Is faster always better? The case of same-day diagnosis of tuberculosis.

Same-day tuberculosis (TB) diagnosis and treatment initiation are increasingly promoted to reduce delays in care and loss to follow-up. Rapid molecular diagnostics have made this feasible, but their implementation among marginalized rural populations presents important challenges. An exclusive focus on speed may compromise diagnostic quality and patient-centred care in settings marked by chronic malnutrition and limited access to healthcare. Chronic malnutrition may impair sputum production, reducing specimen quality and diagnostic sensitivity, while socioeconomic constraints shape care-seeking and continuity of care. Drawing on experience from rural primary healthcare, we argue that diagnostic strategies should balance speed, specimen quality and patient-centred care. Flexible, context-specific approaches, rather than a universal emphasis on same-day diagnosis, are needed to improve TB care among vulnerable populations.