**9. Diagnostic research direction**

TB diagnostic research course moves toward blood parameters such as immune response components, protein, and pathological parameters or other tissues (cerebral-spinal fluid). Such parameters shed more light for future informed diagnosis including status and stage of infection or treatment. Converging different research routes may provide an outcome, which shows effects of interactions. For sure there may be antagonistic but also synergistic outcome. For instance, an approach that will detect the presence of the pathogen and also inform about immune status, pathological, or prognostic prediction is required. All in all, instituting programs that focus on screening tests for early detection of the disease can perfectly fit in the strategy of disease control and management. In so doing, disease elimination can be made possible.

### **10. Conclusion**

There is no single best diagnostic approach that can suit all settings including low-income endemic areas. Some procedures are weak in some aspects and can be complemented by others synergistically. This calls for research focus on combinations of procedures and programs, which give out quick and discriminatory results. For instance, a diagnostic procedure should be able to detect LTBI, active TB and different stages of recovery during treatment. Nevertheless, having programs that focus on screening of the disease in our population will definitely reduce diagnostic as well as treatment costs. This can be done particularly through active case finding (ACF) that will enable screening of TB by systematically searching individuals who would otherwise spontaneously not nock the door and present for care at health facility. In so doing early case detection will be increased particularly in marginalized populations [73–76]. Such areas are devoid of reliable and dedicated diagnostic facility under normal settings.
