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The Oncology Nursing Society (ONS) Research Agenda for 2024-2027 is not just for academic researchers to reference in grant applications. It is a practical guide for all oncology nurses, offering direction for research that.
Despite efforts to reduce health disparities, racism is recognized as a global public health crisis. Addressing racism aligns with international healthcare policies and healthcare goals of promoting health justice. Nursing students, as future healthcare workers, are key to re-establish social patterns. This study aims to explore nursing students' experiences of racism in healthcare and their perspectives on how such situations can be avoided. Qualitative data were collected in two phases through written reflections upon case scenarios and individual interviews of nursing students. Data were analysed through an inductive content analysis approach. The data analysis led to developing one theme `there is an urgent need for ways to handle and prevent racism' and four categories. Our results clearly reveal the presence of both overt and covert racism in healthcare, influencing professional integrity and patient rights. Racism in healthcare has a complex and multifaceted nature and an expectation that nurses respond to racist behaviour toward patients and colleagues is emphasized. However, it is difficult to identify racism and react in 'real life' than in a hypothetical situation. Reactions to racist behaviour depend on patient's background and health condition. Sharing of experiences, increased knowledge of cultural sensitivity, and clear healthcare leadership are strategies that help with preventing racism in healthcare. This study enhances international understanding of racism within healthcare, as experienced by nursing students. It underscores that racism is not always overt or easily identifiable. Also, nursing students often feel unprepared to respond effectively in real-life situations, underscoring the need for education and training on how to address racism in practice and thereby promote health justice. Not applicable.
People commonly exhibit a bias blind spot (BBS), judging themselves as less susceptible to bias than the "average other." However, less is known about how people attribute bias to familiar others who evoke strong affect. We examined whether attributions of bias are sensitive to affective impressions of others. In Experiment 1, participants viewed themselves as considerably less biased than the average survey respondent and a personally-known disliked other, but not less biased than a familiar individual whom they liked. Experiments 2 and 3 examined the BBS in politically polarized groups of Democrats and Republicans. While participants judged themselves as somewhat less biased than co-partisans, they viewed themselves as much less biased than their political opponents. In all experiments, the effect of other target selection on the BBS was mediated by affective evaluations. We discuss the theoretical implications of affective evaluations guiding how people attribute bias to familiar others.
Although evidence of adverse effects on human health is still scarce, exposure to pesticides has been shown to have a negative impact outside agroecosystems. We compared exposure to current use pesticides in one area surrounded by crop fields (Area 1) with exposure in another area located in the center of a city (Area 2). Both areas are located within one of the world's most agriculturally productive regions. We analyzed the presence of glyphosate and its metabolite aminomethylphosphonic acid (AMPA) in urine samples from 86 female volunteers who had been environmentally exposed. Potential genotoxicity was tested using the micronucleus assay on buccal mucosa samples taken from the same donors. We also evaluated the residues of current use pesticides in drinking water and soil samples taken from public places in the two areas. All the analytical determinations were performed using ultra-high performance liquid chromatography coupled with mass spectrometry (UHPLC-MS/MS). When glyphosate-positive samples were considered, significantly higher concentrations of glyphosate were found in Area 1 than in Area 2 (p = 0.02). An increase in the frequency of binucleated cells (p = 0.039) and linked nucleus (p = 0.035) was observed in women from Area 1 compared to those from Area 2. All the drinking water samples tested positive for at least two pesticide residues while 85% of the soil samples tested positive for at least 1. A total of 27 different pesticides were detected in the drinking water in Area 1, with detection frequencies ranging from 5 to 79%. In Area 2, imidacloprid, 2,4-D, atrazine and dichlosulam were detected at detection frequencies of 100%, 71%, 57% and 29%, respectively. In soils from Area 1, the metabolites hydroxy atrazine and AMPA presented the higher detection frequency, while in Area 2, glyphosate and AMPA were detected in 71% of samples, followed by atrazine and its metabolites. Modelling showed that the distance between donors' homes and crop fields was the key factor in explaining glyphosate and AMPA concentrations in urine, the presence of pesticides in drinking water and the observed cytotoxicity. The significant cytotoxicity detected in women living near crop fields is a particular cause for concern regarding potential hazards to human health in that area. On the other hand, this study has also demonstrated the ubiquity of the current use pesticides in environmentally exposed women, since glyphosate has been found in the urine of people living in urban areas. This fact merits further, more in-depth analysis.
