2.2 Diagnostic testing

An essential step in the pathway of tuberculosis (TB) care is rapid and accurate diagnostic testing. Since 2011, rapid molecular tests that are highly specific and sensitive have transformed the TB diagnostic landscape, which previously relied upon more traditional microscopy and culture methods.

People diagnosed with TB using rapid molecular tests recommended by WHO (1), lateral flow urine lipoarabinomannan (LF-LAM) assays, sputum smear microscopy or culture are defined as “bacteriologically confirmed” cases of TB (2). The microbiological detection of TB is critical because it allows people to be correctly diagnosed and started on the most effective treatment regimen as early as possible. People diagnosed with TB in the absence of bacteriological confirmation are referred to as “clinically diagnosed” or “bacteriologically unconfirmed” cases of TB (2,3).

Bacteriological confirmation of TB is necessary to test for resistance to anti-TB drugs. This can be done using rapid molecular tests, phenotypic susceptibility testing or genetic sequencing.

Fig. 2.2.1 provides an overview of global numbers in 2025 related to diagnostic testing for TB as well as resistance to 2 first-line drugs: rifampicin and isoniazid.

Fig. 2.2.1 Global overview of numbers^a related to TB diagnosis as well as testing for resistance to rifampicin and isoniazid, 2025

Rapid diagnostic testing

At the second United Nations (UN) high-level meeting on TB in 2023, Member States adopted a new target that, by 2027, 100% of people diagnosed with TB should be initially tested with a WHO-recommended rapid diagnostic test (WRD) (4).

Globally, there is a big gap between the number of people newly diagnosed with TB and the number of these people who were initially tested with a WRD (Fig. 2.2.1 above).

A WRD was used as the initial diagnostic test for 59% (4.9 million) of the 8.4 million people newly diagnosed with TB in 2025, an increase from 54% (out of a total of 8.3 million) in 2024 and up from 48% (out of a total of 8.2 million) in 2023 (Fig. 2.2.2). Among WHO regions, the best level of coverage was achieved in the Eastern Mediterranean Region (66%) and the Western Pacific Region (76%); the lowest coverage was in the South-East Asia Region (47%).

Fig. 2.2.2 Percentage of people newly diagnosed with TB who were initially tested with a WHO-recommended rapid diagnostic test (WRD), globally and for WHO regions, 2015–2025^a

Use of WRDs varied substantially among countries in 2025 (Fig. 2.2.3).

Fig. 2.2.3 Percentage of people newly diagnosed with TB who were initially tested with a WHO-recommended rapid diagnostic test (WRD),^a 2025

Among the 30 high TB burden countries, those with high proportions (≥80%) of people newly diagnosed with TB who were initially tested with a WRD in 2025 included Cambodia, China, Mongolia, Namibia, the Philippines, South Africa, the United Republic of Tanzania and Zambia (Fig. 2.2.4).

Among the 50 countries in one of the 3 global lists of high burden countries (for TB, HIV-associated TB and RR-TB) being used by WHO in the period 2026–2030 (Annex 3 of the core report document), 35 reported that a WRD had been used as the initial test for more than half of their notified TB cases in 2025. This was down from 38 in 2024 although still better than in 2023 (30 countries). Countries in which there was a noticeable reduction between 2024 and 2025 included the Central African Republic, the Congo, the Democratic Republic of the Congo, Mozambique and Papua New Guinea.

Fig. 2.2.4 Percentage of people newly diagnosed with TB who were initially tested with a WHO-recommended rapid diagnostic test (WRD), 30 high TB burden countries, 2015–2025

A major influence on the coverage of rapid testing is the proportion of TB diagnostic sites with access to WRDs. In 2025, this varied considerably by country (Fig. 2.2.5). Only 9 of the 30 high TB burden countries reported that more than 50% of their TB diagnostic sites had access to WRDs: Bangladesh, China, Lesotho, Mongolia, Namibia, Nigeria, Papua New Guinea, South Africa and Zambia. Expanding access to TB diagnosis using rapid tests should be a top priority for all countries.

