The perspectives and experiences of people receiving and providing low‐complexity NAATs to diagnose tuberculosis and tuberculosis drug resistance reveal key desirable outcomes of accessible, affordable, accurate, timely diagnosis for framing an evaluation of testing along the intervention pathway. Yet, the findings reveal how multiple challenges risk undoing the added values new diagnostics of low complexity can bring for people with tuberculosis and healthcare professionals. These challenges compound underutilization of low‐complexity NAATs. Overall, the review findings suggest that the promise of low‐complexity diagnostics to overcome deficiencies in laboratory infrastructure and skilled professionals is misleading. We had high confidence in the evidence contributing to these review findings. The findings reveal a fundamental paradox between supporting technological innovations but not in parallel investing in health system infrastructure strengthening, and in responses to the social context of an intervention, when these aspects are in fact inseparable from the technological innovation. Without jointly addressing these sociotechnical aspects, equitable and quality care is impossible. This paradox needs to be addressed at global and country level because ignoring it harms the implementation and impact of the technology and renders it in many settings underutilized. Implementation of new diagnostic technologies, like those considered in this review, will need to tackle the challenges identified in this review including weak infrastructure and systems, and insufficient data on ground level realities prior and during implementation, as well as problems of conflicts of interest in order to ensure equitable use of resources.