With a Tiny Device, the Fight Against TB Takes a Giant Step Forward
In 2024, Zambia endured a debilitating drought – the worst in a generation. The effects were felt across nearly every aspect of daily life, including the country’s health systems.
As rivers and reservoirs receded, Zambia's electricity supply was pushed to the brink of collapse. With more than 80% of its electricity coming from hydropower, the country saw power generation fall to historic lows as the drought took hold. Blackouts disrupted businesses, brought production lines to a halt, and curtailed public services. Among the less visible consequences of the power cuts was the impact on tuberculosis (TB) diagnosis.
Much of the world’s large-scale TB testing depends on big molecular diagnostic machines. These machines are highly accurate, but they are expensive to maintain, require stable electricity and often need air-conditioned environments to function properly. As the energy crisis deepened across Zambia, TB testing on large diagnostic machines began to break down.
“We had challenges, we could go for hours without power,” said Dr. Eddie Solo, Head of the Tuberculosis Laboratory at the University Teaching Hospital in Lusaka. “We tried to install back-up systems, but we could not cover the power lost.”
But standing in his bustling laboratory, Dr. Solo pointed to a device that fits easily in the palm of his hand – and offers an answer to that challenge. “The new device is battery operated; it makes a big difference.”
Known as a near-point-of-care (NPOC) test, the machine is designed to operate with minimal power. In settings where electricity is scarce or unreliable, the test’s low power requirements could make all the difference. Unlike the large diagnostic platforms that dominate much of the world's TB infrastructure, NPOC devices can be used in primary healthcare centers – where most people with TB first seek care – helping close a critical gap in the TB response: timely diagnosis at the community level.
Their significance extends far beyond Zambia.
TB remains the world’s deadliest infectious disease. In 2024 alone, TB claimed more than 1.2 million lives around the world. That same year, 10.7 million people fell ill with the disease, among them an estimated 2.4 million who were “missed” by health systems – left undiagnosed, untreated or unreported. Those who are missed are at risk not only of dying from the disease, but also of transmitting the infection to as many as 15-20 other people each year.
Once diagnosed, treatment is highly effective, with global treatment success rates close to 90%. The challenge is to identify people early enough – before the disease takes a devastating toll on their health, potentially becoming fatal, and before they unknowingly spread it to others.
That is why new NPOC tests matter. By bringing high-quality diagnostics closer to people – especially those in underserved and remote communities – health workers can identify more people with the disease, faster.
Over the coming months, a partnership led by the Global Fund, the Children's Investment Fund Foundation (CIFF) and implemented by the Aurum Institute will deliver nearly 3 million of these tests to people in countries including Bangladesh, Benin, Cameroon, Ethiopia, Indonesia, Kenya, Nigeria, Peru, the Philippines, South Africa, Uganda, Viet Nam and Zambia.
These deliveries could change the game in the fight against TB. Benin’s Minister of Health, Benjamin Hounkpatin, whose country was first in line to receive the diagnostics this June, captured the spirit of the moment: “This marks a major step forward in our efforts to make quality TB services accessible to all, including people living in remote communities. By bringing rapid, accurate diagnosis closer to the front lines of care, we can find people earlier, begin treatment faster and save many lives.”
Delivering results in under an hour, this new class of NPOC tests offers significantly greater accuracy than smear microscopy, which has long been the sole diagnostic tool in many decentralized settings.
For countries facing the dual challenge of a high TB burden and fragile or overstretched health systems – strained by conflict, emerging disease outbreaks and increasingly frequent extreme weather events – the potential of these devices is immense.
This new tool also complements more centralized molecular diagnostic platforms like GeneXpert, which remain essential to perform additional testing for people who test positive following an NPOC test, such as diagnosing drug-resistant TB. As more people are tested at the primary care level, demand for drug-resistant TB testing is expected to grow.
“These new tools are transformative for TB diagnosis, but we do not see them as a replacement for existing molecular tests. Rather, they are a powerful complement to the diagnostic tools already in use – that can help accelerate efforts to find the millions of missing people with TB,” said Dr. Eliud Wandwalo, Head of Tuberculosis at the Global Fund.
For the TB community, which has endured decades of a historically neglected innovation pipeline — from century-old microscopy used for diagnosis, to a century-old vaccine, to treatments for drug-resistant TB marked by severe and debilitating side effects – this breakthrough is especially significant.
The near-point-of-care tool adds momentum to a growing wave of innovations in TB care in the last few years and marks another major milestone on the path to defeating one of humanity’s oldest and deadliest diseases.
““For far too long, TB has been the forgotten pandemic,” said Dr. Wandwalo. “With a rejuvenated product pipeline that has given us tools like NPOC among others, we can supercharge the response and finally consign this disease to the past.”