Pulmonology Pulmonology
Pulmonol 2018;24:73-85 - Vol. 24 Num.2 DOI: 10.1016/j.rppnen.2017.12.002
Review
Point of care diagnostics for tuberculosis
A.L. García-Basteiroa,b,c,, , A. DiNardod, B. Saavedraa, D.R. Silvae, D. Palmerof, M. Gegiag, G.B. Migliorih, R. Duartei,j, E. Mambuquea, R. Centish, L.E. Cuevask, S. Izcoa,c, G. Theronl
a Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
b Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
c ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic – Universitat de Barcelona, Rossello 132, 08036 Barcelona, Spain
d Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, United States
e Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
f División Tisioneumonología Hospital F.J. Muñiz, Buenos Aires, Argentina
g Global TB Programme, World Health Organization, Geneva, Switzerland
h WHO Collaborating Centre for TB and lung diseases, Maugeri Care and Research Institute, Tradate, Italy
i UGI Torax, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
j Departamento de Ciências da Saúde Pública, Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
k Liverpool School of Tropical Medicine, Liverpool, UK
l DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
Received 27 November 2017, Accepted 07 December 2017
Abstract

The goals of the End TB strategy, which aims to achieve a 90% reduction in tuberculosis (TB) incidence and a 95% reduction in TB mortality by 2035, will not be achieved without new tools to fight TB. These include improved point of care (POC) diagnostic tests that are meant to be delivered at the most decentralised levels of care where the patients make the initial contact with the health system, as well as within the community. These tests should be able to be performed on an easily accessible sample and provide results in a timely manner, allowing a quick treatment turnaround time of a few minutes or hours (in a single clinical encounter), hence avoiding patient loss-to-follow-up. There have been exciting developments in recent years, including the WHO endorsement of Xpert MTB/RIF, Xpert MTB/RIF Ultra, loop-mediated isothermal amplification (TB-LAMP) and lateral flow lipoarabinomannan (LAM). However, these tests have limitations that must be overcome before they can be optimally applied at the POC. Furthermore, worrying short- to medium-term gaps exist in the POC diagnostic test development pipeline. Thus, not only is better implementation of existing tools and algorithms needed, but new research is required to develop new POC tests that allow the TB community to truly make an impact and find the “missed TB cases”.

Keywords
Tuberculosis, Point-of-care, Diagnosis, Target product profile, Xpert, LAM, NAATs
Pulmonol 2018;24:73-85 - Vol. 24 Num.2 DOI: 10.1016/j.rppnen.2017.12.002
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