Grant: Project Grant

Tuberculosis (TB) whole genome sequencing (WGS) allows outbreak identification and disease transmission tracking. We hypothesize that prospective WGS-guided epidemiological investigations improve case detection compared to current best practices by adapting contact tracing strategies to local transmission patterns. A cluster randomized controlled trial (cRCT) will be performed in high TB incidence villages of Haute Matsiatra region in Madagascar. Communities will be randomized in three separate TB control strategies comparing standard of care, WHO recommended best practices and a novel intervention involving TB WGS cluster-guided epidemiologic investigations. The incremental value of TB WGS on case notifications and reduction of TB burden will be measured. Secondary studies will be nested within this cRCT. Qualitative approaches will increase the understanding of the factors facilitating and hindering implementation of WGS-based diagnostics within health systems. A cost analysis will measure the cost effectiveness of newly implemented laboratory methods. Field and genomic epidemiology data from this project will inform future work on the design of community-level TB elimination strategies in collaboration with Madagascar National TB program.