WHO has subsequently continued to support diagnostic integration. In 2017, the World Health Organization (WHO) issued an information note on multi-disease testing devices in integrated laboratory networks, saying such platforms could improve efficiency, reduce costs and increase patient access by allowing disease-specific tests for TB, HIV and viral hepatitis on a common platform.
The proposed guidance covers HIV, viral hepatitis and sexually transmitted infections and is intended to establish principles for integrated testing. Increasing the number of targets in a testing system can affect sensitivity in some circumstances, potentially resulting in a missed infection. Handling multiple tests also raises the risk of cross-contamination and false-positive results unless laboratories have validated workflows and strong quality assurance. TB and HIV already provide the clearest example. WHO identifies collaborative TB/HIV activities as a key component of its TB strategy. Dr. She proposes integrating screening for HIV, diabetes, undernutrition and anaemia alongside TB screening for people presenting with symptoms suggestive of TB. Dr. Arun cautions, however that multi-testing should not become indiscriminate testing. Most people are not simultaneously infected with several unrelated pathogens. Its greatest value is likely in populations where the probability of co-infection is higher. He sees greater value in targeting populations where co-infection is suspected.
Arun Panchapakesan, assistant professor and laboratory manager at the Molecular Biology Laboratory, YR Gaithonde Centre for AIDS Research and Education, Chennai, says the main challenge is therefore not whether technology can identify multiple pathogens, but whether the right specimen is being used. In September 2025, WHO announced the development of its first guideline specifically on multiplex testing, describing it as the use of one sample and a single assay or platform to detect multiple infections simultaneously. A 2026 review published in The Lancet , involving 19,581 people with TB across 21 countries, found that diabetes screening identified diabetes in 7.8% of people screened overall, with higher yields in South-East Asia and other high-burden settings. The WHO also estimates that about 15% of people with TB have diabetes and has embedded integrated, patient-centred care for TB and related conditions within the End TB Strategy .
“The challenge lies in the choice of the clinical sample itself,” he says. There are technical considerations too, says Subramanian Swaminathan, senior consultant, infectious diseases, Gleneagles Chennai. Krishnan says this approach could be widened. “These are the key co-morbidities but are often overlooked, except HIV,” she says. “Routine multiplex molecular testing of all patients is unlikely to be cost-effective,” Dr. Arun says.
