India accounts for the largest share of the global tuberculosis (TB) burden, and diagnostic gaps remain a major barrier to elimination. Despite significant expansion of molecular testing and laboratory infrastructure under NTEP, delayed diagnosis, incomplete drug-resistance testing, underutilized platforms, inequitable access, and weak private-sector integration continue to undermine outcomes. This article highlights the central role of diagnostics in reducing transmission and improving survival, and proposes high-impact strategies including targeted screening, universal upfront molecular testing, baseline drug-resistance testing, decentralized point-of-care diagnostics, private-sector engagement, and adoption of future ready tools. Strengthening diagnostics is essential to accelerate TB elimination in India.

Abstract: Despite advances in centralized molecular diagnostics, such as GeneXpert, nearly 30-40% of global TB cases remain undiagnosed because of logistical barriers at the periphery, such as lack of power, cold chains, and skilled staff at primary health centres (PHCs). This study evaluated two near-point-of-care (nPOC) platforms, Uniamp (Huwel Diagnostics)/ Pluslife MiniDock and TruePOC MTB Ultima (Molbio), for integration into the National TB Programmes (NTPs). Utilizing insights from field trials conducted in Southeast Asia, and Sub-Saharan Africa, along with WHO benchmarks for 2024–2025, we summarised evidence on technical performance, operational resilience, and economic factors. TruePOC offers micro-PCR on disposable chips with the ability to detect Rif/Isoniazid resistance, whereas Pluslife employs isothermal RHAM amplification for quicker, energy-efficient results. Both systems achieve 91–93% sensitivity in sputum samples compared to GeneXpert Ultra, with Pluslife allowing (85.7% sensitivity) and TruePOC (77.9% sensitivity) for tongue swabs in patients who are difficult to sample, such as children. The average cost per sample is $3.6, which is way more economical than centralized testing costs of $18–25 (including transportation). Challenges include digital integration and scaling up training; however, with adaptations by NTP, such as linking to the Nikshay portal and implementing quality assurance (QA), these tools support the goal of decentralized TB elimination by 2030.

Tuberculosis (TB) remains one of our most formidable public health challenges. Despite extensive global initiatives, strides in TB control are persistentlyobstructed by factors like drug resistance, missed diagnoses, and the financialburden on patients. A nuanced understanding of these challenges, coupled with groundbreaking research and innovative approaches, promises a brighter future for TB management. Several recent articles in the current issue have shed light on these multi-dimensional efforts, offering insights into the contemporary landscape of TB control and possible pathways forward.

Traditional methods of diagnosing tuberculosis require significant time and resources, particularly in countries where the disease is prevalent and healthcare systems are less developed. Additionally, more and more tuberculosis cases are becoming resistant to drugs, posing a significant hazard to public health. Culture-based TB diagnosis, which has long been considered the most reliable method, faces challenges due to its long testing times. To address this issue, MTB/RIFassays such as GeneXpert and Truenat were developed. These are rapid molecular tests that detect Mycobacterium tuberculosis DNA and rifampicin resistance. However, as of 2022, their use remains limited, with only 33% of people globally using them as initial diagnostic tests.

From the time of Hippocrates, Tuberculosis was known as phthisis, a term derived from the Greek language which means “decaying”. There is no more dangerous disease than pulmonary phthisis; no other is so common. It destroys a very great part of the human race. Antoine Portal, Paris, 1832 The swollen glands of the neck were known as scrofula and the King’s evil. Although Tuberculosis (TB) is essentially a medical disease, a sizeable proportion of patients fall into the realm of surgery, may it be due to the primary disease or its sequelae. TB was the leading cause of death in the 17th century. Patients were nursed in sanatoriums and treated with plenty of sunlight and good food. Surgery then became widely prevalent as a treatment modality, and Pulmonary Tuberculosis (TB) became the history of thoracic surgery.

Treating multidrug-resistant tuberculosis (MDR-TB), characterized by Mycobacterium tuberculosis strains resistant to both isoniazid and rifampicin, presents significant challenges, especially in resource-constrained settings. Persistent sputum culture positivity despite the administration of second-line TB medications leaves limited options for patients, particularly when the disease has progressed too far for surgical intervention to be viable. In this context,  salvage therapy is employed, which involves formulating a treatment plan that combines new and previously used medications in a last effort to achieve sputum conversion before declaring the treatment unsuccessful.