New and improved tuberculosis diagnostics: evidence, policy, practice, and impact.
OBJECTIVE
The aim is to summarize the evidence base for tuberculosis (TB) diagnostics, review recent policies on TB diagnostics, and discuss issues such as how evidence is translated into policy, limitations of the existing evidence base, and challenges involved in translating policies into impact.


RESULTS
Case detection continues to be a major obstacle to global TB control. Fortunately, due to an unprecedented level of interest, funding, and activity, the new diagnostics pipeline for TB has rapidly expanded. There have been several new policies and guidelines on TB diagnostics. However, there are major gaps in the existing pipeline (e.g. lack of a point-of-care test) and the evidence base is predominantly made up of research studies of test accuracy.


CONCLUSIONS
With the availability of new diagnostics and supporting policies, the next major step is translation of policy into practice. The impact of new tests will depend largely on the extent of their introduction and acceptance into the global public sector. This will itself depend in part on policy decisions by international technical agencies and national TB programs. With the engagement of all key stakeholders, we will need to translate evidence-based policies into epidemiological and public health impact.
Pai
Madhukar
M
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. madhukar.pai@mcgill.ca
Minion
Jessica
J
Steingart
Karen
K
Ramsay
Andrew
A
D003140:Communicable Disease Control / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D005260:Female; D014943:Global Health; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007391:International Cooperation; D008297:Male; D011050:Policy Making; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D014944:World Health Organization