Have a personal or library account? Click to login
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

By: Xiaodong Liu,  Qingjun Jia and  Cai Hu  
Open Access
|Sep 2025

References

  1. Morino G, Mulongo CM, Cattaneo P, De Vita MV, Paone G, Scarlata S, Gobbi F, Kinyita S, Odhiambo H. Finding the missing many: improving tuberculosis care in Kajiado county through active case finding and community approaches. BMC Public Health. 2024; 24: 144.
  2. Xia J, Liu Y, Ma Y, Yang F, Ruan Y, Xu JF, Pi J. Advances of long non-coding RNAs as potential biomarkers for tuberculosis: new hope for diagnosis? Pharmaceutics. 2023; 15: 2096.
  3. Dippenaar A, Derendinger B, Dolby T, Beylis N, van Helden PD, Theron G, Warren RM, de Vos M. Diagnostic accuracy of the FluoroType MTB and MTBDR VER 2.0 assays for the centralized high-throughput detection of Mycobacterium tuberculosis complex DNA and isoniazid and rifampicin resistance. Clin Microbiol Infect. 2021; 27: 1351e1–e4.
  4. Scheffer MC, Prim RI, Wildner LM, Medeiros TF, Maurici R, Kupek E, Bazzo ML. Performance of centralized versus decentralized tuberculosis treatment services in Southern Brazil, 2006–2015. BMC Public Health. 2018; 18: 554.
  5. Rabodoarivelo MS, Brandao A, Cergole Novella MC, AG CB, Imperiale B, Rakotosamimanana N, Morcillo N, Rasolofo V, Palomino JC, Martin A. Detection of multidrug-resistant tuberculosis from stored DNA Samples: A multicenter study. Int J Mycobacteriol. 2018; 7: 40–4.
  6. Asandem DA, Asante-Poku A, Asare P, Aboagye SY, Stephen OW, Danso E, Klevor PM, Hayibor KM, Yeboah-Manu D. OMNIgene SPUTUM: A good transport and decontaminating reagent for tuberculosis testing. Int J Mycobacteriol. 2018; 7: 222–7.
  7. Lemaire JF, Cohn J, Kakayeva S, Tchounga B, Ekouevi PF, Ilunga VK, Ochieng Yara D, Lanje S, Bhamu Y, Haule L, et al. Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: a before-and-after study in Nine Sub-Saharan African Countries. PLOS Glob. Public Health. 2024; 4: e0002865.
  8. Cattamanchi A, Reza TF, Nalugwa T, Adams K, Nantale M, Oyuku D, Nabwire S, Babirye D, Turyahabwe S, Tucker A, et al. Multicomponent Strategy with decentralized molecular testing for tuberculosis. N Engl J Med. 2021; 385: 2441–50.
  9. Ma H, Zhu J, Liu J, Zhang X, Liu Y, Yang Q. Hospital biosecurity capacitation: Analysis and recommendations for the prevention and control of COVID-19. J Biosaf Biosecur. 2020; 2: 5–9.
  10. Meredith LW, Aboualy M, Ochola R, Ozel M, Abubakar A, Barakat A. A phased strengthening of laboratory capacity in the Eastern Mediterranean Region during the COVID-19 pandemic. Influenza Other Respir Viruses. 2024; 18: e13225.
  11. Dai C, Xiong H, He R, Zhu C, Li P, Guo M, Gou J, Mei M, Kong D, Li Q, et al. Electro-Optical multiclassification platform for minimizing occasional inaccuracy in point-of-care biomarker detection. Adv Mater. 2024; 36: e2312540.
  12. Wang Z, Sun H, Ren Z, Xue B, Lu J, Zhang H. Feasibility and performance of loop-mediated isothermal amplification assay in the diagnosis of pulmonary tuberculosis in decentralized settings in Eastern China. Biomed Res Int. 2019; 2019: 6845756.