Severe maternal morbidity (SMM) and maternal mortality (MM) rates are higher in the U.S. than in other high-income countries, with Black birthing individuals disproportionately impacted. Research highlights the need for collaborative, team-based approaches to tackle these disparities. Interprofessional education and practice (IPEP) competencies provide a promising framework to foster interdisciplinary relationships and improve maternal health outcomes. However, there is still insufficient integration of these competencies in educational curricula and clinical practice. This study aims to evaluate the effectiveness of an interprofessional education (IPE) maternity care training to reduce disparities in maternity care. The study is a multisite step-wedge cluster randomized trial to evaluate the extent to which IPE training reduces racial disparities in maternity care, indexed by postpartum pain experience, assessment, and treatment. IPE training will be implemented at four maternity hospitals in central North Carolina that provide intrapartum care to about 15,000 people each year. The IPE training will be delivered to healthcare team members who provide postpartum maternity care at each facility. The training design includes a 30-minute pre-work module, a 90-minute interprofessional collaboration session utilizing virtual reality (VR) headsets, and a 30-minute post-work module. The pre- and post-work modules will be delivered through an online learning platform. Outcomes will be measured over six study periods, each lasting four months. In the first study period, hospital maternity staff will continue to receive standard continuing education. During study periods 2 to 5, hospitals will sequentially invite their staff to participate in the BELIEVE IPE training. During study period 6, all hospitals will have completed the staff training intervention. Outcomes will be assessed before, during, and after implementation of the IPE training at all four hospitals over 24 months. Our primary outcome is prevalence of severe postpartum pain among Black and white birthing people. The protocol version at time of writing is 6.1. This project will evaluate the effectiveness of a virtual reality interprofessional training to reduce disparities in clinical care. Results will inform future IPE training for maternity care teams to improve quality of care and reduce disparities. National Clinical Trial (NCT) Identified Number: NCT06483022 (date registered: July 1, 2024).
Immigrant and racialized Canadians constitute an increasing percentage of the older adult population. Attention is needed to the role of municipalities and their key partners in creating urban environments that are supportive of aging in place. We conducted a qualitative descriptive sub-study of policy partners' perceptions of age-friendly policies and initiatives as part of a larger community-based participatory project in Edmonton (Alberta, Canada). Nineteen participants, including elected municipal representatives, city administrators, advisory committee volunteers and seniors-serving organization staff, took part in semi-structured interviews, which was followed with a reflexive thematic analysis of the data. Participants described high levels of awareness about inequities faced by immigrant and racialized older adults. Advocacy and policy efforts, however, were constrained by insufficient funding, lack of capacity for sustainable initiatives, unclear jurisdictional boundaries and competing priorities.
This study examines how South Korean lesbian feminists negotiate safety and threat within Twitter (X)-based safe spaces, drawing on digital ethnography and in-depth interviews with eight participants. We develop the concept of insider-invaders to capture how individuals simultaneously constitute these spaces while also being perceived as potential or actual threats. Rather than fixed boundaries between insiders and outsiders, we show that belonging and safety are continuously reconfigured through participants' interpretations of misogyny, their situated understandings of feminism and lesbian identity, and their assessments of others' identities and practices. The insider-invader framework illuminates how suspicion, identification, and conditional acceptance emerge within a community often imagined as homogeneous, rendering safety an ongoing relational achievement rather than a stable condition. By moving beyond the binary between exclusionary and non-exclusionary feminisms, this study reconceptualizes safe spaces as fluid and contested formations, shaped by the shifting interplay of solidarity, difference, and vulnerability in digital queer feminist contexts.
