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.