Towards the elimination of tuberculosis: advances in diagnostics, treatment, and vaccination

Abstract Tuberculosis (TB) remains a major global health challenge, causing over 10 million new cases and more than 1 million deaths annually despite the availability of effective treatment and long-standing preventive measures. Progress towards the WHO End TB targets remains insufficient, particularly in settings affected by delayed diagnosis, drug resistance, and limited access to care. This narrative review summarizes recent advances in tuberculosis diagnostics, treatment, and vaccine development, with particular emphasis on technologies and strategies of growing clinical relevance. In diagnostics, conventional methods such as smear microscopy, culture, tuberculin skin testing, and interferon-gamma release assays remain important but have well-recognized limitations. Rapid molecular assays have improved early detection and rifampicin-resistance assessment, while next-generation sequencing enables broader resistance profiling and supports molecular epidemiology. Mass spectrometry-based approaches, including lipid profiling by FIA–MS/MS, have emerged as promising complementary tools for rapid mycobacterial characterization directly from clinical specimens. Additional technologies, such as digital PCR, microarrays, Raman spectroscopy, and artificial intelligence-supported tools, further expand the diagnostic landscape. Therapeutic progress includes the growing use of shorter, fully oral regimens for drug-resistant TB, particularly BPaL and BPaLM, while newer combinations such as BDLLfxC remain under evaluation. At the same time, the vaccine pipeline has expanded beyond BCG to include protein-subunit, live attenuated, recombinant BCG-derived, and mRNA-based candidates. Recent advances have significantly broadened the range of tools available for TB control. However, their population-level impact will depend on further validation, affordability, standardisation, and successful implementation in high-burden settings.