The World Health Organization (WHO) is issuing, for the first time, recommendations on new near-point-of-care (NPOC) molecular tests for the diagnosis of tuberculosis (TB); easy-to-collect tongue swab samples to simplify and expand access to testing; and a cost-saving sputum pooling strategy to increase testing efficiency for TB and rifampicin-resistant TB.
"These new WHO recommendations mark a major step forward in making TB testing faster and more accessible," said Dr Tereza Kasaeva, Director of WHO's Department for HIV, TB, Hepatitis & STIs. "WHO urges countries and partners to work together to roll out these guidelines to close persistent diagnostic gaps and ensure that everyone with TB can be diagnosed early and start life-saving treatment without delay."
Under WHO's End TB Strategy and the political declaration of the United Nations High Level Meeting on TB, countries committed to ensuring early TB diagnosis and universal access to WHO-recommended rapid molecular tests. Yet critical diagnostic gaps persist. Millions still face delayed or missed diagnoses due to systemic barriers, such as continued reliance on sputum as a sample type that cannot be produced by all people that may have TB, sole availability of laboratory-based tests that are not always available where people seek care or are evaluated for TB, and high costs of tests and associated testing equipment that limit availability and expansion of testing networks.
To support countries in their efforts to strengthen detection of TB disease and drug resistance, WHO issues evidence-based policy guidance on TB testing that is routinely updated. Since the most recent consolidated guidelines on TB diagnosis were issued in 2025, evidence became available on new tests, sample types, and strategies for the initial diagnosis of TB with and without drug resistance detection. In response, the WHO consolidated guidelines on tuberculosis, Module 3: Diagnosis, 2nd edition are updated and will be published in the coming weeks. The methods used to develop the new policy guidance may be found here .
This new edition recommends for the first time:
- A new class of near-point-of-care nucleic acid amplification tests (NPOC-NAATs) for the initial detection of TB without rifampicin resistance at peripheral levels of the health system (i.e., peripheral laboratories, primary healthcare centres and communities) and at lower unit costs than other molecular test and instrument types;
- Tongue swabs as new, readily available and easy-to-collect specimens for use with NPOC-NAATs and low-complexity automated NAATs (LC-aNAATs) for the initial detection of TB with and without rifampicin resistance among adults and adolescents that are unable to produce sputum; and
- Pooling of sputa as a diagnostic strategy for the initial detection of TB and rifampicin resistance using LC-aNAATs with the potential to improve turnaround times and costs when resources are constrained.
Next steps
- The complete policy for the diagnosis of TB and drug-resistant TB will be released this year in the WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis. 2nd edition. The summary of findings and the evidence to decision tables will be produced in conformity with the GRADE method and made available on the WHO website.
- The updated guidelines will be accompanied by the WHO operational handbook on tuberculosis. Module 3: Diagnosis. 2nd edition. The handbook will provide guidance on all technologies, sample types and strategies currently recommended, steps to introducing new TB diagnostics into a health programme and the model algorithms for testing and clinical management.
- The updated operational handbook will also be accompanied by a WHO Toolkit for near point-of-care and swab-based tuberculosis testing that will outline key steps for implementation of these new tools and provide customizable planning, readiness assessment, testing, training, and monitoring and evaluation materials to facilitate program uptake.
- The release of the new guidance will be followed by a series of WHO and partner organization webinars for different regions. The updates will also be included on the online WHO TB Knowledge Sharing Platform providing easy access to the guidelines and operational handbook in one place. The operational guidance, toolkit, webinars and the platform will support countries in updating their national guidelines, training staff, informing programme budgets and facilitating the transition to the use of the new interventions. National TB programmes and other stakeholders are encouraged to seek advice from WHO before introducing the latest technologies recommended in the revised guidelines.
