Brazil builds genomic network to fight drug‑resistant tuberculosis

Tuberculosis remains one of the deadliest infectious diseases worldwide, killing about 1.5 million people each year and carrying major social and economic costs. It is a priority in the United Nations 2030 Agenda for Sustainable Development, and the WHO's End TB Strategy highlights the need for research, innovation and fast adoption of new technologies. Responding to that call, a team led by corresponding author Emilyn Costa Conceição has designed a study to consolidate genomic epidemiological surveillance for TB in Brazil’s North and Northeast regions. The study will bring whole genome sequencing (WGS) into routine surveillance, focus on drug-resistant TB (DR-TB) cases and combine laboratory work with training and a national data platform. It is an observational, cross-sectional, prospective study that uses both quantitative and qualitative approaches and will take place in the states of Pará, Amazonas, Ceará and Bahia. The project will sequence 500 Mycobacterium tuberculosis complex (MTBC) isolates from DR-TB cases, which represents 87% of the expected DR-TB cases in the target areas, and it will also include cases where non-tuberculous mycobacteria (NTM) are found among the DR samples.

At the heart of the protocol is the application of whole genome sequencing (WGS) to 500 MTBC isolates collected from DR-TB cases. The study will analyze sequence data to search for genotype-phenotype correlations, identify mutation patterns and look for associations between genetic findings and patients' clinical or epidemiological characteristics. Samples will be processed within a networked and decentralised framework so that sequencing and analysis can be integrated into local public health workflows. The project also includes capacity-building: theoretical instruction and hands-on bioinformatics training for laboratory and public health professionals so teams can interpret sequence data and use it for action. To make the results useful at the local level, a national surveillance platform called GEMIBRA will be deployed to support data visualization, map spatial distribution of strains, and inform clinical decision-making. The protocol describes these methods and tools but does not report outcome data; instead, it lays out how genetic and clinical data will be combined to inform surveillance and care.

If implemented as planned, this work will create practical evidence about what integrating WGS into Brazil’s TB surveillance system can deliver. The study is explicitly aimed at supporting precision treatment approaches—using genetic information to tailor therapy for drug-resistant cases—and at guiding public health interventions by revealing transmission dynamics and emerging resistant strains. By training local staff and testing a decentralised model, the project seeks to build a sustainable workforce and make WGS-based diagnostics feasible in resource-limited settings in the North and Northeast. Its translational research model and networked approach are intended to speed the flow of new knowledge into routine practice, so that laboratories, clinicians and public health teams can act on genomic data. Ultimately, the protocol aims to produce information that will help refine the National Plan to End TB as a public health problem and reduce transmission through better detection and response to drug-resistant tuberculosis.