The implementation of whole-genome sequencing for <i>Mycobacterium tuberculosis</i> in Vietnam

The implementation of whole-genome sequencing for Mycobacterium tuberculosis in VietnamDear Editor, TB remains a major infectious disease with an estimated 10.6 million cases in 2022. 1 Drug-resistant TB, particularly multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB), remains a public health threat, accounting for 3.3% of new TB cases and 17% of previously treated cases worldwide.To curb the spread of TB drug resistance, accurate diagnosis and treatment are key, alongside epidemiological surveillance to inform community-level public health interventions.Molecular WHO-recommended rapid diagnostics (mWRDs) such as Xpert Ultra (Cepheid, Sunnyvale, CA, USA), and line-probe assays (LPAs) only detect resistance-conferring mutations in specific target regions and for a limited number of drugs. 2 Whole-genome sequencing (WGS) can be used to tailor treatment plans for TB patients and inform surveillance.The feasibility of using WGS for the routine diagnosis of DR-TB has been demonstrated in high-income countries, 3 but few data are available from low-income, high TB burden settings.Here, we present our experience of setting up WGS for Mycobacterium tuberculosis complex (MTBc) in Vietnam, describing the challenges and lessons learnt for other TB programmes that are planning to deploy WGS in similar settings.Vietnam has an estimated TB incidence of 176/ 100,000 population with approximately 9,200 MDR-TB cases in 2022. 4 MDR-TB accounts for 3.3% of new diagnoses and 15% of previously treated TB cases, but only 3,577 of an estimated 9,200 MDR-TB cases were laboratory-confirmed.The Vietnam National TB Control Programme (Vietnam NTP) guidelines recommend routine drug resistance detection using Xpert, Truenat (Molbio Diagnostics, Goa, India), and LPA.A research