The World Health Organization (WHO) has issued updated recommendations on tuberculosis (TB) diagnostics, introducing new approaches aimed at improving detection across healthcare settings. The guidance focuses on three key developments: near point-of-care molecular tests, the use of tongue swab samples, and sputum pooling strategies.
The recommendations form part of an upcoming update to WHO’s consolidated TB diagnostic guidelines and reflect new evidence on test formats, specimen types, and diagnostic workflows.
A central element is the introduction of near point-of-care nucleic acid amplification tests (NPOC-NAATs). These molecular assays are designed for use outside centralized laboratories, including in peripheral labs, primary care settings, and community environments. They are portable, can operate on battery power, and provide results in under an hour, enabling faster clinical decision-making. The tests are intended for initial TB detection, with or without rifampicin resistance, and may be available at lower cost than existing molecular platforms.
The updated guidance also recommends tongue swabs as an alternative sample type. These are easier to collect than sputum and may be particularly useful for patients who are unable to produce sputum. Tongue swabs can be used with both near point-of-care and low-complexity NAAT platforms, potentially expanding access to diagnostic testing in underdiagnosed populations.
In addition, WHO recommends sputum pooling as a strategy to improve efficiency in resource-limited settings. This approach involves combining samples from multiple individuals for testing using low-complexity NAAT platforms. Sputum pooling may reduce reagent use, laboratory workload, and turnaround times while lowering overall costs.
These recommendations indicate a shift toward more decentralized testing models and adaptable workflows. Near point-of-care testing may reduce reliance on centralized laboratory systems and sample transport, while alternative specimens such as tongue swabs may require validation and updated protocols.
WHO has indicated that further operational guidance will accompany the updated recommendations, including implementation toolkits, training materials, and standardized diagnostic algorithms. These resources are intended to support integration of the new tools into national TB programs.
Overall, the updated recommendations aim to expand diagnostic access, simplify sample collection, and improve efficiency across TB testing pathways.
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