New tools and policies herald a major advance in tuberculosis diagnosis

For decades, tuberculosis (TB) care has relied heavily on sputum samples and smear microscopy, making diagnosis the weakest part of the TB cascade of care. [1][2]2][3] In adults, an estimated quarter of people with presumptive TB are unable to provide sputum samples, and the limitations of microscopy, especially low sensitivity, are well known. 4,5cognising this, in 2023, World Health Organization (WHO) published a new standard for universal access to rapid tuberculosis diagnostics, which recommends that: (i) facilities in all districts require the use of a WHO-recommended rapid diagnostic (WRD) as the initial diagnostic test for all individuals with presumed TB, (ii) all primary healthcare facilities have access to WRDs, (iii) all individuals with presumptive TB receive initial WRD testing, and (iv) that all clinicians have access to WRD test results to guide patient management. 6