Laboratory strengthening strategies to advance drug susceptibility testing for BPaL regimens in TB treatment

Background To support BPaL (bedaquiline [Bdq], pretomanid [Pa] and linezolid [Lzd]) rollout, countries require ongoing technical and policy support for standardized drug susceptibility testing (DST). Methods The Leveraging Innovation for the Faster Treatment of Tuberculosis (LIFT-TB) operational research project aimed to strengthen laboratory capacity for DST in 7 countries (the Philippines, Myanmar, Indonesia, Vietnam, Uzbekistan, Kyrgyzstan and Ukraine) through needs assessments, reagent and equipment support, quality control and training. Results During the project, we trained 157 professionals in phenotypic and molecular DST, enhancing quality assurance and implementation. We found there was variable DST capacity and resistance patterns. Conclusion Our study highlights the need for continued investment in training and infrastructure to integrate DST into routine diagnostics and to support scale-up of BPaL regimens in high TB-burden settings.