Acceptability and feasibility of oral swabs for tuberculosis diagnosis in young children: a qualitative study from Uganda and Peru.

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality in young children, particularly in settings with limited diagnostic capacity. Oral swabs represent a promising alternative specimen type due to their ease of collection, but evidence on their acceptability and feasibility remains limited. Methods: This qualitative sub-study was nested within the NOD-pedFEND diagnostic trial evaluating novel tests for pediatric TB. We conducted semi-structured interviews and focus group discussions with 81 participants across Uganda (n=57) and Peru (n=24), including caregivers (Uganda n=30; Peru n=7), healthcare workers (Uganda n=23; Peru n=12), and National TB Program stakeholders (Uganda n=4; Peru n=5). Participants were recruited purposively from among those involved in or linked to the parent NOD-pedFEND study. Data were analyzed using thematic analysis. Results: Oral swabs were widely perceived as acceptable due to their non-invasive nature, minimal discomfort, and ease of collection. Caregivers and healthcare workers valued the reduced burden on children compared to more invasive sampling methods. Across both countries, participants expressed concerns about perceived low diagnostic sensitivity in children, particularly when compared with reference standard specimens. Despite these reservations, oral swabs were welcomed as a complementary, rather than substitute, diagnostic modality. Stakeholders highlighted their potential role within future point-of-care diagnostic strategies in low-resource settings. Conclusions: Oral swabs are acceptable and feasible for pediatric TB diagnosis in diverse settings, though concerns about sensitivity persist. Their integration as an add-on test could expand diagnostic access, especially if incorporated into scalable, point-of-care approaches.