Abstract Objective Eastern Europe and Central Asia (EECA) is experiencing a rise in the number of new HIV infections and is lagging in reaching the testing and treatment cascade targets. We aimed to identify gaps in prevention, testing, and treatment services, with a focus on key populations (KPs), and propose key actions for the EECA region to achieve the goal of ending AIDS by 2030. Methods A mixed-method review was conducted. Quantitative data, covering 15 EECA countries, were extracted from the standardised global and regional data collection systems, as well as a regional survey on HIV surveillance. Qualitative insights were drawn from WHO HIV Programme Reviews conducted in 2022 to 2024 across nine countries: Albania, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan. Epidemic patterns, surveillance systems, policies, service delivery, KP size estimation, prevention coverage, and HIV status awareness among KPs were analysed. Findings While progress has been observed, none of the countries has achieved the UNAIDS 95‑95‑95 targets. Common challenges identified across EECA included persistent late diagnosis, patterns suggestive of possible misclassification of transmission modes, underutilisation of routinely collected data, limited implementation of innovative policies and approaches, suboptimal prevention coverage and awareness of HIV status among KPs, and high levels of stigma. By integrating quantitative indicators with evidence from the WHO HIV Programme Reviews, this study provides additional insight into how implementation‑level constraints shape observed epidemiological patterns across EECA. Conclusion In EECA, while much progress has been made in the last decade, many gaps and challenges in HIV prevention, testing, and treatment impede effective control of HIV. Identified priority actions should be promoted to contain the fast-growing HIV infection and achieve ending AIDS by 2030.

Inappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance.https://bit.ly/3i43wb6

Technical advances in diagnostic techniques have permitted the possibility of multi-disease-based approaches for diagnosis and treatment monitoring of several infectious diseases, including tuberculosis (TB), human immunodeficiency virus (HIV), viral hepatitis and sexually transmitted infections (STI). However, in many countries, diagnosis and monitoring, as well as disease response programs, still operate as vertical systems, potentially causing delay in diagnosis and burden to patients and preventing the optimal use of available resources. With countries facing both human and financial resource constraints, during the COVID-19 pandemic even more than before, it is important that available resources are used as efficiently as possible, potential synergies are leveraged to maximise benefit for patients, continued provision of essential health services is ensured. For the infectious diseases, TB, HIV, hepatitis C (HCV) and STI, sharing devices and integrated services starting with rapid, quality-assured, and complete diagnostic services is beneficial for the continued development of adequate, efficient and effective treatment strategies. Here we explore the current and future potential (as well as some concerns), importance, implications and necessary implementation steps for the use of platforms for multi-disease testing for TB, HIV, HCV, STI and potentially other infectious diseases, including emerging pathogens, using the example of the COVID-19 pandemic.

The World Health Organization (WHO) recently revised its guidelines for rapid diagnosis of drug-resistant tuberculosis (TB). This study aimed to investigate if TB reference diagnostic services are prepared to support these revisions. An online survey was performed among 44 TB National Reference Laboratories (NRLs) in the WHO European Region. Questions addressed the use of WHO-recommended molecular techniques for the diagnosis of drug-resistant TB, the techniques applied to investigate antimicrobial resistance, and questions on quality assurance. Among 35 of 44 (80%) participating NRLs, 29 of 35 (83%) reported using the GeneXpert platform as the initial test to detect Mycobacterium tuberculosis complex and rifampicin resistance. Five laboratories reported using another WHO-recommended, moderate-complexity, automated nucleic acid amplification test for detection of Mycobacterium tuberculosis complex and resistance to rifampicin and isoniazid. Most (32 of 35; 91%) NRLs reported the capacity to test second-line drugs that have been in clinical use for many years (fluoroquinolones, linezolid, and injectable agents). Only 23 of 35 (66%) and 21 of 35 (60%) NRLs reported the capacity to test bedaquiline and clofazimine. Further efforts will be needed to improve the availability of quality-controlled testing against WHO Group A and Group B drugs. Earlier considerations on the scale-up of diagnostic capacities should be enforced as part of future approval processes for new antimycobacterial agents.

We assessed the impact of COVID-19 on diagnostic services for tuberculosis (TB) by national reference laboratories in the WHO European Region. Of 35 laboratories, 30 reported declines in TB sample numbers, amounting up to > 50% of the pre-COVID-19 volumes. Sixteen reported reagent or consumable shortages. Nineteen reallocated ressources to SARS-CoV-2 testing, resulting in an overall increase in workload, largely without a concomitant increase in personnel (n = 14). This poses a risk to meeting the 2025 milestones of the End TB Strategy.

