Precision Public Health Applications of CRISPR-Based Diagnostics for Tuberculosis: Evidence, Equity, and Implementation Challenges

Timely and accurate detection of Mycobacterium tuberculosis (Mtb) remains a cornerstone of global tuberculosis (TB) control. Traditional diagnostic tools face limitations, including delayed results, variable sensitivity, and restricted access in resource-limited settings. CRISPR-based diagnostics, leveraging Cas12 and Cas13 nucleases with guide RNAs for highly specific nucleic acid detection, have emerged as promising alternatives capable of rapid, sensitive, and point-of-care testing. This chapter synthesizes current evidence on CRISPR TB diagnostics, highlighting their potential to advance precision public health by enhancing early case detection, supporting epidemiologic surveillance, and informing timely clinical and public health interventions. Implementation challenges, including operational feasibility in diverse settings, workforce training, health system integration, ethical considerations, and sustainable financing, are discussed. Equity considerations emphasize the importance of affordable, accessible diagnostics to maximize population-level benefits. Case studies from Ethiopia, India, and South Africa illustrate diverse deployment contexts and inform strategies for scaling CRISPR-based TB diagnostics in alignment with national TB control priorities. Overall, CRISPR diagnostics represent a transformative opportunity to strengthen TB control, improve health outcomes, and reduce inequities when integrated thoughtfully into public health systems. Keywords: CRISPR-based diagnostics, Tuberculosis (TB), Precision public health, Equity in health access, and Implementation challenges.