World Tuberculosis Day will be celebrated on 24 March, and new recommendations for tuberculosis (TB) diagnostic techniques from the World Health Organization (WHO) may mark a major step towards fast and accessible testing for infection. TB, caused by Mycobacterium tuberculosis, generally affects the lungs but has the potential to infect other organ systems. Many people who are infected with TB have inactive infection, which causes no symptoms, but can transition to active disease at any time when the immune system can no longer manage the infection. For this reason, TB testing of individuals with no symptoms or very few or non-specific symptoms is an effective strategy to prevent the future spread of TB and costly active TB infections. New tests recommended by the WHO can address these cases more quickly and improve access to life-saving treatment.
These new WHO recommendations include advice to utilise near-point-of-care tests for TB, which detect TB without resistance to the antibiotic rifampicin; the use of tongue swabs for the collection of specimens for tests in those patients who cannot produce a sputum sample; and advice to pool sputa as a diagnostic strategy in resource-constrained settings.
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These new diagnostic practices will, if implemented at scale, create the illusion of an increase in incident cases of TB as undiagnosed patients receive the proper diagnosis. In the longer term, more access to testing alone will likely not change incidence, but if paired with improved treatment and drug adherence programs to support patients through the long course of treatment for TB, it can lead to a notable decrease in TB incidence as chains of transmission are interrupted earlier.
GlobalData monitors incident M. tuberculosis infection in the 16 major markets (16MM: US, France, Germany, Italy, Spain, UK, Japan, Australia, Brazil, Canada, China, India, Mexico, Russia, South Africa, and South Korea), and data suggests these new diagnostic recommendations may increase an already increasing trend in incident cases from 2023 to 2033. In only one market, Germany, a decrease in incident cases is forecast, and even this is slight, from approximately 5,200 cases in 2023 to just over 5,100 cases in 2033. All other markets show an increase in incident cases, even with diagnostic practices held constant. With these and other improvements in diagnostics, GlobalData epidemiologists expect to see an initial increase in diagnosed incident cases of TB due to improved case finding and decreased time between symptom onset and a positive test.
This World TB Day, improved diagnostic practices more in line with modern technology are a sign of progress. TB has been with humanity for more than 9,000 years, and much of that time has been an unknown killer. Now, TB is treatable and preventable. The ability of health systems to find cases of TB is an important lever to end TB, but treatment and appropriate follow-up must come with these improvements. Otherwise, improving TB case-finding will only serve to increase the number of diagnosed TB cases without addressing the underlying issue. On World TB Day on 24 March, we celebrate these new diagnostics and many other impressive strides towards the end of TB and renew our dedication to finishing the fight against TB.
