For decades, tuberculosis care and control have relied on suboptimal diagnostic options (such as smear microscopy), leaving millions of people diagnosed late or entirely missed. While molecular tests offered great hope, they have struggled to reach scale in low- and middle-income countries.
In February 2026, the World Health Organization (WHO) recommended, for the first time, near point-of-care NAATs (NPOC-NAATs) (1) on sputum as an initial diagnostic test for adults and adolescents with symptoms or screen-positive of pulmonary TB, replacing smear microscopy, and (2) on tongue swabs as an alternative when sputum cannot be obtained. Currently, the only WHO-endorsed technology (Figure) in this new NPOC class is the MTB Nucleic Acid Test Card with the MiniDock Ultra device by Pluslife Biotech (Guangzhou, China). This technology is available at a special per-test cost of USD 3.60 through the Global Drug Facility, a cost that is substantially lower than any other WHO-endorsed molecular test.
Remarkably, with months, efforts are already underway to implement these NPOC tests in more than 15 high TB burden countries. For example, 13 countries are rolling out these tests as part of an Early Adopter initiative driven by the Global Fund, supported by the Children's Investment Fund Foundation (CIFF) and implemented on the ground by National TB Programs, with technical support by the Aurum Institute. This initiative will deliver nearly 3 million tests in Bangladesh, Benin, Cameroon, Ethiopia, Indonesia, Kenya, Nigeria, Peru, the Philippines, South Africa, Uganda, Viet Nam and Zambia.
In addition, several implementors are trying out these tests across various projects funded by TB REACH by the Stop TB Partnership. Supported by Global Affairs Canada, the Gates Foundation, and UK FCDO, TB REACH Wave 11 Plus is investing US$ 2.7 million across 18 projects in 12 countries, with about 150,000 tests expected to roll out in 2026 . From primary health care clinics to community settings to prisons, Wave 11Plus is building the real-world evidence that can help implementation across the world.
At a recent conference (Image) hosted by the Global Fund and Stop TB Partnership, many of the above early adopters and implementers came together in Bangkok, Thailand, from July 8 to 10th, to showcase their work, share early lessons, and learn from each other. Several NPOC technology manufacturers also attended the conference to demonstrate their technologies.
My big takeaways from attending this inspiring, exciting meeting are:
The policy to implementation gap has dramatically shortened: It is very rare to see this level of uptake for any TB technology that has only recently been endorsed by WHO. The fact that over 15 countries are rolling out the MiniDock test already is a remarkable success, given the long, convoluted pathways seen with previous technologies. I have never seen anything like this before and all signs point to greater ambition by countries to close the big diagnostic gap.
Countries are trying out a wide range of implementation strategies: Listening to the country presentations, I was struck by the diversity of strategies being considered. Several countries are replacing smear microscopy with NPOC testing. Others are hoping to take these tests into the community (Figure). Some are using tongue swab collection as a way of expanding TB care to those who are unable to produce sputum samples. Some are deploying NPOC tests in the private health sector, a dominant service provider in many countries. Some countries will likely replace the more expensive existing molecular tools with the more affordable NPOC tests.
Interestingly, most countries see primary care as the right setting for NPOC tests due to their simplicity, low cost, and limited infrastructure requirements.
Not all countries are relying on external donors: It was very inspiring to presentations from National TB Program leaders of countries such as Indonesia and Nigeria, as these nations are investing domestic funding for NPOC roll-out.
In particular, Indonesia (Figure) got a huge round of applause for their incredibly ambitious NPOC roll-out where they hope to deploy NPOC testing across 10,640 primary health centers in 38 provinces by 2027, with 90% of the TB budget coming from domestic sources. Truly inspiring!
The NPOC technology space is buzzing: While Pluslife MiniDock is the only NPOC product that is WHO endorsed right now, several fast-follower technologies (Figure) are now in the pipeline, and many of these were showcased at the Bangkok meeting. Some of the companies in this space include Huwel Lifesciences, India; Molbio Diagnostics, India; UStar Biotechnologies, China; Coyote Bioscience, China; and Co-Dx, USA.
Interestingly, most fast-follower technologies are from the Global South, especially India and China. As we wrote in a previous Devex article, as G7 aid cuts threaten TB programs, affordable diagnostics developed in the Global South offer a path forward for high-burden countries to help close the testing gap and save lives.
Civil society advocacy is key to raise the ambition: At the Bangkok meeting, civil society members and advocates called on the TB community to show more ambition, double the rate of TB testing, reduce diagnostic delays, decentralize TB testing, and push for universal access to rapid molecular testing. The meeting ended with participants proposing the Bangkok Declaration (Figure), which states: "We commit, in our personal capacities, to a phased replacement of smear microscopy with WHO-recommended molecular testing for the initial diagnosis of TB, to be completed by 2028.”
Hundreds of people (including me!) around the world have signed this declaration, and I hope you will too! We not only need to replace suboptimal tests like microscopy, but also reach large numbers of people who are currently not being tested. Our ability to end the TB epidemic depends on it.
Note: I have no financial or industry conflicts with any of the technologies or companies in this article. I serve as an advisor for several non-profits, including WHO, Partners in Health and the Gates Foundation