Fig. 2.2.5 Proportion of diagnostic sites for TB with access to WHO-recommended rapid diagnostic tests (WRDs), by country, 2025

Bacteriological confirmation

A global total of 8.4 million people were newly diagnosed with TB and notified as a TB case in 2025; of these, 7.2 million (86%) had pulmonary TB (Fig. 2.2.1, Table 2.1.1 of Section 2.1). Worldwide, the percentage of people diagnosed with pulmonary TB based on bacteriological confirmation was 65%, a slight improvement from 64% in 2024 (Fig. 2.2.6). Among the six WHO regions, there have been steady improvements in the African Region (from 65% to 71% between 2020 and 2025) and the Western Pacific Region (from 54% to 60% between 2020 and 2025); there was also an improvement in the Eastern Mediterranean Region between 2024 and 2025, from 55% to 59%. In other regions, levels of bacteriological confirmation have remained stable or fallen slightly. Efforts to reach the level already achieved in the Region of the Americas (80% in 2025) are required in other regions.

Fig. 2.2.6 Percentage of people newly diagnosed with pulmonary TB who were bacteriologically confirmed, globally and for WHO regions,^a 2010–2025

In 2025, there was considerable country variation in the proportion of people newly diagnosed with pulmonary TB who were bacteriologically confirmed (Fig. 2.2.7).

Fig. 2.2.7 Percentage of people newly diagnosed with pulmonary TB who were bacteriologically confirmed, by country,^a 2025

In the 30 high TB burden countries (Fig. 2.2.8 below), variation in the proportion of people diagnosed with pulmonary TB who were bacteriologically confirmed likely reflects differences in diagnostic and reporting practices, including access to rapid diagnostic tests. The countries with relatively high levels of bacteriological confirmation in 2025 (75% or above) were Bangladesh, Mongolia, Namibia, Nigeria and Viet Nam.

There is clear scope for improvement in most other high TB burden countries. This is particularly needed in the Democratic People’s Republic of Korea, Mozambique, Pakistan, Papua New Guinea and the Philippines, where levels of bacteriological confirmation remained around or below 50% in 2025. Such levels of bacteriological confirmation show overdependence on clinical diagnosis of TB and potentially over-diagnosis. When the proportion of people diagnosed with pulmonary TB based on bacteriological confirmation falls to around or below 50%, a review of the diagnostic tests in use and the validity of clinical diagnoses is warranted (e.g. via a clinical audit).

In the Democratic Republic of the Congo, the level of bacteriological confirmation declined steadily from 2015–2025 (from 83% to 71%). Recent increases in the number of people notified as a new or recurrent case of TB may have resulted from an overreliance on clinical diagnosis of TB (Fig. 2.1.3 of Section 2.1).

Among the other 30 high TB burden countries, 7 have made considerable progress in recent years: China, the Congo, Ethiopia, South Sudan, Thailand, the United Republic of Tanzania and Uganda.

Fig. 2.2.8 Percentage of people newly diagnosed with pulmonary TB who were bacteriologically confirmed, 30 high TB burden countries,^a 2010–2025

Resistance to rifampicin

Bacteriological confirmation of TB is required to test for drug resistance. To ensure that people are enrolled on the right TB treatment regimen, all those diagnosed with bacteriologically confirmed TB should be tested for resistance to rifampicin (the most effective first-line anti-TB drug) (5).

Globally in 2025, 85% of people with bacteriologically confirmed TB were tested for rifampicin resistant TB (RR-TB). This was unchanged from 85% in 2024, but major progress compared with 71% in 2020 and enormous progress compared with 31% in 2015 (Fig. 2.2.9), driven by country efforts to adopt and use WRDs that support on-site resistance testing. There has been substantial progress in recent years in all 6 WHO regions. In 2025, the highest coverage of testing was in the European Region (92%), the South-East Asia Region (95%) and the Western Pacific Region (95%).

