# Tuberculosis laboratory capacity building in the WHO African Region: The past, the present and the future: A Viewpoint

## TL;DR

This paper reviews the progress and challenges of tuberculosis laboratory services in Africa, highlighting the need for improved diagnostics and funding to combat TB.

## Contribution

The paper provides a comprehensive analysis of TB laboratory capacity building in the WHO African Region and proposes future strategies for improvement.

## Key findings

- Only 42% of the targeted reduction in TB deaths was achieved by 2025, indicating slow progress.
- Molecular tests for TB diagnosis have been adopted but are not widely used as initial tests in many countries.
- The establishment of TB Supranational Reference Laboratories in Africa has improved diagnostic services, but more funding is needed.

## Abstract

Tuberculosis remains a leading infectious disease killer in the World Health Organization African Region, with 2.5 million cases and 404,000 deaths in 2023, including 112,000 people with HIV. There is slow progress with only 42% of the 75% targeted reduction in death by 2025. Out of 60,266 estimated multidrug-resistant TB cases in 2023, only 22,515 were notified. Laboratory diagnostic services in the African region still need urgent attention. By 2005, the new smear-positive case detection rate was nearly 51%, falling short of the 70% target. By 2015, the benchmark for one microscopy center per 100,000 population was reached in some Member States, but gaps remained in culture and drug susceptibility testing coverage. Molecular tests were adopted, however there is slow uptake among countries to use them as initial diagnostic tests. The Global Laboratory Initiatives were established in 2007 and 2013 globally and in the WHO African Region respectively to enhance access to quality-assured TB laboratory services. The WHO TB Supranational Reference Laboratory (SRL) Network was established in 1994 and expanded to the African region, including South Africa, Uganda, and Benin. The nomination of Mozambique and Rwanda in 2021 as candidate SRLs aims to strengthen this network. Future perspectives involve leveraging the established TB laboratory networks to integrate systems for diagnosing multiple diseases while enhancing efficiency. Advocacy for increased funding is vital for sustaining gains in the laboratory capacities, advancing universal health coverage and enhancing health outcomes in the African region. Here we discuss the TB laboratory capacity building in the WHO African region, focusing on the past, present and the future perspectives. We suggest recommendation towards sustaining and strengthening the existing achievements, while accelerating the laboratory interventions towards the End TB Strategy.