Reviewer #2: 
Evidentiary Rating: Strong
Written Review:
Scope of study: This is a qualitative study on the acceptability and feasibility of taking tongue swabs for TB testing (rather than collecting sputum), from the perspective of adults, children’s carers and health practitioners in a clinic.
The taking of tongue swabs is a narrower scope than the phrase ‘novel tongue swab Diagnostics’ implies. This is an important distinction because, as the authors acknowledge, patients’ preferences for testing are likely to be influenced by the speed and accuracy of the results, and neither of these factors were investigated.
Study design and methods: These are well chosen and described in detail, particularly the methods for working in multiple languages, and the teamwork for developing the interview guides, collecting and analysing the data. Framework analysis is an appropriate method to support thoughtful and consistent qualitative analysis by a team. A better study would have given more explanation about the framework, particularly what the a priori codes were and how they were chosen, and what additional codes were indicated by the data.
Results: The results are presented narratively in themes, with illustrative quotes. Table 2 provides a succinct overview.
Discussion: The findings appropriately present participants’ perceptions. It would be helpful to compare some of these perceptions with other studies. For instance, the finding that “[p]eople accessing TB care generally felt that collecting tongue swabs posed a lower risk of TB transmission”, could be put into context either by stating the risk of TB transmission for the two collection methods, or by stating that the transmission risks are unknown. Similarly, there was mention by one or more health practitioners that the tongue swab produced a better quality sample than sputum collection. Are there studies that measure the quality of these two sample types? Lastly, as “[p]articipants… perceived diagnostic accuracy was crucial in shaping test preference”, it would be helpful to know the diagnostic accuracy of this test, and how this compares with testing sputum.
Conclusion: The authors conclude that ‘tongue swabs are generally an acceptable and preferred method for TB testing.’ This may be an over interpretation for two reasons. First, a more accurate conclusion would be that tongue swab collection is generally more acceptable than sputum collection for TB testing. Second, as this study was conducted in clinics with people who were seeking care, the findings cannot be extrapolated to community settings without investigating the safe transport of samples to a laboratory.