On November 11, 2024, the Asia Pathogen Genomics Initiative (Asia PGI) convened a milestone gathering of 63 representatives — including country partners, international donors, and Next-Generation Sequencing (NGS) manufacturers — from 15 countries to discuss the application of genomics in Tuberculosis (TB) surveillance and management in Asia. Participants explored recent advancements, shared country-level experiences, and identified priorities for scaling up NGS in TB control.
The case for TB genomics
Next-Generation Sequencing has emerged as a transformative tool in TB diagnostics and public health surveillance, offering unparalleled speed and precision in detecting drug-resistant TB (DR-TB). The World Health Organization's (WHO) updated Consolidated Guidelines for Tuberculosis (2023-2024) now endorse targeted NGS (tNGS) for diagnosing DR-TB. This class-based recommendation reflects robust evidence demonstrating tNGS's ability to rapidly and accurately map resistance profiles, supporting both individualized patient care and public health responses.
Examples of NGS implementation highlight its potential:
- Australia employs Whole Genome Sequencing (WGS) to track TB transmission pathways, identifying imported cases and clusters for targeted interventions.
- In Papua New Guinea, sequencing revealed previously undetected drug-resistant strains, informing more effective outbreak responses.
Despite promising outcomes, challenges remain, particularly in low- and middle-income countries where financial, technical, and operational hurdles limit broader adoption.
Insights from regional implementation efforts
Several countries presented case studies on the integration of NGS into TB control:
- Indonesia: A pilot program targeting 7,600 patients across 34 provinces aims to compare the effectiveness of tNGS and WGS. However, logistical complexities, low sample quality, and high costs pose significant barriers.
- Thailand: WGS implementation has identified TB clusters linked to specific regions and high-risk populations, such as incarcerated individuals. However, initial costs and the need for technical expertise remain key challenges.
- Malaysia: WGS studies revealed genetic diversity in TB strains, including mutations undetected by conventional diagnostic tools, underscoring the critical role of genomics in comprehensive TB management.
Overcoming barriers to implementation
The discussions highlighted the need for a multifaceted approach to advance NGS adoption:
- Capacity building: Training healthcare and laboratory personnel to optimise sample collection and interpret genomic data.
- Cost reduction: Leveraging manufacturer-supported access programs, such as Illumina’s Global Health Access Initiative and MGI’s Pandemic Preparedness Program, to make NGS more affordable.
- Policy and infrastructure development: Establishing standardised protocols and integrating NGS workflows into national TB programs.
To further streamline adoption, innovative bioinformatics tools like Sequentia’s MAGMA-MICK software offer user-friendly analysis of TB genomic data, facilitating clinical decision-making and public health planning.
Future Directions
Asia PGI emphasised the importance of regional collaboration to address gaps in TB genomics. Key priorities include:- Integrating sequencing technologies into national health strategies.
- Expanding access to affordable genomic assays.
- Enhancing regional capacity through training and knowledge exchange.
To drive these efforts forward, Asia PGI has established a TB Genomics Regional Expert Working Group, designed to offer continuous guidance and support for advancing regional TB genomics initiatives.
As TB remains a pressing global health challenge, the integration of genomics offers a path toward more effective diagnostics, tailored treatments, and proactive public health interventions. The Asia PGI meeting marked a significant step in this journey, fostering collaboration and charting a course for the broader adoption of NGS technologies.