P107

1:Australian National University National Center for Epidemiology and Population Health; 2:The University of Sydney, Sydney Infectious Diseases Institute; 3:NSW Health Pathology - Institute of Clinical Pathology and Medical Research; 4:Victorian Tuberculosis Program, the Royal Melbourne Hospital

Whole genome sequencing (WGS) is increasingly being adopted for the management of tuberculosis (TB). However, questions remain regarding its utility in different settings and barriers for implementation. We conducted a systematic review to explore the applications and documented challenges in using WGS for TB detection and response. We only included studies that prospectively obtained WGS data and actively linked it with epidemiological data. 54 studies met our inclusion criteria. Most of the studies (36/54, 66.7%) were published after 2022. 41 were surveillance studies, 6 were outbreak investigations, and 7 had a research focus. Most studies (38/54, 70.4%) investigated TB in World Bank low to upper-moderate TB burden countries (<100 per 100,000 population). Sequencing was primarily performed in high-income countries (31/54, 57.4%); no sequencing was conducted in low-income countries. Most studies used WGS to identify transmission/clusters (50/54, 92.6%). Drug-resistant TB was the focus of 20/54 (37.0%) studies. Only 16/54 (29.6%) studies reported using WGS to inform public health decisions, most commonly to prompt intensified epidemiological investigation or guide active case detection of genomically-clustered patients. Reported challenges around WGS implementation included lack of culture-confirmed cases (cultures rarely done in resource-limited settings), long delays in getting WGS results, high costs, and limited reported engagement of the local TB control team to act on results. This review investigates the utility of WGS for public health, including in detecting transmission links and drug resistance, but also highlights challenges around implementation and the need for increased access to WGS for public health agencies in lower-income settings.