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1.     Summary and Overall Impression

This paper investigates if nurses, rather than laboratory personnel, can effectively conduct Xpert MTB/RIF Ultra tests to identify tuberculosis (TB) in children using nasopharyngeal aspirates. Part of the TB-Speed study, it was conducted in seven countries and examined hospitals as well as primary-health facilities. The aim was to find out whether task-shifting could increase access to TB diagnosis, particularly in locations with few laboratory personnel. The outcomes are encouraging. With comparable TB detection rates as technicians, nurses were able to finish almost all the tests. Tests performed by nurses in hospitals frequently got to doctors faster, hence accelerating treatment choices. Though they also encountered difficulties such sporadic technical problems, less experience in certain environments, and more work, nurses said training and support helped them to feel more secure performing the exams. All things considered, this is a pertinent and timely research that provides significant proof to back decentralizing TB treatment. It indicates that in environments with constrained laboratory resources, task-shifting may be a feasible answer. How sites were selected is one area that might be bettered as the task wasn't random and other variables could have affected the outcomes. Furthermore, a little additional information on the analysis of the qualitative results would help to support the research.

2.    Section-by-Section Review

Abstract

Major issues:

Not enough about the qualitative side: Since this is a mixed-methods study, it would be good to highlight at least one insight from the interviews or surveys with nurses. Right now, the abstract leans heavily on the numbers and gives very little attention to the nurses' perspectives.

Minor issues:

Inconsistent naming of the test: The test is called “Ultra” in some places and “Xpert Ultra” in others. It would be clearer to use “Xpert MTB/RIF Ultra” the first time and then stick to one version afterward.

Introduction

Major issues

The introduction does a good job explaining the background and rationale for decentralizing TB diagnosis, but it could more clearly state the research question or main objective of the study. Right now, the goal is implied but not directly spelled out in a single, clear sentence.

Minor issues

There’s a sentence that says: “Another use for G1 and reason justifying training of nurses...” — it’s a bit clunky. A smoother version could be: “Another reason to train nurses on the G1 is to make testing available on pediatric wards outside of lab hours.”

Methods

Major Issue

The methods describe the data sources and study activities in good detail, but it’s not entirely clear how sites were selected for nurse-led vs. technician-led testing. Since site selection can strongly influence outcomes, more information about this process—or a clearer statement that it was not randomized—would help readers assess potential bias.

Minor Issue

The description of the performance scoring system (site supervision indicators) is a bit hard to follow at first. It would help to briefly explain how the overall scores were calculated or interpreted before diving into individual indicators and Likert scale values.

Results

Major Issue

While the results are comprehensive, there’s a lot of detail presented without clear summarizing takeaways. The section could benefit from a few short sentences highlighting the main comparisons—especially where nurse-led testing outperformed or underperformed technician-led testing—to help the reader quickly grasp what matters most.

Minor Issue

Some transitions between paragraphs or result categories (e.g., from test uptake to quality assurance to nurse perceptions) feel abrupt. Adding brief connecting phrases—like “In terms of quality control…” or “When looking at nurses’ experiences…”—would improve the flow and help readers follow the structure more easily.

Discussion and Conclusion

Major Issue

The discussion highlights the study’s positive outcomes and practical implications well, but it tends to downplay the limitations. While it briefly mentions site selection bias and support conditions, it doesn’t fully explore how these may have impacted the findings or the generalizability to real-world settings without external support. A deeper reflection on these issues would strengthen the credibility of the conclusions.

Minor Issue

There are a few instances of repetitive phrases, like variations of “training and supervision are key” mentioned multiple times. Slightly streamlining or rephrasing these would make the discussion more concise and avoid redundancy.

Competing interests

The author declares that they have no competing interests.