Implementation of targeted next-generation sequencing for the diagnosis of drug-resistant tuberculosis in low-resource settings: a programmatic model, challenges, and initial outcomes
Leonardo de Araujo, Andrea Maurizio Cabibbe, Lusia Mhuulu, Nunurai Ruswa, Viola Dreyer, Azaria Diergaardt, Gunar Günther, Mareli Claassens, Christiane Gerlach, Christian Utpatel, Daniela María Cirillo, Emmanuel Nepolo, Stefan Niemann
Abstract
Targeted next-generation sequencing (tNGS) from clinical specimens has the potential to become a comprehensive tool for routine drug-resistance (DR) prediction of Mycobacterium tuberculosis complex strains (MTBC), the causative agent of tuberculosis (TB). However, TB mainly affects low- and middle-income countries, in which the implementation of new technologies have specific needs and challenges. We propose a model for programmatic implementation of tNGS in settings with no or low previous sequencing capacity/experience. We highlight the major challenges and considerations for a successful implementation. This model has been applied to build NGS capacity in Namibia, an upper middle-income country located in Southern Africa and suffering from a high-burden of TB and TB-HIV, and we describe herein the outcomes of this process.