To identify clinicians' perceived challenges and barriers in the management of low anterior resection syndrome (LARS) through exploration of attitudes and decision-making practices around screening, diagnosis and management. Exploratory interpretive qualitative design. Semi-structured interviews were undertaken and a reflexive thematic qualitative analysis was conducted using an iterative-inductive approach. Eleven colorectal surgeons, six physiotherapists and three specialist nurses were interviewed. Data were grouped into four major themes and 13 sub-themes. Variation in clinician engagement with LARS was identified, with clinicians' knowledge, training and personal interest in managing patients raised by participants as contributing factors. An absence of standardized management pathways presented challenges in clinical practice with the lack of structured multidisciplinary approaches and referral pathways combined with a perceived lack of established treatment guidelines impacting on clinical decision-making. Inequities in access to specialist pelvic services and treatment were identified as systemic limitations which influence clinical decision-making in relation to clinical practice and implementation of patient care. The interpretation of the patient experience with LARS and perceptions of treatment acceptability were identified to influence clinical decision-making and demonstrated divergent perceptions of patient experience. This study identified several challenges in LARS management from a clinician's perspective. A lack of standardized treatment guidelines and pathways, limited treatment access, and inconsistent clinician engagement present challenges. Divergent perceptions of patient experience and treatment acceptability further complicate care. These findings highlight the urgent need to address these systemic limitations through enhanced surgeon education, standardized treatment/referral guidelines, improved patient resources and expanded access to multidisciplinary care.
Difficulties in emotion regulation (ER) have been identified as a core mechanism in mental health problems. Preventive interventions targeting ER in adolescents, both in universal and selected settings, show promising effects in reducing ER difficulties and supporting general health, though further research is needed to confirm these findings. Earlier studies also highlight the potential value of involving parents in such interventions to strengthen parent-child relationships and promote healthy ER, but this approach also requires further exploration. The aim of the current study was to explore how adolescents and parents described their experiences and perceptions of participating jointly in a preventive ER skills training in a school setting. Such experiential and perception-focused insights underscore the need for a qualitative approach. The skills training consisted of five sessions of psychoeducation about emotions and ER skills. Twelve participants (seven parents and five adolescents) were interviewed. The interviews were transcribed and analyzed with reflexive thematic analysis. The participants expressed a general need for emotional awareness, including understanding emotions and ER, as well as recognizing the role of emotions in everyday issues. The perceived stigma associated with mental health and emotional expression, along with a lack of knowledge about emotions, was seen as concealing the need for emotional awareness. Parents were viewed as facilitating the learning and application of ER skills among adolescents. Participants experienced insights (e.g., increased emotional awareness) that benefited their daily lives, but also perceived challenges with preventive ER skills training regarding timing and the need for continued practice to maintain skills. Participants found the ER skills training to be valuable and meaningful. The results highlight both the benefits and challenges of jointly targeting ER preventively in adolescents and their parents within a school setting, particularly with regard to recruitment and evaluation. The findings also contribute to ongoing discussions in prevention research about the optimal timing of interventions, ER focus, and parental involvement.
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In Australia, methamphetamine ('ice') use has been framed as a major social problem, contributing to punitive policy responses and ongoing criminalisation through which stigma is enacted. Although smoking is the predominant route of use, little is known about how people who smoke methamphetamine experience stigma. In-depth interviews were conducted with nine people with histories of smoking methamphetamine, no lifetime history of injecting drug use; and prior interactions with the criminal legal system in Victoria, Australia. Interviews explored experiences of drug use and treatment, criminal legal involvement, stigma and wider social and economic conditions. With stigma as the primary analytic focus, data were thematically analysed using Iterative Categorisation. Findings demonstrated how stigma impacted participants' lives in multiple and intersecting ways, shaping their experiences across personal relationships and institutional settings. Stigma was enacted through criminal legal practices that normalised surveillance and neglect, social relationships marked by exclusion and conditional support, and gendered judgements that intensified moral scrutiny of women who use methamphetamine. Across these contexts, participants described experiences of stigma that limited their access to care, protection, and social support. Three themes were identified: 1) "You're just treated like an animal": Institutional stigma in policing; 2) "Everyone's calling me a crackhead, I'll go and be one": Social and relational stigma; 3) "It was kind of like everyone turned against me": Gendered stigma among women. Participants' experiences of stigma extended beyond isolated interpersonal encounters and were embedded within institutional practices and social relationships. These findings highlight how participants experienced stigma as reinforcing inequities in access to care, protection, and social support across social and institutional settings.
