Brazzaville – Salomon*, in his 30s, arrives for his consultation with an envelope containing the results of his laboratory tests and an x-ray of his lungs, which he hands to Amélie Makoundou, public health assistant at the Brazzaville Tuberculosis (TB) Centre. After a thorough inspection, Makoundou says: “It’s okay, you’re cured.” Salomon remains impassive, as if he hasn’t heard what the assistant said. She repeats: “You can stop treatment, you are cured.” Salomon, who has just completed six months of treatment, thanks Makoundou and leaves with a broad smile.

Diagnosis plays a central role in the fight against TB, enabling rapid detection and treatment. It starts with monitoring chronic coughs, and ends with confirmation of TB through sputum analysis in the laboratory. To strengthen its efforts to eliminate TB, the Republic of the Congo, with support from the World Health Organization (WHO) in the African Region, has restructured its policy to put laboratory capacity-building at the centre of its strategy. 

In 2013, Congo acquired its first GeneXpert machine, which enables rapid detection of the bacteria responsible for TB. But with limited capacity, the country continued to send samples abroad to culture the mycobacteria and determine resistance to the antibiotics used for treatment. Results took between six and eight months to become available. 

“This situation complicated the therapeutic follow-up of patients suffering from multidrug-resistant tuberculosis, which requires a laboratory capable of producing cultures. This significantly delayed the treatment of patients with highly-resistant tuberculosis and, at the end of treatment, the absence of culture results meant that these patients could not even be confirmed as cured,” explains Dr Darrel Ornelle Elion Assiana, Director of the National Mycobacterial Reference Laboratory (NMRL).

WHO supported the mobilization of resources from the Global Fund, and in 2018 the National Tuberculosis Control Programme (NTCP) acquired a modular microbiological safety laboratory for handling dangerous strains of bacteria. The NMRL now has 46 GeneXpert machines and covers a network of 113 testing and treatment centres across the country’s 12 departments. 

Since 2024, thanks to the support of WHO and partners such as the United Nations Development Programme (UNDP) and the Global Fund, Congo has been classified as a high-burden TB country with a mycobacteria reference laboratory that meets WHO standards. The NMRL does more than just screening. It offers advanced techniques including microscopy, culture, anti-TB drug sensitivity tests and molecular diagnostic tests, including genomic surveillance. “Within two weeks, or a month at most, the results of susceptibility tests are available and the patient can begin appropriate treatment,” Assiana says, adding that for genotypic susceptibility tests, the results are available in between 24 to 48 hours. 

Public health assistant Makoundou sees about 50 patients every day. With nearly 30 years’ experience in the field of endemic diseases, and just months away from retirement, Makoundou has treated thousands of TB patients in Congo.

All her work is based on laboratory results. “I’m the one who sends the patient to the laboratory. We cannot put the patient on treatment without a lab result,” she explains. “On what basis can we put a patient on treatment if they don’t undergo screening?”

Makoundou’s question underlines the central role of testing in the fight against TB, a disease that killed more than 400 000 people in the WHO African Region in 2023, with nearly 1.9 million new cases detected and notified in Africa, 14 370 of these in Congo.

WHO and partners are supporting Congo to improve diagnostic conditions by strengthening the national TB reference laboratory. The Organization has supported capacity-building for its five technicians, and deployed an international laboratory consultant to provide ongoing technical assistance. “WHO supports the laboratory pillar as it is essential for the rapid detection of the disease, allowing clinicians to put patients on treatment as quickly as possible, and help save lives,” explains Dr Vincent Dossou Sodjinou, Acting WHO Representative in Congo.  “Our Organization is working with countries to end tuberculosis. Eliminating the disease is a key factor to ensuring better health for people, boosting productivity and supporting the economy.”

Thanks to various laboratory efforts, 41% of new TB cases were detected using rapid diagnostic methods recommended by WHO. The detection of new cases increased slightly, by almost 5% between 2022 and 2023, while the number of people initiating treatment for drug-resistant TB more than doubled over the same period, from 231 to 494. Early diagnosis means better preventive treatment. More than 1700 people received preventive treatment for TB in 2023, a 46% increase compared to 2022.

“It is thanks to the laboratory that we can isolate the bacterium responsible for tuberculosis and assess its susceptibility to treatment,” stresses Professor Franck Hardain Okemba-Okombi, Director of the NTCP. “When treatment is initiated, it is still the laboratory that enables us to say that there has been clinical improvement. It is always the laboratory that will guide us on the duration of treatment, whether the patient has completed his treatment, and whether he can be declared cured.”

In 2022, the treatment success rate in Congo was 82%, up from 72% in 2019. “It’s an indescribable feeling when a patient completes treatment and is declared cured,” Makoundou says. “Every cure is a victory and a step forward in the fight against tuberculosis.”