TY - JOUR T1 - Achieving universal access to rapid tuberculosis diagnostics JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2023-012666 VL - 8 IS - 5 SP - e012666 AU - Nazir Ismail AU - Carl-Michael Nathanson AU - Matteo Zignol AU - Tereza Kasaeva Y1 - 2023/05/01 UR - http://gh.bmj.com/content/8/5/e012666.abstract N2 - Tuberculosis (TB) is one of the leading causes of death globally from a single infectious agent, despite being a preventable and curable disease.1 A significant concern is the large number of people estimated to have TB who are currently not diagnosed or reported, which further increased during the COVID-19 pandemic from approximately 3–4 million in 2020 and only showed a partial recovery in 2021.1The first WHO-recommended rapid diagnostic (WRD), endorsed by WHO in 2010, revolutionised the diagnosis of TB. It was simple to perform, produced results in under 2 hours and could detect resistance to rifampicin, one of the most potent drugs to treat TB. Over the years, evidence has shown WRDs are highly accurate, reduce time to treatment initiation, impact patient-important outcomes and are cost-effective.2 In the past decade, WHO has endorsed several WRDs, including products suited to different contexts.2The WHO End TB Strategy adopted by all countries calls for all people with TB to be diagnosed with a WRD as an initial test by 2025.3 However, in 2021, only 38% of people with TB were tested with a WRD as an initial test,1 while only 25% of all TB diagnostic testing sites had access to WRDs.4 Lack of access and insufficient use of WRDs contribute to the large gap in the detection of TB and drug resistance. Most people with TB still undergo a smear microscopy test as the initial TB test or do not receive any bacteriological diagnosis. Smear microscopy has several limitations, the most notable being very low sensitivity and inability to detect drug resistance. Furthermore, patient pathway analyses and work on diagnostic cascades highlight the importance of a holistic and decentralised approach to improve timely access to WRDs at the primary healthcare level, where … ER -