A review of tuberculosis diagnostic guidelines: identification of areas of consensus and divergence to support diagnostic access decision-making

Tuberculosis (TB) remains a leading cause of infectious disease morbidity and mortality worldwide despite substantial advances in diagnostic technologies. Multiple international and national organizations have developed evidence-based recommendations for TB diagnosis; however, differences in guidance can create uncertainty for laboratories, clinicians, and policymakers implementing diagnostic services. Understanding areas of consensus and divergence may facilitate evidence-informed decision-making and improve access to appropriate TB diagnostics. This minireview compares major TB diagnostic guidelines from the World Health Organization and organizations in Canada, the United States, Europe, the United Kingdom, and Australia, highlighting areas of consensus and divergence. While substantial agreement exists regarding the core components of TB diagnosis, recommendations differ in the positioning of molecular diagnostics, specimen selection, biomarker use, sequencing technologies, and treatment monitoring. Understanding the factors underlying these differences, including epidemiology, laboratory capacity, resource availability, and approaches to evidence appraisal, can support context-specific implementation of diagnostic strategies, improve equitable access to high-quality TB diagnostics, and identify priorities for future research and guideline harmonization.