Falls and related injuries requiring rehabilitation are a frequent occurrence in older people. There are several commercially available assistive technologies available that aim to prevent and detect falls. The latest advancement is automatic falls detection in the form of wrist-worn technology referred to as a smartwatch. Sold as a consumer item, this paper explores the potential clinical application of smartwatches to occupational therapy practice and aimed to understand occupational therapists' perceptions of using smartwatches to detect falls in older adults (aged over 60). An exploratory quantitative study using an online self-administered survey was used to gather data including: (1) multiple choice questions on demographics, (2) Likert scale questions using the Technology Acceptance Model to understand therapists' perceptions, and (3) open-ended questions to explore facilitators and barriers to using smartwatches to detect falls. A total of 36 participants fully completed the survey, showing that occupational therapists are open to prescribing smartwatches for fall detection purposes. Personal, environmental, and occupational facilitators and barriers to utilising smartwatches for falls detection were identified by thematic analysis. Smartwatches are perceived as a promising option as a fall detection device for some of the population. Identified barriers reported relate to the end user's ability to manage a smartwatch, therapist skills and knowledge regarding smartwatches and limited insight into funding. Smartwatches are not a solution for everyone, however, do provide an additional choice to keep older people at risk of falls safe and the reassurance that if they fall, help can be alerted. The number of older people is increasing, as is the demand to prevent falls and keep people safe and independent in their homes. There are a range of falls detection devices marketed to assist with the knowledge that should they fall, help can be alerted. Ownership of smartwatches is increasing and include several health assistive functions such as fall detection. As rehabilitation specialists, occupational therapists have a role of assessing the older persons falls risk in the home, prescribing suitable devices, and supporting access to fund to these items. As smartwatches are seen as a fashion accessory, they have the potential to be more acceptable to some individuals, however, are unlikely to be considered as a strategy by occupational therapists when prescribing falls detection systems. Using a survey, it was found that occupational therapists are open to the idea, however identified barriers that relate to the end user’s ability to manage a smartwatch, (such as physical disabilities or sensory limitations), skills and knowledge of therapists around the strengths and limitations of smartwatches and limited insight into funding sources. It is recognised that smartwatches are not a solution for everyone, however, do provide an additional choice to keep older people at risk of falls safe and the reassurance that if they fall, help can be alerted.
People with dementia often report a lack of post-diagnostic support, and much of the current dementia training available is for staff or carers, not for the person diagnosed. The Good Life with Dementia course was designed with and for people with a diagnosis of dementia and is co-delivered by peer-tutors living with dementia, supported by a trained facilitator. This study used realist-informed methods, underpinned by a co-productive ethos which values all sources of expertise equally, to better understand the core constructs underpinning the Good Life approach and how these operate to produce outcomes. The resultant, evidence-based programme theory suggests that - in a context characterised by shared experience, equality and positive expectations - three key mechanisms can trigger: sharing of experiences and resources; peer-led learning and responding; and the taking on of meaningful roles. Qualitative evidence indicates that these mechanisms are likely to lead to four interconnected outcomes: enjoyment; feeling valued (personhood); (re)building social confidence and connections; and positive reframing of life with dementia, meaning participants felt more prepared to face the challenges ahead. Not everyone diagnosed with dementia will want to take part in a peer-led course, but interventions like a Good Life with Dementia could be part of a suite of post-diagnostic options available to help people with dementia to live as well as possible. The next step will be to establish whether the approach can be manualised, delivered with different communities and evaluated in trial conditions. This will be assessed via an inclusive feasibility study already underway and due to conclude in August 2027.
Bladder cancer (BC) is the most common malignancy of the urinary tract, with more than 75% of cases diagnosed as non-muscle-invasive bladder cancer (NMIBC). Intravesical Bacillus Calmette-Guérin (BCG) remains the gold standard adjuvant treatment for high-risk NMIBC owing to its ability to induce a robust local immune response within the bladder tumor microenvironment. Nevertheless, a substantial proportion of patients experience disease recurrence or progression, highlighting the need for improved therapeutic strategies. This narrative review examines the biological rationale and available clinical evidence supporting the combination of intravesical BCG with immune checkpoint inhibitors (ICIs) in high-risk NMIBC. A literature review was conducted to analyze the immunological mechanisms underlying BCG-induced antitumor activity, adaptive immune resistance, and the potential role of ICIs in modulating the tumor microenvironment. Clinical trials were evaluated with particular attention to patient populations, study design, safety profiles, and efficacy end points. From a biological perspective, BCG acts as an immunological primer by recruiting and activating innate and adaptive immune cells, while immune checkpoint inhibitors may counteract functional exhaustion of BCG-induced antitumor responses. However, translation of this rationale into consistent clinical benefit remains challenging. Early-phase studies have reported variable response rates in selected patient populations, particularly in BCG-unresponsive disease. In contrast, recent phase III data have shown that upfront combination strategies do not necessarily translate into improved oncological outcomes. Overall, while the combination of BCG and immune checkpoint inhibition is supported by a strong immunological rationale, current clinical evidence remains heterogeneous and largely derived from early-phase or ongoing trials, precluding definitive conclusions regarding long-term oncological benefit and durable bladder preservation. Despite a strong immunological rationale, the combination of BCG with immune checkpoint inhibitors remains investigational. Its adoption into routine clinical practice will require mature phase III evidence, validated predictive biomarkers, and a clear demonstration of superiority over established bladder-preserving treatment strategies. Bladder cancer is a common condition, and in many cases it does not spread into the muscle of the bladder. In these patients, a treatment called Bacillus Calmette–Guérin is commonly used to stimulate the immune system to fight cancer cells. However, this treatment does not work for everyone, and the disease may return or worsen over time. New therapies have been developed to help the immune system better recognize and attack cancer. This review explores whether combining these treatments could improve patient outcomes. Although there is strong scientific reasoning behind this approach, current studies show mixed results, with only limited benefit thus far. Further research is needed to understand which patients may benefit most and how best to use these treatments together.
