Informing People-Centered Target Product Profiles for TB Diagnostics: A Multi-Country Qualitative Study.

Background: Timely and accurate tuberculosis (TB) diagnosis remains a key challenge in high-burden settings. The World Health Organization (WHO) has developed Target Product Profiles (TPPs) to guide diagnostic development, which have largely reflected the perspectives of experts, with limited input from people affected by TB. This qualitative study explored preferences and experiences to inform people-centered TB diagnostic strategies. Methods: We conducted 75 semi-structured interviews with adults undergoing TB evaluation at outpatient clinics in India, the Philippines, South Africa, Uganda, and Vietnam. Participants were purposively sampled to ensure diversity in sex, TB status, age and treatment. Thematic analysis was utilized. Findings: Preferences were shaped by five interrelated domains: perceived diagnostic accuracy, sample collection experience, time-to-results, affordability, and testing location. Diagnostic accuracy was consistently prioritized, with many expressing willingness to trade comfort and convenience for more trustworthy results. Sputum and blood were widely trusted despite collection challenges, whereas tongue swabs and urine were easier to provide but perceived as less accurate. Rapid, same-day turnaround was valued for minimizing emotional distress, financial and logistical burdens. Although testing was typically free, indirect costs such as transport and lost income, remained barriers. Hospital-based testing was preferred due to trust in staff and infrastructure, though some acknowledged the appeal of community-based approaches if reliability and privacy were ensured. Conclusion: People seeking TB care prioritize accuracy and trustworthiness, even at the expense of comfort or convenience. These preferences can inform WHO policy updates, especially regarding the adoption of novel sample types and testing strategies, to support uptake and equitable access to novel diagnostics.