The World Health Organization (WHO) has released a new note outlining anticipated updates to recommendations that broaden the range of acceptable specimens and techniques for tuberculosis (TB) testing. These updates will be included in the next edition of the consolidated TB diagnostic guidelines, which the WHO plans to publish later this year. Among the new features, the upcoming guidelines introduce a class of near-point-of-care NAATs and confirm that tongue swabs can be used with these systems for adults and adolescents who are unable to produce sputum. The document also discusses sputum pooling as a strategy that laboratories may adopt when resources are limited, combining multiple specimens into a single test to lower costs and increase throughput.
Tongue swabbing reaches formal recognition
The inclusion of tongue swabs marks a significant shift in TB sampling practices. The WHO describes tongue swabs as “readily available and easy to collect” and states their suitability for molecular tests at peripheral healthcare levels, including low-complexity automated platforms. Tongue swabs are considered particularly useful for individuals who cannot expectorate sputum, a common issue among several patient groups, including adolescents, some adults with minimal symptoms, and people living with HIV.
Other public health reports underscored the importance of this technique. A recent summary by Médecins Sans Frontières notes that many people with TB do not produce sputum despite contributing to transmission, and that simple swab collection could improve diagnostic access to meet real-world needs.
This development aligns with long-term efforts on swab-based TB specimen collection: over the years, studies often relied on FLOQSwabs® to standardize collection, and the recognition in a global guideline gives formal visibility to a method that has been under review for over a decade in both academic and field settings. The upcoming WHO consolidated guideline will instruct national programs to adopt this method, integrating it into diagnostic workflows instead of treating it as an exception.
Sputum pooling as a cost-management strategy
In parallel, the WHO guidance highlights sputum pooling as a way to stretch laboratory capacity without compromising test accuracy. The pooling approach, described in the same WHO document, applies to low‑complexity automated NAATs used for both TB detection and rifampicin resistance testing. This method can help programs manage high testing volumes in resource-limited environments: by allowing batches of specimens to be tested collectively, laboratories can reduce cost per result and free up instruments for confirmatory testing or follow‑up investigations.
Near‑Point‑of‑Care Molecular Testing
The WHO update also describes a new category of near-point-of-care NAATs, positioned between traditional centralized molecular testing and fully portable systems. The organization states that these platforms can operate in primary healthcare centers and community settings, offering lower unit costs and simpler workflows. Their compatibility with non-sputum samples helps expand diagnostic coverage to groups that have traditionally been under-tested.
From policy to implementation: a toolkit for country programs
On 6 May 2026, WHO and the Stop TB Partnership jointly released the TB near point-of-care and swab-based testing toolkit, led by the WHO’s HIV, TB, Hepatitis, and STI Testing and Diagnostics team and developed in collaboration with the Global Laboratory Initiative Core Group and the R2D2 TB Network. The package was built around one of the trickiest aspects of the new guidelines: countries receiving a new WHO recommendation often spend months constructing their own verification protocols and monitoring spreadsheets from scratch. The toolkit addresses that directly, with ready-to-adapt materials covering readiness assessment, staff competency checks, standard operating procedures for tongue swab and sputum specimen collection, and a site-level calculator that accounts for both instrument capacity and local battery supply, a detail that reflects how NPOC platforms are expected to perform in facilities without reliable grid power. Countries can access the full toolkit through the Stop TB Partnership’s Global Laboratory Initiative page, and the WHO has indicated that the formal consolidated guideline, incorporating NPOC-NAATs, tongue swabs, and sputum pooling, will follow later this year.
Mycobacteria culturing remains vital
While the WHO update focuses on specimen types and molecular workflows, this occurs within a broader context that includes culture-based confirmation and drug susceptibility testing. As programs adopt tongue swabbing, pooling, and molecular workflows, upstream detection may become quicker, which could lead to more referrals for confirmatory or extended resistance testing, where systems like MycoTB continue to support laboratories with structured, reproducible workflows.
What should we expect next?
Diagnostic gaps remain a significant barrier to TB control, but the changes outlined by the WHO reflect practical considerations: simpler specimen collection, lighter instrumentation requirements, and resource-conscious laboratory practices. According to the WHO, the full updated policy will appear in the second edition of the consolidated TB diagnostic guidelines later this year. Countries will then be able to align procurement plans, algorithm updates, and training materials with the new recommendations.
Bibliography
- https://www.who.int/publications/digital/global-tuberculosis-report-2021/featured-topics/tb-guidelines
- https://www.msf.org/report-near-point-care-tests-tuberculosis
- https://www.stoptb.org/who-we-are/stop-tb-working-groups/global-laboratory-initiative-gli/gli-guidance-and-tools/tb-near-point-care-and-swab-based-testing-toolkit
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