Social isolation and communication barriers are critical challenges faced by hospitalized patients, particularly those in long-stay, Alternate Level of Care (ALC), and acute care units. This scoping review of published literature aimed to answer the research question: How technologies including communication technologies are being used to address social isolation and communication barriers among hospitalized older adults, and what is known about their influence on patient experience. CINAHL, APA PsycINFO, PubMed, ScienceDirect, and Web of Science were searched for studies published from 2015-2025. Thirty-five articles met the inclusion criteria, including qualitative, quantitative, and mixed methods research. Key contributors to social isolation included restricted mobility, cognitive decline, and limited visitation and emotional wellbeing. Communication barriers stemmed from institutional routines, physical impairments, and lack of access to digital tools. These challenges are linked to negative outcomes such as depression, anxiety, cognitive deterioration, and diminished quality of life. Technology-based solutions, ranging from video calls and tablets to wearable devices demonstrate potential in bridging communication gaps and reducing social isolation. Video and phone call tools can improve communication and connection, but they do not work the same for everyone. Involving patients, caregivers, and healthcare staff in designing technology may help make these tools more useful, easier to use, and more sustainable in healthcare settings. This scoping review identifies the need for accessible and well-supported digital interventions to improve communication and well-being among older adult inpatients. Future research needs stronger study designs, bigger sample sizes, and interventions that are better matched to patients' needs.
BackgroundPre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) transmission, particularly for individuals at increased risk. However, uptake and long-term adherence remain challenging, with limited data on pharmacies beyond pilot studies. This study explored how psychological, social, and structural factors shape perceptions of HIV risk and influence PrEP adherence, using the Tripartite Risk Perception (TRIRISK) model, Protection Motivation Theory, and the Theory of Planned Behavior.MethodsA qualitative design using in-depth interviews (IDIs) was conducted pre-implementation (May 2023) and during implementation (April-July 2024) of pharmacy-based PrEP services. Participants were adults (18+years) accessing pharmacy-based PrEP services in Gauteng and the Western Cape, South Africa. Data were analyzed thematically using Excel and MAXQDA, guided by the integrated behavioral frameworks.ResultsA total of 99 IDIs were conducted, 30 in 2023, 69 in 2024. Through the TRIRISK model, this study found that decisions to start or continue PrEP were shaped by perceived vulnerability to HIV, awareness of risky sexual behaviors, mistrust of partners, and emotional experiences like fear and trauma. The PMT further highlighted how emotional triggers, along with perceived severity and coping efficacy, affected motivation to initiate or continue PrEP. The TPB helped explain how subjective norms, such as stigma and social judgment, and perceived behavioral control, shaped by access, convenience, and privacy, impacted adherence.ConclusionIntegrated behavioral frameworks offer critical insights into PrEP-related decision making. Interventions, including pharmacy-based PrEP models, should address emotional barriers, such as stigma-sensitive messaging, strengthening social support, and reducing structural inequalities. HIV Risk Perception and PrEP UsePre-exposure prophylaxis (PrEP) is a highly effective medicine that helps prevent human immunodeficiency virus (HIV). However, not everyone who needs PrEP uses it effectively. In South Africa, PrEP is being offered in some pharmacies to make it easier to access compared to most public clinic settings. This study looked at what people think and feel about their risk of getting HIV, and how those thoughts shape their decision to take PrEP. We interviewed 2 groups of pharmacy clients at different stages of implementation: one group before pharmacy-based PrEP was rolled out, and another group during implementation after PrEP had been initiated. We used 3 behavioral theories to understand how people assess their risk and make decisions about PrEP use. We found that people were more likely to start PrEP when they felt personally at risk of HIV, for example due to a partner's unfaithfulness or past traumatic experiences. Support from peers, privacy at the pharmacy, and easy access made it easier to keep using PrEP. However, stigma, travel, and life challenges like family responsibilities often made it harder to continue. This study shows that providing PrEP through pharmacies can work well, but emotional, social, and structural barriers must be addressed. PrEP programs should include supportive messaging, flexible access options, and tools that help people stay on PrEP even when life gets difficult.
