ABSTRACT:
In response to the COVID-19 pandemic, India established 524 RT-PCR laboratories to boost testing capacity. With declining cases, many remain underutilized. Post-pandemic efforts emphasize strengthening public health infrastructure for pathogen detection and surveillance. Countries should prioritize repurposing COVID-19 RT-PCR equipment for expanded tuberculosis (TB) diagnostics and wastewater-based surveillance (WWS) of existing and emerging pathogens. The existing closed systems for the diagnosis of Tuberculosis becomes a road block in regions receiving excess samples for testing and should also look beyond tuberculosis by adapting syndromic approach or using multiplex kits for the screening and diagnosis. This strategy leverages accessible post-pandemic RT-PCR infrastructure and open-source kits (processing 48-96 samples per batch) to enhance TB diagnostics and WWS. It boosts testing throughput, aligning with WHO-endorsed initiatives for disease elimination by 2025, including WWS. Underutilized COVID-19 labs can use open-source kits for TB detection and WWS from pulmonary/extrapulmonary clinical samples and wastewater at sewage treatment plants (STPs). Validate and standardize protocols per manufacturer guidelines for nucleic acid extraction from clinical samples and filtered wastewater, followed by RT-PCR for TB diagnosis and surveillance. Repurposing these labs in high-burden countries increases daily TB diagnoses and surveillance. Multiplex kits extend to other diseases; a syndromic approach counters kit shortages, enables timely identification/treatment, and reduces costs for patients, hospitals, and governments. This innovative model bolsters diagnostic capabilities, advancing the WHO End TB Strategy 1-2.