This report provides the conclusions and recommendations of the 22nd meeting of WHO Strategic and Technical Advisory Group for Tuberculosis (STAG-TB), held in June 2022. In its work on TB, the World Health Organization (WHO) aims for a world free of TB and, as part of the Sustainable Development Goals, to end the global TB epidemic by 2030. It seeks to enable universal access to TB prevention and care, guide the global response to threats, and promote innovation. The WHO Secretariat, at all its levels, requires regular scientific, technical and strategic advice from the STAG-TB, the most recent of which is outlined in this report.

The Technical Advisory Group (TAG) on diagnostics and laboratory strengthening reviewed evidence for the comparability of results of the assays Xpert MTB/RIF and Xpert MTB/RIF Ultra performed on the GeneXpert 6-colour system compared to the 10-colour instrument. The evidence showed that the two systems are comparable in detecting Mycobacterium tuberculosis complex as well as detecting resistance to rifampicin. Based on the conclusion drawn by the TAG, WHO/GTB issues this policy statement in order to guide countries regarding running the two tests on the two systems.

This book recounts the biology of M. bovis, followed by the status of bovine Tuberculosis (bTB) in African countries, primarily based on zoonotic and epidemiological field reports. Since the accumulation of data is valueless unless it led to practicable control measures, emphasis is put on locally adapted protocols for future control of the disease. In order to systematically evaluate the knowledge base of bTB, Epidemiologic Problem Oriented Approach (EPOA) methodology was used. The methodology is composed of two triads: i) the problem identification/characterization triad, which is mainly descriptive in nature, and ii) the problem management/solution/mitigation triad, which is mainly geared toward problem management/solution (see figure). The first triad comprises three pillars: i) agent ii) host, and iii) environment and the second one: i) therapeutics/treatment, ii) prevention/control, and iii) health maintenance/promotion. The two triads are linked together by the diagnostic procedure linkage. The systematic and detailed studies of the ‘Host-Agent-Environment’ interactions are the building blocks to the understanding of agent transmission pathways and disease spread. These may include data about the disease status of the country, the nature of the disease agent and its hosts, the modes of transmission, the wildlife reservoirs in nature, persistence of infection, and agent survival in animal products and the environment. The problem identification and characterization triad identifies these interactions. Once a problem has been identified and well understood, the next step is to minimize the risk of transmission and spread of a disease. This area, referred to as problem solution/management triad, consists of problem management alternatives that rely upon prevention/control, and health maintenance/promotion of the disease in livestock, wildlife, and humans with the emphasis on resource-poor, developing countries in Africa.

Tuberculosis is an ancient disease with a high incidence and mortality rate, unequally distributed worldwide. Epidemiological indicators, but also risk factors, play a key role in the natural history of the disease and need to be regulary addressed. Low and middle income countries are not prepared for appropriate response and are also the most affected. The incidence of this extrapulmonary disease is far from being clearly established. Epidemiological studies in different geographical areas will help in this field.