Truenat brings faster TB testing to local clinics

Timely and appropriate diagnosis and treatment are essential to ending tuberculosis (TB), but many health systems face delays and barriers when testing is centralized. To better understand how to bring testing closer to people, María del Mar Castro and colleagues embedded a qualitative study within a cluster randomized controlled trial to explore the values and preferences of multiple stakeholders for a diagnostic strategy using the Truenat platform with MTB Plus and RIF Dx Assays. The work took place in Mozambique and Tanzania and focused on how real users — people with presumptive TB, health professionals and national decision makers — experienced decentralized testing. By asking those directly affected and observing testing practice, the researchers aimed to learn whether a portable molecular option could fit local needs, speed results, and support faster treatment starts. The study centered on practical, on-the-ground perspectives about what matters for adopting new tools in routine care, including ease of use, counseling and how long people wait for results.

The team used semi-structured interviews with people with presumptive TB (n=34), professional users including laboratory technicians, nurses and clinicians (n=19), and national decision makers (n=5). They combined these interviews with direct observations of testing procedures and usability surveys, and analyzed the data using thematic analysis informed by the Consolidated Framework for Implementation Research. Facilities showed wide variation in testing capacity and time-to-results, ranging from same-day to more than two weeks. Healthcare workers reported that availability and supply of reagents and cartridges could cause delays. The Truenat platform for detection of TB was considered easy-to-use, with a median SUS score of 90/100, and was described as acceptable and well suited to the study settings. Participants highlighted Truenat’s advantages in locations with limited prior testing capacity — for example where samples were previously shipped or microscopy was used — noting shorter time-to-results, reduced need for patients to return with more samples, and fewer infrastructure needs compared to GeneXpert. People with presumptive TB favored same-day results and rapid treatment start, while some said waiting longer than one day could be acceptable if it meant higher accuracy. Across the diagnostic process, participants valued support and counseling from healthcare workers.

The findings point to practical implications for expanding decentralized TB testing. Because the Truenat platform and its MTB Plus and RIF Dx Assays were perceived by health providers as easy to use and appropriate for local conditions, implementing them at the point of care may be an acceptable and feasible alternative to off-site Xpert testing for TB in Mozambique and Tanzania. Shorter time-to-results and fewer infrastructure demands could reduce patient return visits and help start treatment sooner, especially in clinics that previously had to send samples away or rely on microscopy. However, consistent supply of reagents and cartridges is critical: shortages were identified as a potential cause of delayed results. The emphasis participants placed on counseling and support suggests that technology rollout should be paired with staff training and patient communication. Altogether, the study offers evidence that bringing molecular testing closer to patients is promising, but successful scale-up will depend on reliable supply chains and attention to the broader care process.