{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:23:27Z","timestamp":1787066607226,"version":"build-2736575974"},"reference-count":21,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Tuberculosis Control Program"},{"name":"Ministry of Health and Population of the Republic of Congo, as well as by technical and financial partners"},{"name":"Global Fund through the GC7 grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>National Tuberculosis Reference Laboratories (NTRLs) are central to tuberculosis (TB) control programs. Between 2018 and 2024, the Republic of Congo, a country of 6 million inhabitants, achieved a transformative strengthening of its TB diagnostic system, coordinated by the NTRL. Strategic investments, supported mainly by international partners, enabled a substantial decentralization of services, expanding the diagnostic network from 38 to 113 diagnostic and testing centers and increasing GeneXpert sites from 3 to 31. The expansion of the diagnostic network and specimen referral system was associated with a reduced structural gap in diagnostic coverage by extending access to GeneXpert testing to a larger number of peripheral and previously underserved centers. Critically, the establishment of a BSL-3 laboratory and the deployment of advanced assays like Xpert MTB\/XDR ended the reliance on overseas testing by introducing in-country capacity for multidrug-resistant and pre-extensively drug-resistant TB detection. These systemic improvements were associated with significant positive outcomes, including an annual molecular testing surging from 11,609 in 2022 to over 27,000 in 2024 and bacteriological confirmation rates rising from 34 to 73%. This comprehensive laboratory systems strengthening, which also facilitated cross-programmatic initiatives like HIV and Mpox testing integration, underscores how sustained investment in infrastructure, logistics, and quality management is fundamental to improving case detection, surveillance, and progress toward the WHO End TB Strategy milestones.<\/jats:p>","DOI":"10.3390\/tropicalmed11010023","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T08:17:32Z","timestamp":1768292252000},"page":"23","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Strengthening the National Reference Laboratory in the Republic of Congo: An Investment Imperative for Tuberculosis Diagnostics"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2666-0719","authenticated-orcid":false,"given":"Darrel Ornelle","family":"Elion Assiana","sequence":"first","affiliation":[{"name":"Facult\u00e9 des Sciences et Techniques, Universit\u00e9 Marien Ngouabi, Brazzaville P.O. Box 69, Congo"},{"name":"Programme National de Lutte contre la Tuberculose, Brazzaville P.O. Box 1066, Congo"},{"name":"Laboratoire National de R\u00e9f\u00e9rence des Mycobact\u00e9ries, Brazzaville P.O. Box 1066, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franck Hardain","family":"Okemba-Okombi","sequence":"additional","affiliation":[{"name":"Programme National de Lutte contre la Tuberculose, Brazzaville P.O. Box 1066, Congo"},{"name":"Laboratoire National de R\u00e9f\u00e9rence des Mycobact\u00e9ries, Brazzaville P.O. Box 1066, Congo"},{"name":"Facult\u00e9 des Sciences de la Sant\u00e9, Universit\u00e9 Marien Ngouabi, Brazzaville P.O. Box 2672, Congo"},{"name":"Service de Pneumologie, Centre Hospitalier Universitaire de Brazzaville, Brazzaville P.O. Box 32, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1055-005X","authenticated-orcid":false,"given":"Salomon","family":"Tchuandom Bonsi","sequence":"additional","affiliation":[{"name":"Programme National de Lutte contre la Tuberculose, Brazzaville P.O. Box 1066, Congo"},{"name":"Laboratoire National de R\u00e9f\u00e9rence des Mycobact\u00e9ries, Brazzaville P.O. Box 1066, Congo"},{"name":"United Nations Development Programme, Brazzaville P.O. Box 465, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5838-6106","authenticated-orcid":false,"given":"Freisnel Hermeland","family":"Mouzinga","sequence":"additional","affiliation":[{"name":"Facult\u00e9 des Sciences et Techniques, Universit\u00e9 Marien Ngouabi, Brazzaville P.O. Box 69, Congo"},{"name":"Fondation Congolaise pour la Recherche M\u00e9dicale, Brazzaville P.O. Box 2672, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet E.","family":"Bryant","sequence":"additional","affiliation":[{"name":"The Global Fund to Fight AIDS, Tuberculosis and Malaria, P.O. Box 1218 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Akiana","sequence":"additional","affiliation":[{"name":"Facult\u00e9 des Sciences et Techniques, Universit\u00e9 Marien Ngouabi, Brazzaville P.O. Box 69, Congo"},{"name":"Facult\u00e9 des Sciences de la Sant\u00e9, Universit\u00e9 Marien Ngouabi, Brazzaville P.O. Box 2672, Congo"},{"name":"Direction des Technologies de la Sant\u00e9, Minist\u00e8re de la Sant\u00e9 et de la Population, Brazzaville P.O. Box 1066, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanou Joseph","family":"Kalivogui","sequence":"additional","affiliation":[{"name":"United Nations Development Programme, Brazzaville P.O. Box 465, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain Disu","family":"Kamalandua","sequence":"additional","affiliation":[{"name":"Programme National de Lutte contre la Tuberculose, Brazzaville P.O. Box 1066, Congo"},{"name":"United Nations Development Programme, Brazzaville P.O. Box 465, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuccia","family":"Saleri","sequence":"additional","affiliation":[{"name":"The Global Fund to Fight AIDS, Tuberculosis and Malaria, P.O. Box 1218 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Caruana","sequence":"additional","affiliation":[{"name":"The Global Fund to Fight AIDS, Tuberculosis and Malaria, P.O. Box 1218 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues Traor\u00e9","family":"Asken","sequence":"additional","affiliation":[{"name":"United Nations Development Programme, Brazzaville P.O. 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