TB tests endorsed by WHO are slow to reach African countries

Tuberculosis remains a major global health concern, and the World Health Organization (WHO) regularly endorses new diagnostic technologies to help detect the disease. Jean de Dieu Iragena and colleagues set out to understand whether those endorsed tools actually reach health systems in the WHO African Region (WHO/FR). They conducted a systematic review of peer-reviewed literature from countries in the WHO/AFR to measure both “uptake” — whether a test is used in a country at any level — and “roll-out” — whether the test is being used in the settings for which WHO recommended it. The team focused on diagnostics endorsed between January 2007 and December 2017 and extended the search to December 2021 to capture more recent uptake and roll-out of newly endorsed technologies. The study followed established reporting steps using PRISMA diagrams and was registered with the ISRCTN database, aiming to provide a clear picture of how endorsement by WHO translates into real-world use across 47 countries in the region.

To gather evidence, the researchers searched PubMed, Google Scholar, and Embase for articles in English or French, and used both qualitative synthesis and quantitative analysis in STATA version 14.0. Their search returned 3,399 records; after removing 1,683 duplicates they screened 1,716 articles and retained 92 for detailed analysis. The analysis focused on specific WHO-endorsed tools including Xpert MTB/RIF (XPERT), Line Probe Assay (LPA), Mycobacteria Growth Indicator Tube (MGIT), and Lipoarabinomannan (LAM). For uptake, among the 47 countries reviewed, the majority of articles concerned XPERT (22 articles, 47%), followed by LPA (10 articles, 21%) and MGIT (9 articles, 19%). For roll-out, publications documented LAM in 11 countries (24%) and XPERT in 16 countries (36%). The study reported median years to uptake: MGIT 6 (IQR 3.2 - 7.9), XPERT 5 (2.5 - 6.5), and LPA 2.5 (3.2 - 7.9), with lower values for other tests. For roll-out the median years were MGIT 7 (3 – 7), LPA 6 (1.6 - 9.4), and XPERT 5 (4 - 7), and again lower for other tests.

The main message from Jean de Dieu Iragena’s review is that endorsement by WHO does not automatically mean rapid adoption of diagnostic tools across the WHO African Region. The pattern of articles and the measured median times suggest a slow pace of both initial uptake and full roll-out for key tests such as Xpert MTB/RIF (XPERT), Line Probe Assay (LPA), Mycobacteria Growth Indicator Tube (MGIT), and Lipoarabinomannan (LAM). Because the study relied on published literature, gaps in reporting may reflect both limited use and limited documentation. The authors conclude that future studies should identify the factors that enable or block faster uptake and roll-out, and they recommend developing strategies and rapid guides to share best practices. In short, more than endorsement is needed: practical steps, clearer documentation, and lessons from successful roll-outs will be required to move new TB diagnostics into routine use more quickly.