Fig. 2.2.9 Percentage of people diagnosed with bacteriologically confirmed TB who were tested for rifampicin-resistant TB (RR-TB^a), globally and for WHO regions, 2010–2025

In 2025, there was considerable variation among countries in the coverage of testing for RR-TB (Fig. 2.2.10). Of the 30 countries (see Annex 3 of the core report document) that WHO has defined as high burden for RR-TB, 22 reached a coverage of at least 80% in 2025: Afghanistan, Angola, Azerbaijan, China, Guinea, India, Indonesia, Kazakhstan, Kyrgyzstan, Mongolia, Myanmar, Pakistan, Papua New Guinea, Peru, the Russian Federation, Somalia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan, Viet Nam and Zambia. There were 3 high RR-TB burden countries that did not reach a coverage level of 50%: the Democratic People’s Republic of Korea (1.9%), the Democratic Republic of the Congo (30%) and Mozambique (2.2%).

As countries implement new diagnostic tools, prioritization of easy-to-collect sample types, strategies for expanding initial WRD testing at the peripheral levels of the health system, and strategies for improving the coverage of testing for RR-TB and other forms of drug resistance, are all crucial.

Fig. 2.2.10 Percentage of people diagnosed with bacteriologically confirmed TB who were tested for rifampicin-resistant TB (RR-TB^a), by country, 2025

Among people tested for RR-TB, 155 333 people were diagnosed with RR-TB and enrolled on treatment in 2025 (Table 2.1.1 of Section 2.1). This was a decrease (-5.8%) from 164 960 in 2024 (Fig. 2.4.1 of Section 2.4).

Resistance to fluoroquinolones and bedaquiline

Fluoroquinolones (a class of second-line anti-TB drug), bedaquiline and linezolid are recommended by WHO as part of treatment regimens for people with drug-resistant TB (5).

All those with RR-TB should be tested for pre-extensively drug-resistant TB (pre-XDR-TB), defined as resistance to rifampicin as well as any fluoroquinolone (6). Those with pre-XDR-TB should be tested for extensively drug-resistant TB (XDR-TB), defined as resistance to rifampicin, any fluoroquinolone and at least one of either bedaquiline or linezolid.

There are major gaps in the global cascade of diagnostic testing for pre-XDR-TB and XDR-TB (Fig. 2.2.11).

Fig. 2.2.11 Global cascade of diagnostic testing^a for rifampicin-resistant TB, pre-XDR-TB and XDR-TB, 2025

Globally in 2025, the percentage of people diagnosed with RR-TB who were tested for resistance to fluoroquinolones was 58%, the same level as in 2024 (Fig. 2.2.12). Among WHO regions in 2025, coverage was highest in the WHO European Region (95%) and lowest in the Western Pacific Region (42%).

Fig. 2.2.12 Percentage of people diagnosed with rifampicin-resistant TB (RR-TB) who were tested for resistance to fluoroquinolones,^a globally and for WHO regions, 2015–2025

In 2025, there was considerable variation at country level in the percentage of people with RR-TB who were tested for resistance to fluoroquinolones (Fig. 2.2.13).

Fig. 2.2.13 Percentage of people diagnosed with rifampicin-resistant TB (RR-TB) who were tested for resistance to fluoroquinolones, by country, 2025

In 2025, the number and percentage of people diagnosed with pre-XDR-TB who were tested for resistance to bedaquiline remained low (Fig. 2.2.11, Fig. 2.2.14).

Fig. 2.2.14 Percentage of people diagnosed with pre-XDR-TB^a who were tested for resistance to bedaquiline, by country, 2025

The coverage of testing for resistance to bedaquiline for all people diagnosed with RR-TB was lower still (Fig. 2.2.15).

However, a total of 23 countries reached a coverage of at least 80% in 2025: Armenia, Belgium, Costa Rica, Czechia, Egypt, Estonia, Germany, Iraq, Ireland, Kyrgyzstan, Latvia, Lebanon, Nigeria, Norway, Poland, Portugal, the Republic of Moldova, São Tomé and Príncipe, Saudi Arabia, Slovenia, Sweden, Switzerland and the United Kingdom of Great Britain and Northern Ireland.

Fig. 2.2.15 Percentage of people diagnosed with rifampicin-resistant TB (RR-TB) who were tested for resistance to bedaquiline, by country, 2025

In 2025, the percentage of people with pre-XDR-TB who were tested for resistance to linezolid varied substantially (Fig. 2.2.16). However, 48 countries and areas reached a coverage of at least 80% in 2025.

