**10. Conclusions and further work**

This is an exciting time for new TB diagnostics. This is in part a reflection of the funding and application of good science, a clear understanding of unmet needs, a commercial sector that is considering new approaches to a global market, and the complexity of and limited prog‐ ress in new drug and vaccine development, which has encouraged more academic and in‐ dustrial partners to participate in diagnostic development.

Overall, the technology for the diagnosis of TB and RMP resistance in pulmonary specimens is well advanced, with high specificity and increasingly high sensitivity. Rapid, high-specif‐ icity molecular assays for TB identification and drug resistance cannot replace the standard diagnostic methods, such as microbiology, clinical and radiological assessments, and con‐ ventional DST for active TB in pulmonary (particularly sputum smear-negative) and extrapulmonary TB specimens. Implementation of all of these tools in routine laboratory practice requires the implementation of appropriate quality assurance systems.

The performance of molecular tools of extra-pulmonary specimens varies and should be considered separately for each specifi c specimen type. Evidence for the use of these assays to identify TB and detect drug resistance in TB-HIV co-infected individuals is limited. There is a need for designed studies among children, including HIV-positive children. There also remains a need to increase the sensitivity of TB detection among all patients, but especially among immunocompromised patients and children [20].
