Tuberculosis (TB)

WHO TB Supranational Reference Laboratory Network

TB diagnostics and laboratory strengthening


Lack of diagnostic capacity is a crucial barrier preventing from an effective response to the challenges of TB-HIV and drug-resistant TB (DR-TB). Only 28% of the estimated burden of DR-TB patients were detected in 2013.

Several operational research studies conducted in different settings have shown that lack of laboratory capacity is the main bottleneck also for the surveillance of resistance to anti-TB drugs (DRS), whereas estimation models and projections have confirmed that an effective response to the diagnostic challenges of TB-HIV and DR-TB requires urgent and massive scale-up of laboratory services.

However, establishing, equipping, financing, and ensuring sustainability of appropriate laboratory networks are challenging, complex and expensive. Hence, strong and tailored interventions to expand TB laboratory services are needed and address different tiers of laboratories with different levels of testing.

Towards these aims, the TB Supranational Reference Laboratory (SRL) Network was created in 1994 in order to support the WHO Global Project on TB drug resistance surveillance and with the objectives to estimate the magnitude of drug resistance globally and provide data to inform WHO policy decisions.

Since 1994 the SRL Network has grown to be a key technical resource in supporting the strengthening of laboratory capacity in countries. Under WHO coordination and support, the Network today has expanded to comprise 31 SRLs, 1 Candidate-SRL, and four National Centres of Excellence (NCE-SRL), largely driven by regional initiatives and institutional interest (see below SRL Network list).

SRL Network map

Global SRL Network Database and Repository of Reports

Improved coordination of technical assistance provided by the SRLs remains a key priority for the Network. To this aim, a Global Repository of technical reports from the SRLs and collaborative Partners (see below) has been established and is publicly available, which should constitute a key instrument for the coordination and continuous monitoring of SRL Network activities globally. The Database provides contact details and technical information on the Supranational TB Reference Laboratories and shows their current links to the National Reference Laboratories in countries.

Factsheet, Terms of Reference and Templates

Since 2010, new Terms of Reference as well as new eligibility and inclusion criteria for the SRL network have been developed (see documents below). Formal collaboration agreements (see also below) now need to be established between an SRL and the National Health Authority or Ministry of Health acting as TB Reference Laboratory at National level (NRL). The collaboration agreements describe the expected roles to be played by the SRL and NRL, and position the SRLs as the leading technical partner for guiding laboratory scale-up and capacity development in countries.