  13. Getahun DA, Layland LE, Hoerauf A, Wondale B. Impact of the use of GeneXpert on TB diagnosis and anti-TB treatment outcome at health facilities in Addis Ababa, Ethiopia in the post-millennium development years. PLoS One. 2023; 18: e0289917.
  14. Molla Y, Jerene D, Jemal I, Nigussie G, Kebede T, Kassie Y, Hiruy N, Aschale G, Habte D, Gashu Z, et al. The experience of scaling up a decentralized, ambulatory model of care for management of multidrug-resistant tuberculosis in two regions of Ethiopia. J Clin Tuberc Other Mycobact Dis. 2017; 7: 28–33.
  15. Sohn H, Kasaie P, Kendall E, Gomez GB, Vassall A, Pai M, Dowdy D. Informing decision-making for universal access to quality tuberculosis diagnosis in India: an economic-epidemiological model. BMC Med. 2019; 17: 155.
  16. Hassane-Harouna S, Gils T, Decroo T, Ortuno-Gutierrez N, Delamou A, Cherif GF, Camara LM, Rigouts L, de Jong BC. Community-supported self-administered tuberculosis treatment combined with active tuberculosis screening: a pilot experience in Conakry, Guinea. Glob Health Action. 2023; 16: 2262134.
  17. du Preez K, Gabardo BMA, Kabra SK, Triasih R, Lestari T, Kal M, Tsogt B, Dorj G, Purev E, Nguyen TA, et al. Priority activities in child and adolescent tuberculosis to close the policy-practice gap in low- and middle-income countries. Pathogens. 2022; 11: 196.
  18. Questa K, Das M, King R, Everitt M, Rassi C, Cartwright C, Ferdous T, Barua D, Putnis N, Snell AC, et al. Community engagement interventions for communicable disease control in low- and lower-middle-income countries: evidence from a review of systematic reviews. Int J Equity Health. 2020; 19: 51.
  19. Naidoo K, Perumal R, Ngema SL, Shunmugam L, Somboro AM. Rapid diagnosis of drug-resistant tuberculosis – opportunities and challenges. Pathogens. 2023; 13: 27.
  20. Rekart ML, Mun L, Aung A, Gomez D, Mulanda W, Kliescikova J, Sitali N, Rajabov A, Azamova S, Pirmahmadzoda B, et al. Detection of mycobacterium tuberculosis complex using the Xpert MTB/RIF ultra assay on the stool of pediatric patients in Dushanbe, Tajikistan. Microbiol Spectr. 2023; 11: e0369822.
  21. Gliddon HD, Frampton D, Munsamy V, Heaney J, Pataillot-Meakin T, Nastouli E, Pym AS, Steyn AJC, Pillay D, McKendry RA. A rapid drug resistance genotyping workflow for mycobacterium tuberculosis, using targeted isothermal amplification and nanopore sequencing. Microbiol Spectr. 2021; 9: e0061021.
  22. Salazar MP, da Costa Lima Suassuna Monteiro JF, Veloso Carvalho-Silva WH, Nunes Diniz GT, Werkhauser RP, Lapa Montenegro LM, Schindler HC. Development and evaluation of a single-tube nested PCR with colorimetric assay for Mycobacterium tuberculosis detection. Biotechniques. 2024; 76(6): 235–244.
  23. van Rensburg C, Berhanu R, Hirasen K, Evans D, Rosen S, Long L. Cost outcome analysis of decentralized care for drug-resistant tuberculosis in Johannesburg, South Africa. PLoS One. 2019; 14: e0217820.
  24. Andom AT, Gilbert HN, Ndayizigiye M, Mukherjee JS, Lively CT, Nthunya J, Marole TA, Ratsiu M, Smith Fawzi MC, Yuen CM. Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: a mixed-methods study in the Kingdom of Lesotho. PLoS One. 2023; 18: e0285774.
  25. Gidado M, Nwokoye N, Ogbudebe C, Nsa B, Nwadike P, Ajiboye P, Eneogu R, Useni S, Elom E, Lawanson A. Assessment of GeneXpert MTB/RIF performance by type and level of health-care facilities in Nigeria. Niger Med J. 2019; 60: 33–9.
