TY - JOUR
T1 - Reimagining the status quo
T2 - How close are we to rapid sputum-free tuberculosis diagnostics for all?
AU - Nathavitharana, Ruvandhi R.
AU - Garcia-Basteiro, Alberto L.
AU - Ruhwald, Morten
AU - Cobelens, Frank
AU - Theron, Grant
N1 - Funding Information: RRN is supported by National Institutes of Health Career Development Award (NIAID K23 AI132648-04) and an American Society of Tropical Medicine and Hygiene Burroughs Wellcome Fellowship. GT acknowledges funding from the EDCTP2 programme supported by the European Union (grant SF1401, OPTIMAL DIAGNOSIS; grant RIA2020I-3305, CAGE-TB) and the National Institute of Allergy and Infection Diseases of the National Institutes of Health (U01AI152087). GT's research group has received funding and/or in-kind donations in the last five years via his employer from Bruker Hain Lifesciences, Cepheid, LumiraDx, FIND, Biopromic, Newmark Diagnostics, Hemocue, Boditech, and Copan. None of the funders had any role in paper design, data collection, data analysis, interpretation, writing of the paper. Funding Information: RRN is supported by National Institutes of Health Career Development Award (NIAID K23 AI132648-04) and an American Society of Tropical Medicine and Hygiene Burroughs Wellcome Fellowship. GT acknowledges funding from the EDCTP2 programme supported by the European Union (grant SF1401, OPTIMAL DIAGNOSIS; grant RIA2020I-3305, CAGE-TB) and the National Institute of Allergy and Infection Diseases of the National Institutes of Health (U01AI152087). GT’s research group has received funding and/or in-kind donations in the last five years via his employer from Bruker Hain Lifesciences, Cepheid, LumiraDx, FIND, Biopromic, Newmark Diagnostics, Hemocue, Boditech, and Copan. Publisher Copyright: © 2022 The Author(s)
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Rapid, accurate, sputum-free tests for tuberculosis (TB) triage and confirmation are urgently needed to close the widening diagnostic gap. We summarise key technologies and review programmatic, systems, and resource issues that could affect the impact of diagnostics. Mid-to-early-stage technologies like artificial intelligence-based automated digital chest X-radiography and capillary blood point-of-care assays are particularly promising. Pitfalls in the diagnostic pipeline, included a lack of community-based tools. We outline how these technologies may complement one another within the context of the TB care cascade, help overturn current paradigms (eg, reducing syndromic triage reliance, permitting subclinical TB to be diagnosed), and expand options for extra-pulmonary TB. We review challenges such as the difficulty of detecting paucibacillary TB and the limitations of current reference standards, and discuss how researchers and developers can better design and evaluate assays to optimise programmatic uptake. Finally, we outline how leveraging the urgency and innovation applied to COVID-19 is critical to improving TB patients’ diagnostic quality-of-care.
AB - Rapid, accurate, sputum-free tests for tuberculosis (TB) triage and confirmation are urgently needed to close the widening diagnostic gap. We summarise key technologies and review programmatic, systems, and resource issues that could affect the impact of diagnostics. Mid-to-early-stage technologies like artificial intelligence-based automated digital chest X-radiography and capillary blood point-of-care assays are particularly promising. Pitfalls in the diagnostic pipeline, included a lack of community-based tools. We outline how these technologies may complement one another within the context of the TB care cascade, help overturn current paradigms (eg, reducing syndromic triage reliance, permitting subclinical TB to be diagnosed), and expand options for extra-pulmonary TB. We review challenges such as the difficulty of detecting paucibacillary TB and the limitations of current reference standards, and discuss how researchers and developers can better design and evaluate assays to optimise programmatic uptake. Finally, we outline how leveraging the urgency and innovation applied to COVID-19 is critical to improving TB patients’ diagnostic quality-of-care.
KW - Active disease
KW - Diagnosis
KW - Non-sputum
KW - Point-of-care
KW - Tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85128334183&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ebiom.2022.103939
DO - https://doi.org/10.1016/j.ebiom.2022.103939
M3 - Review article
C2 - 35339423
SN - 2352-3964
VL - 78
JO - eBioMedicine
JF - eBioMedicine
M1 - 103939
ER -