Editorial Tuberculosis diagnostic networks: Moving beyond the laboratory to end tuberculosis in Africa

Tuberculosis is a curable disease when diagnosed early and treated with an appropriate drug regimen, yet 750 000 Africans die unnecessarily every year from tuberculosis. We know that when a person with tuberculosis is treated in Africa, 81% will be cured – and even those infected with HIV are cured most of the time. Tragically, less than half of all Africans with tuberculosis are diagnosed and started on treatment. This vastly low tuberculosis case detection contributes to unacceptably high rates of death from tuberculosis in Africa. Deaths attributed to tuberculosis, among both HIV-negative and HIV-positive people in Africa, are higher than any region in the world – more than twice the global rate among HIV-negative people, and five times higher among people with HIV. The need for more accurate, faster technologies to diagnose tuberculosis in sub-Saharan Africa is more urgent than ever before. In 2015, 2.7 million Africans fell ill with tuberculosis (30% of whom were infected with HIV); however, only 48% sought and received a diagnosis and were reported to national tuberculosis programmes. Consequently, over 1.4 million people were undiagnosed and likely transmitted tuberculosis to their families and communities for weeks and months, until their probable death. Of these undiagnosed cases, more than 80 000 have multi-drug resistant tuberculosis. Although undiagnosed tuberculosis is a small proportion of the overall missing cases, increasing prevalence of multi-drug resistant tuberculosis will eventually diminish Africa’s current successes toward stopping the tuberculosis epidemic