  26. Byun JY, Kim HL, Lee EK, Kwon SH. A systematic review of economic evaluations of active tuberculosis treatments. Front Pharmacol. 2021; 12: 736986.
  27. Ardizzoni E, Fajardo E, Saranchuk P, Casenghi M, Page AL, Varaine F, Kosack CS, Hepple P. Implementing the Xpert(R) MTB/RIF diagnostic test for tuberculosis and rifampicin resistance: outcomes and lessons learned in 18 countries. PLoS One. 2015; 10: e0144656.
  28. Otieno J, Luciani A, Lumumba S, Gikunda G, Kiilu C, Ogutu N, Sifuma B, Kinyua D, Mukami D, Mwenda C, et al. Mental health issues associated with the management of tuberculosis in Homabay, Busia and Kakamega Counties, Kenya. PLoS One. 2024; 19: e0298268.
  29. Teibo TKA, Andrade RLP, Rosa RJ, de Abreu PD, Olayemi OA, Alves YM, Vaz Tavares RB, da Costa FBP, Dias Moura HS, Ferezin LP, et al. Barriers that interfere with access to tuberculosis diagnosis and treatment across countries globally: a systematic review. ACS Infect Dis. 2024; 10: 2600–14.
  30. Cabral VK, Azeredo ACV, Cionek O, Loureiro MM, De Almeida CPB, Silva DR. The use of information and communication technology in continuing education in tuberculosis. J Eur CME. 2021; 10: 1930962.
  31. Wan Z, Liu X, Xie Y, Wu J. Application of Information technology-based end-to-end process management in the diagnosis and treatment of patients with tuberculosis. Am J Med Qual. 2021; 36: 134–5.
  32. Hwang EJ, Jeong WG, David PM, Arentz M, Ruhwald M, Yoon SH. AI for detection of tuberculosis: implications for global health. Radiol Artif Intell. 2024; 6: e230327.
  33. Okada K, Yamada N, Takayanagi K, Hiasa Y, Kitamura Y, Hoshino Y, Hirao S, Yoshiyama T, Onozaki I, Kato S. Applicability of artificial intelligence-based computer-aided detection (AI-CAD) for pulmonary tuberculosis to community-based active case finding. Trop Med Health. 2024; 52: 2.
  34. Zeng J, Huang H, Liu X, Huang Z, Liu W, Liu H, Lu S. Pooling sputum samples for the Xpert MTB/RIF assay: a practical screening strategy for highly infectious tuberculosis cases. BMC Infect Dis. 2024; 24: 122.
  35. Miotto P, Cabibbe AM, Borroni E, Degano M, Cirillo DM. Role of disputed Mutations in the rpoB gene in interpretation of automated liquid MGIT culture results for rifampin susceptibility testing of Mycobacterium tuberculosis. J Clin Microbiol. 2018; 56: e01599–17.
  36. Choi YJ, Kim Y, Park HJ, Kim D, Lee H, Kim YA, Lee KA. Development of a multiplex droplet digital PCR method for detection and monitoring of Mycobacterium tuberculosis and drug-resistant tuberculosis. Ann Clin Microbiol Antimicrob. 2024; 23: 29.
  37. Lima VC, Bernardi FA, Alves D, Kritski AL, Galliez RM, Rijo R. A permissioned blockchain network for security and sharing of de-identified tuberculosis research data in Brazil. Methods Inf Med. 2020; 59: 205–18.
  38. Singh UB, Rade K, Rao R, Kumar N, Mattoo SK, Nair S, Zumla A, Sahu S. Lessons and updates from India's National Tuberculosis Elimination Program – bold decisions and innovative ways of fast-tracking progress toward ending tuberculosis. IJID Reg. 2025; 14: 100599.
Language: English
Page range: 127 - 134
Submitted on: Apr 22, 2025
Accepted on: Jul 22, 2025
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

© 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.