Near point-of-care tests, tongue swabs, and sputum pooling for TB
To support countries in their efforts to strengthen detection of tuberculosis (TB) disease and drug resistance, WHO issues evidence-based policy guidance on TB testing that is routinely updated.
Since the most recent consolidated guidelines on TB diagnosis were issued in 2025, evidence became available on new tests, sample types, and strategies for the initial diagnosis of TB with and without drug resistance detection. In an updated edition that will be published shortly, WHO is recommending for the first time, new near-point-of-care (NPOC) molecular tests for the diagnosis of TB; easy-to-collect tongue swab samples to simplify and expand access to testing; and a cost-saving sputum pooling strategy to increase testing efficiency for TB and rifampicin-resistant TB.
The new guidelines on TB diagnosis recommend:
A new class of near-point-of-care nucleic acid amplification tests (NPOC-NAATs) for the initial detection of TB without rifampicin resistance at peripheral levels of the health system (i.e., peripheral laboratories, primary healthcare centers and communities) and at lower unit costs than other molecular test and instrument types;
Tongue swabs as new, readily available and easy-to-collect specimens for use with NPOC-NAATs and low-complexity automated NAATs (LC-aNAATs) for the initial detection of TB with and without rifampicin resistance among adults and adolescents that are unable to produce sputum; and
Pooling of sputa as a diagnostic strategy for the initial detection of TB and rifampicin resistance using LC-aNAATs with the potential to improve turnaround times and costs when resources are constrained.
The pages NPOC-NAATs, Tonge swabs on LC-aNAATs, Sputum pooling and Methods provide information on the methods for new policy development, provide descriptions of the new testing classes, sample types, and strategy, and presents the new recommendations and remarks with summaries of the evidence that was used for their establishment.
Next steps
The complete policy for the diagnosis of TB and drug-resistant TB will be released this year in a second edition of the WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis. The summary of findings and the evidence to decision tables will be produced in conformity with the GRADE method and made available on the WHO website.
The updated guidelines will be accompanied by the WHO operational handbook on tuberculosis. Module 3: Diagnosis. 2nd edition. The handbook will provide guidance on all technologies, sample types and strategies currently recommended, steps to introducing new TB diagnostics into a health programme and the model algorithms for testing and clinical management.
The updated guidelines will also be accompanied by a WHO toolkit for near point-of-care and swab-based tuberculosis testing that will outline key steps for implementation of these new tools and provide customizable planning, readiness assessment, testing, training, and monitoring and evaluation materials to facilitate program uptake.
The release of the new guidance will be followed by a series of WHO and partner organization webinars for different regions and audiences. The updates will also be included on the online WHO TB Knowledge Sharing Platform providing easy access to the guidelines and operational handbook in one place.
The guidelines, operational guidance, toolkit, webinars and the Knowledge Sharing Platform will support countries in updating their national guidelines, training staff, informing programme budgets and facilitating the transition to the use of the new interventions. National TB programmes and other stakeholders are encouraged to seek advice from WHO before introducing the latest technologies recommended in the revised guidelines.