Resistance to antibiotics is a growing public health crisis, especially in countries with fragile health systems and in regions at war. One key limitation in most of these settings is a lack of clinical bacteriology laboratory capacity, which leaves medical providers without ways to accurately diagnose patient infections and to tailor antibiotic treatment accordingly. To help fill this critical gap, MSF and partners have developed the Mini-Lab—a small-scale, standalone lab that is easy to transport, set up and operate by staff after only a short training. Its six modules are stocked with everything needed to diagnose common bloodstream and urinary tract infections and to perform antibiotic sensitivity testing using methods adapted to extremely hot climates and remote settings. With Mini-Lab now being rolled out to selected MSF projects, here we highlight the background to its development and some of the research behind the bacteriological tests it incorporates.

Drug-resistant tuberculosis (DR-TB) remains an especially deadly form of the ancient scourge of TB, while current treatments are long, toxic, and ineffective for half of all patients. Aiming to change this unacceptable status quo, in the mid-2010’s MSF and partners launched three clinical trials to test novel regimens containing the first new TB drugs in decades. On 22 December 2022 the New England Journal of Medicine published findings from TB-PRACTECAL, a three-country randomized controlled trial, showing that a shorter regimen is safer and cured 89% of DR-TB patients, compared with 52% on the standard of care. These findings have already been incorporated into the World Health Organization’s new TB treatment guidelines. A separate study shows that the new regimen is also more cost-effective. Alongside these results the content collection linked below highlights other aspects of the trial, from community engagement strategies that helped shape TB-PRACTECAL to setbacks arising from the Covid-19 pandemic. It also examines urgent challenges in scaling up access to these life-saving drugs, including affordability and patent barriers.