Healthcare workers' perceptions of the potential value of whole-genome sequencing for post-exposure management of rifampicin-resistant tuberculosis: a qualitative study.
6 affiliations
- 1Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. [email protected].
- 2Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- 3Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- 4DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- 5Centre for Epidemic Response and Innovation (CERI), School for Data Science and Computational Thinking, Stellenbosch University, Cape Town, South Africa.
- 6Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Abstract
Background
Rifampicin-resistant tuberculosis (RR-TB) remains a public health challenge, with suboptimal treatment outcomes and challenging management of contacts. Whole genome sequencing (WGS) generates a comprehensive drug resistance profile and transmission inference with a single assay. Limited evidence exists on how healthcare workers (HCWs) perceive the value of WGS, especially for post-exposure management.Methods
We conducted a qualitative study with 22 purposively sampled HCWs (9 doctors, 9 nurses, 4 community health workers) at 11 public health care facilities in the Western Cape, South Africa. Following a standardized explanation of WGS and WGS-guided post-exposure management, semi-structured interviews were conducted to elicit responses on anticipated acceptability and value of WGS for post-exposure management. Interviews were audio-recorded, transcribed, and analysed using thematic analysis, combining inductive with deductive approaches informed by the Theoretical Framework of Acceptability themes of intervention coherence, self-efficacy, affective attitude, ethicality, perceived effectiveness and opportunity costs.Results
HCWs demonstrated good anticipated intervention coherence, even though nurses and community health workers required more explanation on WGS than doctors, and pathways for WGS integration into routine care were not clear. Most HCWs indicated high confidence in anticipated application of WGS-supported recommendations. Limited familiarity with genomic tools was identified as a barrier that requires formal training. Affective attitudes were largely positive, with HCWs expressing optimism about improved clinical decision-making and reduced diagnostic uncertainty following access to WGS. Anticipated effectiveness was high, with HCWs hopeful of faster initiation of appropriate regimens for patients and contacts, reduced patient distress, and decreased medication wastage. Less applicable to post-exposure management was the anticipated benefit that WGS could reduce the burden to the health system and patients by limiting repeat visits and reducing laboratory delays. Ethicality emerged as an important advantage, with HCWs anticipating reduced stigma when contact screening is guided by the detection of hotspots. HCWs did not anticipate opportunity costs.Conclusion
HCWs in high-burden settings generally anticipated that WGS would be acceptable to inform post-exposure management strategies. Successful integration of WGS into routine TB care will require tailored training and clear implementation guidance on how to interpret and apply WGS results in clinical and public health practice.Clinical trial number
Not applicable.
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BibTeX
@article{october2026healthcare,
title = {{Healthcare workers' perceptions of the potential value of whole-genome sequencing for post-exposure management of rifampicin-resistant tuberculosis: a qualitative study.}},
author = {Caitlin D October and Busisiwe Beko and Anja Reuter and Vincent Rennie and Nabila Ismail and Emilyn Costa Conceição and Susanne Tonsing and Rob Warren and Stephanus Malherbe and Annelies Van Rie and Lario Viljoen},
journal = {BMC health services research},
year = {2026},
month = jul,
doi = {10.1186/s12913-026-15140-7},
url = {https://europepmc.org/article/MED/42907804},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Healthcare workers' perceptions of the potential value of whole-genome sequencing for post-exposure management of rifampicin-resistant tuberculosis: a qualitative study.
AU - Caitlin D October
AU - Busisiwe Beko
AU - Anja Reuter
AU - Vincent Rennie
AU - Nabila Ismail
AU - Emilyn Costa Conceição
AU - Susanne Tonsing
AU - Rob Warren
AU - Stephanus Malherbe
AU - Annelies Van Rie
AU - Lario Viljoen
PY - 2026
DA - 2026/07/01
JO - BMC health services research
DO - 10.1186/s12913-026-15140-7
UR - https://europepmc.org/article/MED/42907804
AB - Background Rifampicin-resistant tuberculosis (RR-TB) remains a public health challenge, with suboptimal treatment outcomes and challenging management of contacts. Whole genome sequencing (WGS) generates a comprehensive drug resistance profile and transmission inference with a single assay. Limited evidence exists on how healthcare workers (HCWs) perceive the value of WGS, especially for post-exposure management.Methods We conducted a qualitative study with 22 purposively sampled HCWs (9 doctors, 9 nurses, 4 community health workers) at 11 public health care facilities in the Western Cape, South Africa. Following a standardized explanation of WGS and WGS-guided post-exposure management, semi-structured interviews were conducted to elicit responses on anticipated acceptability and value of WGS for post-exposure management. Interviews were audio-recorded, transcribed, and analysed using thematic analysis, combining inductive with deductive approaches informed by the Theoretical Framework of Acceptability themes of intervention coherence, self-efficacy, affective attitude, ethicality, perceived effectiveness and opportunity costs.Results HCWs demonstrated good anticipated intervention coherence, even though nurses and community health workers required more explanation on WGS than doctors, and pathways for WGS integration into routine care were not clear. Most HCWs indicated high confidence in anticipated application of WGS-supported recommendations. Limited familiarity with genomic tools was identified as a barrier that requires formal training. Affective attitudes were largely positive, with HCWs expressing optimism about improved clinical decision-making and reduced diagnostic uncertainty following access to WGS. Anticipated effectiveness was high, with HCWs hopeful of faster initiation of appropriate regimens for patients and contacts, reduced patient distress, and decreased medication wastage. Less applicable to post-exposure management was the anticipated benefit that WGS could reduce the burden to the health system and patients by limiting repeat visits and reducing laboratory delays. Ethicality emerged as an important advantage, with HCWs anticipating reduced stigma when contact screening is guided by the detection of hotspots. HCWs did not anticipate opportunity costs.Conclusion HCWs in high-burden settings generally anticipated that WGS would be acceptable to inform post-exposure management strategies. Successful integration of WGS into routine TB care will require tailored training and clear implementation guidance on how to interpret and apply WGS results in clinical and public health practice.Clinical trial number Not applicable.
SN - 1472-6963
ER -