P109

1:National Center for Epidemiology and Population Health, Australian National University; 2:Microbiological Diagnostic Unit Public Health Laboratory, the Royal Melbourne Hospital; 3:Victorian Tuberculosis Program, the Royal Melbourne Hospital; 4:Sydney Infectious Diseases Institute, The University of Sydney; 5:Institute of Clinical Pathology and Medical Research, NSW Health Pathology

Whole genome sequencing (WGS) is increasingly being adopted for tuberculosis (TB) public health investigations. To ensure effective translation into practice, it is essential to evaluate the utility, implementation, and ethical implications of WGS. We explore these factors in the context of a TB outbreak amongst a Pasifika community in Australia. We used descriptive epidemiology to characterise the outbreak and conducted semi-structured interviews with 10 laboratory and public health staff to examine perspectives on WGS impact, implementation, and ethics. Between 14 February 2017 to 28 July 2023, 36 cases were linked to the outbreak. Interviewees reported that WGS helped to identify transmission links and clusters, enabling more efficient public health action including additional screening and directing contact tracing questioning. Others described a lack of impact due to long sequencing turnaround times and limited translation into action. These diverging experiences highlights the importance of continued program evaluation and developing facilitators to support translation into practice. Interviewees identified patient privacy as a key ethical concern when using WGS, particularly due to TB stigma in the community. They raised the importance of building trust through transparency, engagement, and non-stigmatising language. However, uncertainties around operationalising these principles indicates a gap for clearer frameworks around managing and using WGS information. Conflicting experiences around the utility of TB WGS highlights the importance of program evaluation and translation with a focus on public health outcomes. This study also identifies ethical concerns that require additional strategies to support operational staff and improve public trust.