Universal access to rapid tuberculosis diagnostics

Publication Year 28 Aug 2023

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EXECUTIVE SUMMARY

The 2018 United Nations High-level Meeting set the target of treating at least 40 million people with tuberculosis (TB) between 2018 and 2022; however, only 66% of that target had been attained by 2021. Diagnostic tests are central to meeting the goal, but they are a weak link in the continuum of care. The World Health Organization (WHO)-recommended rapid diagnostics (WRDs) are highly accurate, reduce the time to treatment initiation, impact patient-important outcomes, and are cost-effective. Although the goal is for all notified patients to be tested initially with a WRD by 2025, in 2021, only 38% were tested with a WRD as an initial test, and access to diagnostics was identified as a critical issue. A major consequence of the insufficient use of WRDs is the large gap in the detection of drug resistance.
This WHO standard: universal access to rapid tuberculosis diagnostics is based on the WHO guidelines and the operational handbook. The objectives of the standard are to improve access to and use of WRDs as the initial test for individuals with presumptive TB identified through active and passive case finding, to increase detection of bacteriologically confirmed cases and drug resistance, and to reduce the time to diagnosis. The standard comprises 12 benchmarks to be computed by countries in the four steps of the diagnostic cascade: identifying presumptive TB, accessing testing, being tested, and receiving a diagnosis.
Mapping of enablers, approaches and solutions to scaling up use of WRDs is provided to assist countries in meeting the standard. In addition, two country case studies that provide real-world examples of implementation and specific considerations for investment in scaling up TB diagnostics are included. Universal access to TB diagnostics will result in better health for all and reduce the unacceptably high mortality rate due to this curable and preventable disease. This will require investment and concerted work by countries, partners, donors and civil society.