TB rapid-test access in Africa: in sight but out of reach

Tuberculosis remains a major public health challenge, and fast, accurate testing is essential to find and treat people quickly. Although the World Health Organization endorsed rapid molecular diagnostic tools more than a decade ago, many places still do not have routine access to them. In a study led by Lucy Mupfumi, researchers examined progress toward universal access to WHO-recommended rapid diagnostics (WRDs) in a selection of African countries to understand what is helping or holding back progress. The team used data for 24 African countries from the WHO Global TB database to measure how many people with TB were tested with WRDs between 2021 and 2023, and to assess access according to the WHO Diagnostic Standard. To add practical, on-the-ground perspective, staff from national TB programmes in six countries were surveyed about the real-life factors that influence how WRD-based diagnostic algorithms are implemented. The combined approach of using global surveillance data and frontline programme surveys was designed to show both the numbers and the operational realities shaping access to rapid diagnostics in the region.

The analysis found that across the 24 countries studied, 61% of people with TB were tested with a WRD in 2023. Only seven countries reached levels above 80%, while eight countries reported testing proportions below the global average of 48%. Progress between 2021 and 2023 was limited: the proportion tested with WRDs rose by just 6%, and seven countries showed downward trends over that period. Using the WHO Diagnostic Standard to assess access, the researchers also determined that only seven of the 24 African countries are on track to meet the target for universal access to WRDs by 2027. The survey of TB programme staff highlighted consistent health system barriers: supply chain disruptions, inadequate funding, staffing shortages and weak sample transportation systems all impeded the expansion and reliable use of WRDs. Conversely, facilitators identified included strengthened policy and strategic planning, expansion and optimisation of molecular diagnostic capacity, and the development of integrated sample transport networks.

These findings underline a troubling gap between policy and practice. Even where WHO-recommended rapid diagnostics exist on paper, real-world barriers in supply, financing, workforce and logistics limit their reach and effectiveness. Persisting health system weaknesses pose a threat to diagnostic networks and reduce the potential impact of WRDs on the TB care cascade: fewer people are promptly diagnosed, started on appropriate treatment and linked to follow-up care. The study suggests that simply increasing the number of machines will not be enough; strategic planning is needed to address supply chains, funding shortfalls, staffing and sample transport so that expanded molecular capacity can be used reliably. For countries aiming to achieve universal access to WRDs by 2027, targeted investments and coordinated systems-level solutions are required to translate diagnostic capacity into improved outcomes for people with TB and to slow transmission at the population level.