Fig. 2.2.16 Percentage of people diagnosed with pre-XDR-TB^a who were tested for resistance to linezolid, by country, 2025

HIV status

Of the 8.4 million people newly diagnosed with TB globally in 2025, 83% had a documented HIV test result, up from 82% in 2024 and 81% in 2023 (Fig. 2.2.17). At regional level, the highest percentages were achieved in the WHO African Region (88%), the Region of the Americas (89%), the European Region (93%) and the South-East Asia Region (90%).

Fig. 2.2.17 Percentage of people newly diagnosed with TB whose HIV status was documented,^a globally and for WHO regions,^b 2010–2025

There was considerable variation at national level (Fig. 2.2.18). In 102 countries and areas, at least 90% of people diagnosed with TB knew their HIV status; this included 34 out of 47 countries in the WHO African Region, where the burden of HIV-associated TB is highest. In most countries, the percentage was above 50%. However, in 20 countries and areas in 2025, less than half of the people diagnosed with TB knew their HIV status: Algeria, Argentina, Bangladesh, Canada, Croatia, the Democratic People’s Republic of Korea, Gabon, Hungary, Italy, Japan, Libya, Maldives, New Caledonia, Serbia, Singapore, Sint Maarten (Dutch part), Slovakia, the Solomon Islands, Sudan and Vanuatu. This was an increase from 17 countries and areas in 2024.

Fig. 2.2.18 Percentage of people newly diagnosed with TB whose HIV status was documented, by country, 2025

Worldwide in 2025, a total of 405 436 new cases of TB among people living with HIV were notified (Table 2.1.1 of Section 2.1), equivalent to 5.9% of the 6.9 million people diagnosed with TB who had an HIV test result. Globally, the percentage of people diagnosed with TB who had an HIV-positive test result has been falling for many years, following a peak at 28% in 2006. WHO has compiled data on the number of people diagnosed with TB who had an HIV-positive test result since 2004.

Data shown on this webpage are as of 25 August 2026 (see Annex 2 of the core report document for more details).

Further details and resources

Further country-specific details about diagnostic testing for TB, HIV-associated TB and anti-TB drug resistance are available in the country profiles of the Global tuberculosis report app.

A WHO dashboard focused on progress towards universal access to rapid diagnostics at regional and country levels is also available online. This includes data and visualizations for each of the 12 benchmarks that have been defined by WHO to assess and support progress towards universal access to rapid TB diagnostics across the cascade of care, from screening to use of a test result for clinical management (7). Key findings from data reported by high TB burden countries for the period 2023 to 2025 include:

• expanded use of WRD algorithms at TB diagnostic sites;
• progress in achieving WHO-recommended turnaround times to inform treatment decisions; 
• progress in the number of facilities monitoring test positivity and error rates; and
• progress in access to WRD services at the primary healthcare level.

It is important that countries consistently collect, validate and report data on these benchmarks, to monitor progress and guide programmatic action.

References

1. WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis. Geneva: World Health Organization; 2025 (https://iris.who.int/handle/10665/381003). License: CC BY-NC-SA 3.0 IGO.

2. Consolidated guidance on tuberculosis data generation and use: module 1: tuberculosis surveillance. Geneva: World Health Organization; 2024 (https://iris.who.int/handle/10665/376612). License: CC BY-NC-SA 3.0 IGO.

3. Falzon D, Miller C, Law I, Floyd K, Arinaminpathy N, Zignol M et al. Managing tuberculosis before the onset of symptoms. Lancet Respir Med. 2025;13:14-5 (https://doi.org/10.1016/S2213-2600(24)00372-2).

4. Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. New York: United Nations; 2023 (https://www.un.org/pga/77/wp-content/uploads/sites/105/2023/09/TB-Final-Text.pdf).

5. WHO consolidated guidelines on tuberculosis. Module 4: treatment and care. Geneva: World Health Organization; 2025 (https://iris.who.int/handle/10665/380799). License: CC BY-NC-SA 3.0 IGO.

6. Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020. Geneva: World Health Organization; 2021 (https://iris.who.int/handle/10665/338776). License: CC BY-NC-SA 3.0 IGO.

7. WHO standard: universal access to rapid tuberculosis diagnostics. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/366854). License: CC BY-NC-SA 3.0 IGO.

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