Knee osteoarthritis (KOA) is a major cause of pain and disability worldwide. Although exercise therapy is recommended as first-line treatment, outcomes vary considerably. Treatment expectations may influence rehabilitation response. This randomized controlled trial (RCT) protocol investigates whether brief pre-exercise expectation framing affects pain and functional outcomes in individuals with KOA undergoing structured rehabilitation. This assessor-blinded, three-arm superiority RCT will recruit 90 participants with symptomatic, radiographically confirmed KOA from the outpatient physiotherapy department of Kharazmi University, Tehran, Iran. Participants will be randomized (1:1:1) to receive comprehensive knee exercises combined with positive, negative, or neutral expectation framing. All groups will complete an 18-session supervised exercise program over six weeks. Expectation framing will be delivered once before the first session. Primary outcomes are pain intensity and disability. Secondary outcomes include knee kinematics, muscle activity, pain catastrophizing, self-efficacy, kinesiophobia, and treatment expectations. Assessments will be conducted at baseline, post-intervention, and three-month follow-up; expectation ratings will also be collected immediately after framing to verify the manipulation. This trial will evaluate whether pre-exercise expectation framing influences rehabilitation outcomes in KOA and clarify the role of treatment expectations in clinical practice. The http://www.irct.ir identifier is IRCT20250811066819N1. Knee osteoarthritis is a common problem. It causes pain and makes daily activities harder. Exercise can help many people. But not everyone improves in the same way. One reason may be what people think and expect before they start exercising.This study looks at how a therapist’s first conversation with a patient may change treatment results. We test three ways of giving information: a positive message, a neutral message, or a message that says the results are uncertain.All people in the study will do the same exercise program. The only difference is how the program is explained before the first session. We will check if this first talk changes what patients expect. We will also see if these expectations relate to changes in pain and movement over time.The goal is to find out if simple changes in communication can help patients get better results from exercise. If this works, it could be an easy and low-cost way to improve care.
Timely, accurate tuberculosis (TB) diagnostics and strong laboratory networks are critical for providing high-quality TB care. In the Western Pacific Region, available resources, TB burdens, and access to TB testing vary dramatically between countries. To understand the current regional situation, we described TB diagnostic test availability and laboratory services in seven countries with high TB burdens in the Western Pacific Region: MAIN TEXT: In 2024, World Health Organization's (WHO) Western Pacific Regional Office conducted an assessment of TB diagnostic test availability and laboratory services in seven countries with high TB burdens: Cambodia, China, Lao People's Democratic Republic, Mongolia, Philippines, Papua New Guinea, and Viet Nam. Standardised surveys were sent to members of country national tuberculosis programmes, and follow-up interviews were conducted. An in-person workshop was attended where preliminary findings were presented and updated, if necessary. The exercise revealed a high uptake of WHO-endorsed rapid molecular tests for TB detection, although the use of smear microscopy persists in most countries' remote areas. Regarding drug susceptibility testing, both molecular and phenotypic methods are employed. Testing for first-line TB drug resistance is generally available, but currently, testing capacity for new and re-purposed drugs remains limited. Most countries provide TB testing at district-level facilities in conjunction with well-established specimen transport networks, with laboratories utilising a mix of paper and electronic databases. Comprehensive TB and drug-resistance testing at peripheral settings remains a rarity. The Western Pacific Region has invested significantly in TB testing and laboratory services. To ensure everyone in the region has access to TB diagnostics, these efforts must be maintained.