People with TB want tests they can trust

Timely and accurate diagnosis of tuberculosis (TB) remains a major challenge in places that carry the highest burden of disease. Global recommendations and Target Product Profiles (TPPs) from the World Health Organization (WHO) have long guided the development of new tests, but those documents have mostly reflected expert views rather than the experiences of people who actually seek care. In a qualitative study with corresponding author María del Mar Castro, researchers set out to fill that gap by asking people themselves what matters when they are tested for TB. The team conducted 75 semi-structured interviews with adults who were undergoing TB evaluation at outpatient clinics across five countries: India, the Philippines, South Africa, Uganda, and Vietnam. Participants were purposively sampled to capture a range of sexes, TB status, ages, and treatment experiences. Responses were analyzed using thematic analysis to identify common concerns and priorities. The study asked straightforward questions about what kinds of tests and testing processes patients prefer, how sample collection feels to them, and what practical barriers they face when trying to get test results.

The study used semi-structured interviews and thematic analysis to surface five interrelated domains that shape preferences: perceived diagnostic accuracy, sample collection experience, time-to-results, affordability, and testing location. Across these domains, perceived accuracy and trustworthiness of results came out as the dominant priority. Many participants said they would accept discomfort or inconvenience if it meant getting a more reliable diagnosis. Sputum and blood samples were widely trusted even though they can be difficult or unpleasant to provide; by contrast, tongue swabs and urine samples were often described as easier to give but were perceived by participants as less accurate. Rapid, same-day turnaround was valued because it reduced emotional distress and the practical burdens of travel and lost income. Although testing was typically free at the point of care, indirect costs such as transport and missed work remained important barriers. Hospital-based testing was generally preferred because of trust in staff and infrastructure, while community-based approaches were seen as attractive only when they could guarantee reliability and privacy.

These findings have direct implications for how diagnostic developers and policymakers think about new TB tests. When people seeking care place accuracy and trust at the top of their list, simply introducing a more comfortable or easier sample type will not guarantee uptake unless communities also believe in the test’s reliability. The study suggests that WHO policy updates and future TPPs should take these patient priorities into account, especially when considering the adoption of novel sample types and testing strategies. Attention to time-to-results, measures to reduce indirect costs, and safeguards for privacy and reliability in community settings could help diagnostics reach more people equitably. In short, centering the voices of people undergoing TB evaluation can help shape tools and policies that are not only technically sound but also acceptable and accessible to the people they are meant to serve.