Обратная связьHealth needs are diverse, and programmes are expected to provide a range of diagnostics to assist health workers in managing patients as effectively and efficiently as possible. The diagnosis of TB often begins with assessing symptoms; this is not specific to TB, given that cough and fever overlap with COVID-19 and other respiratory infections. Additionally, people with TB may also have HIV, and services for both diseases are usually provided at the same levels of care. The relative diagnostic volumes are also quite heterogeneous, and they can be low for a specific disease or on a specific day at peripheral health centres. Multidisease testing can maximize the use of limited testing instruments and other resources; an information note describing considerations for multidisease testing is available (59).
All currently recommended molecular diagnostics for the initial diagnosis of TB have a SARS-CoV-2 test available on the same instrument as the TB test, although some may not have received regulatory approval for such use. Several platforms are also widely used in diagnosing and managing TB in people living with HIV, whereas others are used for diagnosis of other viral pathogens (e.g. hepatitis C virus and human papillomavirus) or antimicrobial resistance detection among bacterial pathogens. Additionally, one of the recommended IGRAs also runs on a platform that allows testing a range of other conditions; NGS platforms can also be used to sequence any nucleic acids present in a sample. The response to the COVID-19 pandemic led to NGS capacity being established in many countries, including LMIC, for surveillance. Such capacity and expertise may be available and could be used to facilitate the rapid uptake of targeted NGS-based DST for TB. If multidisease testing on an instrument is planned, then it may be best to employ platforms that use random access approaches (e.g. GeneXpert or Truenat) or allow different types of tests to be performed in the same batch or at the same time (e.g. BD MAX or targeted NGS) so that patient results are not delayed.