With the publication of several systematic reviews, there is now a strong evidence base to support global policy on TB diagnostics. A key challenge is to maintain the momentum gained in the past few years, and expand the scope and role of evidence synthesis to outcomes that go beyond conventional diagnostic accuracy. These outcomes include: accuracy of diagnostic algorithms (rather than single tests) and their relative contributions to the health care system; incremental or added value of new tests; impact of new tests on clinical decision-making and therapeutic choices; cost-effectiveness in routine programmatic settings; impact on patient-centered outcomes; and societal impact of new tools. Indeed, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grading the quality of evidence and strength of recommendations for diagnostic tests recognizes that diagnostic accuracy results are surrogates for patient-centered outcomes, and emphasizes that diagnostic tests are of value only if they result in improved outcomes for patients.
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