics globally.