WHO standard: universal access to rapid tuberculosis diagnostics: Uniting innovation and implementation: a mixed methods systematic review of implementation solutions to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests

Diagnosis remains the weakest link in tuberculosis care delivery. The number of people diagnosed with tuberculosis who were notified to national health systems in 2021 was 6.4 million, demonstrating only a partial recovery in response to the decline in tuberculosis diagnoses attributed to the COVID-19 pandemic. Despite WHO guidelines recommending that molecular WHO-recommended rapid diagnostic tests (mWRDs) should be used as the initial test for all people being evaluated for tuberculosis, only 38% of people newly diagnosed with tuberculosis receive a mWRD. This mixed methods systematic review sought to categorise barriers and enablers that affect mWRD use and impact, and evaluate mWRD implementation strategies with the goal of informing a roadmap of evidence-based approaches for mWRD implementation. Using a systematic search and screening criteria, we analysed data from 117 articles and 13 operational reports to inform understanding of mWRD barriers and enablers, and how implementation strategies can impact the use and impact of mWRDs in varied settings.