WHO Recommends New TB Diagnostic Tools as Researchers Develop Inhalable Treatment

The World Health Organization has issued new guidelines recommending portable, point-of-care diagnostic tests for tuberculosis that can deliver results in less than one hour and cost less than half of existing molecular diagnostics. Simultaneously, researchers have developed an inhalable nanoparticle treatment that could replace months of daily pills, potentially reducing side effects and improving patient adherence.

The new WHO-recommended diagnostic tools are portable, simple-to-use tests that bring TB diagnosis closer to where people routinely seek care. These tests can operate on battery power and deliver results in less than one hour, allowing patients to start treatment sooner. Available at less than half the cost of many existing molecular diagnostics, they can help countries expand access to testing.

The guidelines also recommend easy-to-collect tongue swab samples, as well as a cost-saving sputum pooling strategy to increase testing efficiency for TB and rifampicin-resistant TB. Tongue swabs allow adults and adolescents who cannot produce sputum to receive TB testing for the first time, enabling disease detection among people who are at an increased risk of dying from TB. Sputum pooling, where samples from several individuals are combined and tested together, can significantly reduce commodity costs and machine time, leading to faster results for people and TB programmes.

Beyond TB, these devices have the potential to test for other diseases like HIV, mpox, and HPV, making diagnostics more patient-centered, equitable, and aligned with one-stop-shop style services for emerging and circulating diseases.

Meanwhile, scientists have engineered an inhalable nanoparticle system that keeps a critical TB drug in the lungs longer, raising the possibility of less frequent dosing and fewer systemic side effects. The research describes a biocompatible nanoparticle system designed to be inhaled that can modulate the immune system and is engineered to carry rifampin, one of the most widely used and important drugs for treating TB.

The study found that inhaled nanoparticle treatment delivered rifampin much more effectively to the lungs. Compared to taking rifampin by mouth every day, the inhaled nanoparticles kept higher levels of the drug in the lungs for much longer — up to a week after a single dose. Because the inhaled form allows rifampin to remain in lung tissue for longer periods, patients might eventually need treatment only once a week instead of daily.

TB remains one of the world's deadliest infectious killers. Each day, over 3300 people die from TB and more than 29,000 people fall ill with this preventable and curable disease. Though preventable, treatable and curable, TB remains the world's deadliest infectious disease, claiming 1.2 million lives in 2024.

Global efforts to combat TB have saved an estimated 83 million lives since 2000, however cuts in global health funding are threatening to reverse these gains. Uptake of rapid diagnostic tools has been a challenge in many countries due, in part, to high costs and reliance on sample transport to support testing at centralized laboratories.

The potential public health benefits of the inhalable treatment research extend beyond tuberculosis. Rifampin is not just a TB drug; it is also a key medication for other serious lung infections caused by non-tuberculous mycobacteria, such as Mycobacterium kansasii and Mycobacterium xenopi, which are increasingly recognized in the U.S. These infections often affect people with chronic lung disease and can be difficult to treat.

Global funding for TB research remains far below the estimated annual need of around US$ 5 billion, leaving major gaps in the development of new diagnostics, medicines and vaccines needed to end the epidemic. Sustained investment in health systems, including advanced diagnostics and innovations, can simplify and expand access to testing and treatment, which are essential to ending TB by 2030.