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At present most high prevalence countries can treat only a minority of those who meet the clinical criteria, even with substantial external assistance.
Most high prevalence countries continue to use slow culture-based methods to investigate suspected MDR-TB cases and new simple, rapid tests are needed that are affordable in these settings.
Moreover, routine screening of clinical isolates with WGS is currently not feasible in most high prevalence MDR-TB settings, while a robust and dedicated method like MLPA is more practical to implement.
Most high prevalence countries are in sub-Saharan Africa, perhaps making them programmatically different from most low prevalence countries in Latin America, the Caribbean, South/Southeast Asia, and the former Soviet Union.
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Agencies engaged in humanitarian efforts to prevent the further spread of HIV have emphasized the importance of voluntary counseling and testing (VCT), and most high-prevalence countries now have facilities that offer testing free of charge.
Unfortunately, availability of this treatment in most high-prevalence countries is poor.
In 2016, UNICEF, together with UNFPA, launched a global programme to tackle child marriage in 12 of the most high-prevalence or high-burden countries: Bangladesh, Burkina Faso, Ethiopia, Ghana, India, Mozambique, Nepal, Niger, Sierra Leone, Uganda, Yemen and Zambia.
There is no shortage of labour in most high-prevalence contexts, so human resource constraints would mostly relate to accessing or skilling human resources.
Ideally, routine drug susceptibility testing (DST) should be conducted before initiation of treatment in all patients with TB, but this is not achievable in most high-prevalence countries because of poor access to bacterial culture and DST tools.
Drug-resistant tuberculosis (DR-TB) requires much longer and more costly treatment regimens than drug-susceptible tuberculosis, and in most high HIV prevalence settings, there is limited capacity for diagnosis.
We believe that our findings are reliable and generalizable to most high TB/HIV prevalence resource-limited settings.
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CEO of Professional Science Editing for Scientists @ prosciediting.com