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.

The Democratic Republic of the Congo faces a high tuberculosis (TB) burden. In 2022, 61% of an estimated 402,000 TB cases were reported (World Health Organization Global tuberculosis report). To enhance case detection, the national TB program (NTP) introduced a program quality and efficiency approach (PQE), integrating systematic TB screening into outpatient departments (OPDs). Observational data of the PQE on the TB care cascade (from screening to treatment) across 70 sites in Kinshasa that initiated PQE during the first quarter of 2023 are presented. Data were collected monthly and validated during supervision visits, and disaggregated by sex, healthcare facility type (public, private, or faith-based), facility level (primary or secondary), and OPD within each facility. In 2024, 639,464 individuals were consulted in various OPDs in the participating facilities, 57% of which were female. The median number needed to screen (NNS) was 22.1, with an interquartile range of [9.5–104.3]. There was a significantly lower NNS observed in general practice and human immunodeficiency virus departments. Throughout the TB care cascade, women were less likely than men to be screened, tested, or treated. These findings, to be interpreted within the context of Kinshasa pilot facilities, provide insights to the NTP for developing PQE implementation research aimed at understanding the reasons for these discrepancies and informing NTP scale-up at the national level.

National Tuberculosis Reference Laboratories (NTRLs) are central to tuberculosis (TB) control programs. Between 2018 and 2025, 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 40 to 113 facilities and increasing GeneXpert sites from 3 to 31. This was bolstered by a national sample transport system that slashed diagnostic inequities and a robust External Quality Assessment framework to ensure reliability. Critically, the establishment of a BSL-3 facility 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 extensively drug-resistant TB detection. These systemic improvements directly translated into significant outcomes including an annual molecular testing surging from 11,609 to over 27,000, bacteriological confirmation rates rose from 34 to 73%. This comprehensive laboratory systems strengthening, which also facilitated cross-programmatic initiatives like HIV, 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.