Evidence-based guidance is needed on 1) how tuberculosis (TB) infectiousness evolves in response to effective treatment and 2) how the TB infection risk can be minimised to help countries to implement community-based, outpatient-based care.This document aims to 1) review the available evidence on how quickly TB infectiousness responds to effective treatment (and which factors can lower or boost infectiousness), 2) review policy options on the infectiousness of TB patients relevant to the World Health Organization European Region, 3) define limitations of the available evidence and 4) provide recommendations for further research.The consensus document aims to target all professionals dealing with TB (e.g TB specialists, pulmonologists, infectious disease specialists, primary healthcare professionals, and other clinical and public health professionals), as well as health staff working in settings where TB infection is prevalent.

Globally, high rates (and in the WHO European region an increasing prevalence) of co-infection with tuberculosis and HIV and HIV and hepatitis C virus exist. In eastern European and central Asian countries, the tuberculosis, HIV, and viral hepatitis programmes, including diagnostic services, are separate vertical structures. In this Personal View, we consider underlying reasons for the poor integration for these diseases, particularly in the WHO European region, and how to address this with an initial focus on diagnostic services. In part, this low integration has reflected different diagnostic development histories, global funding sources, and sample types used for diagnosis (eg, typically sputum for tuberculosis and blood for HIV and hepatitis C). Cooperation between services improved as patients with tuberculosis needed routine testing for HIV and vice versa, but financial, infection control, and logistical barriers remain. Multidisease diagnostic platforms exist, but to be used optimally, appropriate staff training and sensible understanding of different laboratory and infection control risks needs rapid implementation. Technically these ideas are all feasible. Poor coordination between these vertical systems remains unhelpful. There is a need to increase political and operational integration of diagnostic and treatment services and bring them closer to patients.

Context: The rapid diagnosis of presumptive tuberculosis (TB) in patients is vital in the fight against the disease. The overall turnaround time (TAT) of the laboratory investigation as well as its individual components can serve as crucial indicators of the standard of TB diagnostic services. Objectives: To evaluate the overall TAT of the Armenian TB diagnostic service in 2017–2018, to assess factors associated with delays within the diagnostic process and to compare TATs before and after the introduction of the rapid diagnostics tool GeneXpert MTB/Rif Ultra. Methodology: A cross-sectional study based on 7307 samples from the National Reference Laboratory electronic database and paper-based registers from regional laboratories from September 2017 to December 2018. Results: The mean overall TAT was 2.5 days, with microscopy, GeneXpert testing and reporting TATs at 0.2, 1.3 and 1.1 days, respectively. Following the introduction of GeneXpert Ultra in September 2018, the testing TAT decreased by 23%. Despite this reduction, the overall TAT actually increased from 2.5 to 3.1 days in this period as a result of increases in reporting TATs, which are heavily dependant on a vehicle transportation system. Conclusion: The introduction of rapid TB diagnostic tools in Armenia, should be accompanied by the introduction of equally efficient systems for the reporting of results to clinicians, such as an electronic TB database, in order to substantially reduce the time to initiate appropriate treatment and improve the overall TB situation.

Introduction: The Republic of Moldova (Moldova) remains among the highest tuberculosis (TB) burden countries in the WHO European Region (1). The main intervention to improve TB diagnostics was the introduction of GeneXpert testing in 2012, which is a molecular investigation based on realtime polymerase chain reaction (PCR). While the efficacy of the GeneXpert test is evident, rifampicin-resistant cases identified by GeneXpert are not always confirmed by the culture method of laboratory diagnosis (phenotypic methods). We suspected that low MTB concentration can be a determining factor in discordant results. Objective: We aimed to determine the effect of low concentration of Mycobacterium tuberculosis (MTB) in sputum samples reported by GeneXpert on discordant results from GeneXpert and phenotypic drug susceptibility testing (pDST). Methods: We conducted a retrospective cohort study of the results of the samples from new TB patients who were examined and reported by the GeneXpert test in the Republic of Moldova between 2013 and 2017. The data were extracted from the National Database and the GeneXpert electronic database. Results: A comparison of GeneXpert and pDST test results in 2 810 analysed samples revealed 87 (3.1%) discordant rifampicin susceptibility results. Among the discordant results, 39 (55.2%) were detected as resistant by the GeneXpert test, but this resistance was not confirmed by pDST. Very low MTB concentration was identified in 16% (450/2 810) of the samples. Statistically significant dependence between low MTB concentrations and discordant results was not identified. Conclusion: The study showed that there is a divergence between DST results and GeneXpert results, which is not necessarily caused by low concentration of MTB. Additional studies are needed to identify factors associated with this divergence.

