Practical manual on tuberculosis laboratory strengthening updated to support the implementation of WHO-recommended diagnostics

The Practical manual on TB laboratory strengthening was released today to support implementation of World Health Organization (WHO) recommended TB diagnostics through quality assured TB laboratory services and networks. The document is an update of the GLI Practical Guide to TB Laboratory Strengthening issued in 2017 and is now aligned with the latest WHO recommendations on new tools to diagnose tuberculosis and detect drug resistance.

The updated manual provides an overview of the WHO recommendations and model algorithms as well as addressing key technical areas covering the TB laboratory network, quality management systems, sample collection and transport, biosafety, and operational management of a laboratory.

The update was developed by the Stop TB Partnership’s Global Laboratory Initiative working group, with its secretariat at the World Health Organization (WHO) Global TB Programme and is available through the respective websites.

Practical manual of processing stool samples for diagnosis of childhood TB

This manual was developed in response recommendations by WHO on the use of stool specimens from children for Xpert MTB/RIF and Xpert MTB/RIF Ultra testing. Two simple processing methods for the preparation of stool samples for Xpert testing are described. The manual also describes the requirements for the implementation of stool testing following 10 clear steps. Finally, the manual includes a checklist of activities for implementation and a laboratory assessment tool for monitoring and supervising laboratories that implement stool testing.

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Manual for selection of molecular WHO recommended rapid diagnostic tests for detection of tuberculosis and drug-resistant tuberculosis

This manual provides practical guidance on the selection of molecular WHO-recommended rapid diagnostic (mWRD) and drug resistance tests for TB and drug-resistant TB. It is designed to be suitable for use in any country, with a customizable approach that assists users to tailor their selection efforts based on their local context. The document includes a stepwise approach to selection of one or more mWRDs and a decision pathway to follow. It also includes a description of all mWRDs recommended by WHO as of December 2021, as well as key considerations and questions to ask when making a final mWRD selection to best meet patient and program needs.

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Line probe assays for detection of drug-resistant tuberculosis: interpretation and reporting manual for laboratory staff and clinicians

This document was developed to provide practical guidance on interpretation of the most commonly used first- and second-line line probe assays (LPAs). In this updated manual, the interpretation of mutations identified by the assays has been revised to align with the WHO catalogue of mutations in Mycobacterium tuberculosis complex and their association with drug resistance. The latest LPA instructions for use of the assays are also presented. Lastly, case studies are provided that support staff at national and regional TB reference laboratories to understand and manage any discrepancies between phenotypic and genotypic drug susceptibility testing results

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GLI Guide to TB Specimen Referral Systems and Integrated Networks

This guide describes the various phases to create and strengthen specimen referral systems, essential components involved in referral, as well as other considerations for TB programme and laboratory managers, Ministry of Health officials, and other stakeholders across disease programmes. In addition to describing transport mechanisms and equipment required to move specimens in a safe manner, this guide also provides information on logistics, results reporting, data management, monitoring and evaluation, and standard operating procedures that will facilitate and improve specimen referral systems.

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GLI Planning for country transition to Xpert MTB/RIF Ultra Cartridges

This guide provides practical guidance to develop an actionable implementation plan to smoothly transition to use of Xpert MTB/RIF Ultra cartridges, ensuring uninterrupted service and avoiding cartridge wastage. Topics covered in the guide include adapting national guidelines and diagnostic algorithms; managing existing cartridge supply, forecasting, procurement and distribution; planning site-level computer software upgrades and trainings of laboratory personnel and clinicians; ensuring coordination among donors and partners supporting Xpert implementation in countries; and monitoring impact of the roll-out of Xpert MTB/RIF Ultra.

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GLI Practical Guide to TB Laboratory Strengthening

This guide provides practical guidance on implementation of WHO recommendations and international best practices for TB laboratory strengthening. It is an updated version of the GLI Guide for Providing Technical Support to TB Laboratories, providing the latest practical guidance on use of newly recommended diagnostics in model algorithms, as well as guidance in key technical areas, including quality assurance and quality management systems, specimen collection and registration, procurement and supply-chain management, diagnostics connectivity, biosafety, data management, human resources, strategic planning and other topics. Providers of technical assistance may also use the guide as a reference for available resources and tools.

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Framework of indicators and targets for laboratory strengthening under the End TB Strategy

This Framework, developed as a collaboration between the WHO Global TB Programme and the GLI core group, comprises 12 core indicators that measure countries’ capacity to detect TB accurately and rapidly using new diagnostics, provide universal DST, and ensure the quality of testing. The Framework serves as a guide for all countries developing plans for laboratory strengthening during 2016-2025, and also provides methods for calculating country-specific targets for the numbers of tests and facilities needed for each of the main diagnostic technologies.

Laboratory Diagnosis of Tuberculosis by Sputum Microscopy - The GLI Handbook

Guidelines for sputum smear microscopy have been published by WHO and The Union, but in the decade since publication, many developments have occurred and a revised and updated text replacing both was considered timely. The GLI Handbook is a practical guide for the laboratory technician; it draws on the ideas outlines above and references best practice documents released by WHO and the GLI. The Handbook uses simple text and clear illustrations to assist laboratory staff in understanding the important issues involved in conducting sputum smear microscopy for the diagnosis of TB.

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GLI TB Microscopy Network Accreditation: an Assessment Tool

Although there are many international guidelines and technical materials for procedures and EQA, there is little or no external validation to assure that countries are adequately managing the microscopy networks. This accreditation tool is based on the many WHO-approved guidelines that provide technical direction, recommendations and specific forms to document and monitor performance of microscopy networks. The tool is composed of eleven standards with each a corresponding measure defining the minimum allowable performance to achieve accreditation.

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GLI/NDWG Meeting report on high-priority target product profiles for new TB diagnostics

Diagnostic manufacturers are increasingly expressing the need to be informed about the type of TB diagnostics they should invest in, as well as the potential market size for these products. The development of target product profiles (TPPs) is therefore an important step to align the needs of end-users with the specifications and targets that product developers should meet in terms of the performance and operational characteristics of such tests. Consensus on the minimal and optimal specifications of four different types of TB diagnostic tests has been reached following a meeting convened by WHO on behalf of GLI and the New Diagnostics Working Group.

GLI Ventilated Workstation Manual for AFB Smear Microscopy


Laboratories performing AFB smear microscopy as well as Xpert MTB/RIF require adequate ventilation to minimize the occupational risk of infection. However, this is difficult to achieve in many settings where facilities have limited airflow, and where commercially produced biosafety cabinets are not affordable or appropriate. This guide provides specifications for the manufacture of a ventilated workstation that has been validated.

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