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Revitalizing decentralized tuberculosis diagnosis in primary laboratories: post-COVID-19 challenges and strategic innovations Cover

Revitalizing decentralized tuberculosis diagnosis in primary laboratories: post-COVID-19 challenges and strategic innovations

Postępy Higieny i Medycyny Doświadczalnej
Volume 79 (2025): Issue 1 (January 2025)
By: Xiaodong Liu,  Qingjun Jia and  Cai Hu  
Open Access
|Sep 2025

Figures & Tables

Figure 1.

Six-Domain Challenges in Decentralized TB Diagnostic ImplementationNote: The implementation of decentralized tuberculosis (TB) diagnostic testing is hindered by interconnected challenges spanning six critical domains (A–F): A. Quality Assurance: Requires regular proficiency testing, external quality assurance, and instrument/equipment calibration to ensure diagnostic accuracy [13,25,35]; B. Human Resources: Includes shortages of trained personnel, limited career development opportunities, and difficulties in retaining staff [14,24]; C. Infrastructure and Logistics: Encompasses inadequate infrastructure, sample transportation difficulties, and operational logistics challenges [1,7]; D. Financial Sustainability: Entails high initial setup costs, gaps in ongoing operational funding, and long-term sustainability concerns [19,23]; E. Community Engagement: Involves trust-building barriers, insufficient community advocacy, and concerns regarding test accuracy [16,18]; F. Socio-Cultural Barriers: Encompasses social stigma, low health literacy, and cultural misconceptions that limit service uptake [18,24,29]
Six-Domain Challenges in Decentralized TB Diagnostic ImplementationNote: The implementation of decentralized tuberculosis (TB) diagnostic testing is hindered by interconnected challenges spanning six critical domains (A–F): A. Quality Assurance: Requires regular proficiency testing, external quality assurance, and instrument/equipment calibration to ensure diagnostic accuracy [13,25,35]; B. Human Resources: Includes shortages of trained personnel, limited career development opportunities, and difficulties in retaining staff [14,24]; C. Infrastructure and Logistics: Encompasses inadequate infrastructure, sample transportation difficulties, and operational logistics challenges [1,7]; D. Financial Sustainability: Entails high initial setup costs, gaps in ongoing operational funding, and long-term sustainability concerns [19,23]; E. Community Engagement: Involves trust-building barriers, insufficient community advocacy, and concerns regarding test accuracy [16,18]; F. Socio-Cultural Barriers: Encompasses social stigma, low health literacy, and cultural misconceptions that limit service uptake [18,24,29]

Figure 2.

Strategic enablers of decentralized TB diagnostics in the post-pandemic context. Six domains are facilitating the transition from centralized to decentralized TB diagnostic models: enhanced laboratory infrastructure, digital connectivity, artificial intelligence, portable molecular platforms, miniaturized automation, and policy-driven diagnostic networks. These enablers work synergistically to promote accessibility, accuracy, and sustainability in TB testingAbbreviations: EHRs: Electronic Health Records; LIS: Laboratory Information Systems; AI: Artificial Intelligence; LAMP: Loop-mediated Isothermal Amplification; NTEP: National Tuberculosis Elimination Program
Strategic enablers of decentralized TB diagnostics in the post-pandemic context. Six domains are facilitating the transition from centralized to decentralized TB diagnostic models: enhanced laboratory infrastructure, digital connectivity, artificial intelligence, portable molecular platforms, miniaturized automation, and policy-driven diagnostic networks. These enablers work synergistically to promote accessibility, accuracy, and sustainability in TB testingAbbreviations: EHRs: Electronic Health Records; LIS: Laboratory Information Systems; AI: Artificial Intelligence; LAMP: Loop-mediated Isothermal Amplification; NTEP: National Tuberculosis Elimination Program

Policy and Action Matrix for Decentralized TB Diagnostic Implementation

Future DirectionPolicy FocusImplementation Level
Institutionalization in NTPsHealth PolicyNational
Regulatory & Quality FrameworksRegulation & StandardsNational
Sustainable FinancingHealth EconomicsNational/International
Capacity Building for WorkforceHuman ResourcesRegional/National
Integration of Digital & AI ToolsDigital HealthNational/Facility
Community-Centered ModelsPublic EngagementLocal/Community
Global CollaborationGlobal HealthRegional/Global
Evidence quality and researchPromote high-quality RCTs, prospective studiesNational/International
Patient-centered designIncorporate patient feedback and satisfaction measuresLocal/Community
Regional adaptationTailor strategies to local contextNational/Regional

Comparative Features of Centralized vs_ Decentralized Tuberculosis (TB) Diagnostic Models

DimensionCentralized TestingDecentralized Testing
Test LocationNational or regional central laboratoriesPrimary care settings or point-of-care (POC) sites
Turnaround TimeDays to weeksMinutes to hours
InfrastructureHigh-complexity set-up with biosafety and cold chainLow-resource adaptable, portable platforms
Sample LogisticsRequires long-distance transport, cold chainOn-site testing, minimal logistics
Human ResourcesRequires highly-trained laboratory specialistsOperable by general health workers with minimal training
Diagnostic AccessLimited in rural and remote areasHigh accessibility across decentralized regions
Operational CostHigh fixed and variable costsLower marginal cost after implementation
ScalabilityLimited by central lab capacityHighly scalable across diverse health system levels
Patient PerspectiveIndirect; limited engagementHigher satisfaction, reduced travel costs, better adherence
Socio-cultural adaptabilityLow (standardized protocols, limited cultural tailoring)High (adaptable to local context, community involvement)
DOI: https://doi.org/10.2478/ahem-2025-0017 | Journal eISSN: 1732-2693
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Language: English
Page range: 127 - 134
Submitted on: Apr 22, 2025
|
Accepted on: Jul 22, 2025
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Published on: Sep 18, 2025
Published by: Hirszfeld Institute of Immunology and Experimental Therapy
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
tuberculosis,
decentralized testing,
point-of-care,
diagnostic capacity,
COVID-19
Related subjects:
Life sciences,
Molecular biology,
Microbiology and virology,
Medicine,
Basic medical science,
Immunology

© 2025 Xiaodong Liu, Qingjun Jia, Cai Hu, published by Hirszfeld Institute of Immunology and Experimental Therapy
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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