Harald's Interview & Publication
SYNLAB Germany
Dr med Harald Hoffmann
Specialist in microbiology, virology and infectious disease epidemiology, Medical Director WHO Supranational Reference Laboratory for Tuberculosis, Gauting
What inspired your research and what did it cover?
Multidrug-resistant (MDR) tuberculosis (TB) poses the toughest challenge to TB control worldwide. Central Asia is one of the global hotspots with the highest MDR-TB rates. Our institute is the World Health Organization Supranational Reference Laboratory partner for all Central Asian TB control programmes. Kyrgyzstan is the smallest Central Asian country with the highest TB and MDR-TB incidence rates.
Detecting multidrug-resistant tuberculosis and the susceptibility profiles of the infecting pathogens take up to two months with conventional methods – time during which the patients can further spread the disease. Whole genome or targeted sequencing on next-generation sequencing (NGS) platforms offer new and promising possibilities to shorten this diagnostic delay. With this pilot project, we aimed at helping the Kyrgyz tuberculosis programme accelerate MDR-TB detection and the implementation of fully active anti-TB treatment.
Looking at the potential of your findings, what difference can they make?
We were able to demonstrate the proof of concept of NGS implementation in a low- to low-middle-income country. Furthermore, we have given a practice guideline on how to implement the technology and on how much it costs. With this, we have significantly reduced the number of obstacles to the roll-out of NGS technology for MDR-TB diagnostics also in low- and middle-income countries. This is an important step forward for case detection and management in all high-prevalence countries where MDR-TB is a serious challenge.
Publication
Implementation of whole genome sequencing for tuberculosis diagnostics in a low-middle income, high MDR-TB burden country
National Library of Medicine – https://pubmed.ncbi.nlm.nih.gov/34321545/
Multi-drug resistant (MDR) Mycobacterium tuberculosis strains are a major challenge for TB control worldwide. It is now possible to genetically determine most resistance by decoding the bacterial genomic code using Next Generation Sequencing (NGS). With this proof-of-concept study, we were the first group in the world to successfully implement NGS in a low/middle-income country with high TB prevalence. We implemented an Illumina MiSeq sequencer in the National Reference Laboratory (NRL) of Kyrgyzstan. This enabled us to reduce the turnaround time of TB resistance tests from two months to about one week. We also calculated in detail the costs of NGS-based resistance testing in low- and middle-income countries. With our report, we have produced a practical guide for low- and middle-income countries on how to introduce NGS into their TB laboratory network.