Diagnostic algorithms for tuberculosis in Europe: insights from the European Reference Laboratory Network for...

Area of Science:

• Microbiology
• Public Health
• Genomics

Background:

• Extensively drug-resistant tuberculosis (TB) presents significant treatment challenges in the European region, leading to poor outcomes.
• Existing World Health Organisation (WHO) diagnostic algorithms require adaptation for the specific context of the European Union/European Economic Area (EU/EEA), characterized by low TB incidence and high resources.

Purpose of the Study:

• To propose a context-specific diagnostic algorithm for extensively drug-resistant TB in the EU/EEA.
• To optimize diagnostic strategies by integrating molecular rapid tests, culture, and whole genome sequencing (WGS).

Main Methods:

• Development of a stepwise, resource-sensitive diagnostic algorithm.
• Prioritization of universal WHO-recommended molecular rapid diagnostic tests.
• Integration of systematic culture and whole genome sequencing (WGS).
• Strategic incorporation of phenotypic drug susceptibility testing and targeted next-generation sequencing (tNGS).

Main Results:

• The proposed algorithm aligns diagnostic practices with EU/EEA epidemiology and laboratory infrastructure.
• It emphasizes diagnostic harmonization, cross-border collaboration, and investment in sequencing capacity.
• The approach aims to improve the effectiveness of TB diagnostics in a high-resource setting.

Conclusions:

• A tailored diagnostic approach is crucial for improving TB treatment outcomes in the EU/EEA.
• The integration of advanced molecular diagnostics, including WGS, is key to strengthening TB control.
• Sustained investment and collaboration are essential for successful implementation.