We read with great interest the letter from Tomasz Jagielsi and colleagues1Jagielski T et al.FATE: the new partnership to Fight Against TB in Central and Eastern Europe.Lancet Infect Dis. 2017; 17: 363Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar presenting the Fight Against TB in Central and Eastern Europe (FATE). As the authors point out, eastern Europe is a hotspot for drug-resistant tuberculosis involving countries both within and outside the EU. The correspondence rightly highlights the need for intercountry and regional collaboration; however, it does not mention the existing regional initiatives and networks including WHO's European TB Laboratory Initiative (ELI),2European TB Laboratory Initiative core group membersAlgorithm for laboratory diagnosis and treatment-monitoring of pulmonary tuberculosis and drug-resistant tuberculosis using state-of-the-art rapid molecular diagnostic technologies. World Health Organization Regional Office for Europe, Copenhagen2017Google Scholar the Regional Collaborating Committee on TB,3Regional Collaborating Committee on Tuberculosis Control and Care (RCC-TB)http://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/areas-of-work/community-engagement-and-advocacy/regional-collaborating-committee-on-tuberculosis-control-and-care-rcc-tbDate: 2017Google Scholar the European Centers for Disease Prevention and Control (ECDC) networks,4Drobniewski FA Nikolayevskyy V Hoffner S et al.The added value of a European Union tuberculosis reference laboratory network-analysis of the national reference laboratory activities.Euro Surveill. 2008; 13: 8076Crossref PubMed Scopus (16) Google Scholar and professional societies, among others. Timely and accurate diagnosis of drug-resistant pathogens, especially tuberculosis, is of key importance for rapid treatment initiation, adequate infection control measures, and surveillance purposes. With WHO's European region having the highest multidrug-resistant (MDR) tuberculosis rates globally, the WHO Regional Office for Europe established ELI, bringing experts from across the region (including countries with both high and low tuberculosis and MDR tuberculosis burden) together to review the major challenges in tuberculosis and MDR tuberculosis laboratory diagnosis and to find solutions to overcome them. The group has recently developed comprehensive new diagnostic algorithms for the WHO European region, applicable to all countries of the region regardless of income or tuberculosis incidence.2European TB Laboratory Initiative core group membersAlgorithm for laboratory diagnosis and treatment-monitoring of pulmonary tuberculosis and drug-resistant tuberculosis using state-of-the-art rapid molecular diagnostic technologies. World Health Organization Regional Office for Europe, Copenhagen2017Google Scholar The emphasis is on the rational use of, ideally, rapid point-of-care molecular tests, or as geographically close to the patient as possible, for timely institution of the most appropriate therapeutic and infection control measures to the benefit of individual patients and public health. Moreover, all nine high MDR tuberculosis burden countries within WHO's European region receive support from WHO's Supranational Reference Laboratory Network. The European region has benefitted from large-scale projects funded through the EU's FP7 programme and the formation of a network of EU European National Reference laboratories (ERLN) coordinated through the ECDC. All these initiatives are jointly contributing to the understanding of the clinical, epidemiological, behavioural, evolutionary, and genetic factors underlying the emergence, evolution, and clinical consequences of antimicrobial drug resistance, especially MDR tuberculosis and the use of novel diagnostics within quality assured laboratories. At an international level, the ECDC network and WHO's ELI have been balancing best diagnostic practices, promoting consistent quality across laboratories, training a cadre of new scientists, and developing pan-European diagnostic strategies.2European TB Laboratory Initiative core group membersAlgorithm for laboratory diagnosis and treatment-monitoring of pulmonary tuberculosis and drug-resistant tuberculosis using state-of-the-art rapid molecular diagnostic technologies. World Health Organization Regional Office for Europe, Copenhagen2017Google Scholar, 4Drobniewski FA Nikolayevskyy V Hoffner S et al.The added value of a European Union tuberculosis reference laboratory network-analysis of the national reference laboratory activities.Euro Surveill. 2008; 13: 8076Crossref PubMed Scopus (16) Google Scholar, 5Hillemann D Hoffner S Cirillo D et al.First evaluation after implementation of a quality control system for the second line drug susceptibility testing of Mycobacterium tuberculosis joint efforts in low and high incidence countries.PLoS One. 2013; 8: e76765Crossref PubMed Scopus (12) Google Scholar More collaborative efforts are needed but a strong start has been made by the existing initiatives. We declare no competing interests. FATE: the new partnership to Fight Against TB in Central and Eastern EuropeWith its association with HIV and the emergence of drug-resistance, tuberculosis remains the most deadly of all infectious diseases affecting human beings.1 Today, multidrug-resistant and extensively drug-resistant tuberculosis leave patients and physicians with very few treatment options.2 Full-Text PDF

Tuberculosis and particularly multidrug resistant TB remains a major public health concern in the WHO European Region. In order to reduce the burden of the disease, early, accurate and rapid diagnoses play a crucial role. Sputum smear microscopy that has long been used as the main TB diagnostic method detects TB only with low sensitivity and phenotypic culture-based methods require several weeks and high biosafety laboratory infrastructures. The use of the WHO endorsed rapid molecular method for simultaneous detection of TB and rifampicin resistance detection has promising advantages to overcome these challenges and lead to major advances for early and accurate diagnosis of TB. With better understanding appearing discordances between phenotypic and genotypic methods, as well as the development and implementation of regionally adapted diagnostic algorithms, the precision of result acquisition and interpretation can advance even further.