{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:37:59Z","timestamp":1786451879089,"version":"build-2736575974"},"reference-count":29,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-060942"],"award-info":[{"award-number":["INV-060942"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"FIND","award":["TB24-0048"],"award-info":[{"award-number":["TB24-0048"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,28]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Targeted next-generation sequencing (tNGS) offers promise in the rapid detection of drug-resistant tuberculosis (DR-TB) directly from sputum. While pilot studies on tNGS are emerging, there is limited empirical qualitative evidence on tNGS implementation. This study, therefore, aimed to explore the experiences of tNGS programmatic implementation by clinicians, laboratory technicians and policymakers to identify perceived key operational barriers and enablers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An exploratory qualitative study employing inductive thematic analysis. Data were collected via semi-structured interviews and focus group discussion. Analysis was guided by the theoretical framework of acceptance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted between March and October 2025 as part of a broader implementation study evaluating tNGS potential programmatic integration in West Java, Indonesia. Participants were recruited from a DR-TB reference laboratory and a tertiary care hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A purposive sample of 18 tNGS users participated, including clinicians (n=7), laboratory technicians (n=9) and policymakers (n=2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis revealed a dual challenge for tNGS implementation: technical-operational complexity and unguided clinical utility. Technical barriers include laboratory workflow optimisation and the need for highly skilled technicians for routine operation. From a clinical point of view, lack of local tNGS guidelines for clinicians and absence of local evidence such as cost-effectiveness and diagnostic performance at the policy levels hampered clinical adoption. Several enablers for tNGS implementation were identified, namely technicians with prior sequencing experience, perceived clinical value for complicated cases and advocacy within professional networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Successful scale-up of tNGS for DR-TB in high-burden settings requires a coordinated multisectoral strategy. Generating local evidence on robust laboratory data for technical guidelines, clinical utility and cost-effectiveness are warranted to support tNGS adoption. This evidence can then be integrated into the national tNGS roll-out strategy to enable sustainable and nationwide adoption of tNGS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117319","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:05:48Z","timestamp":1786449948000},"page":"e117319","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Is targeted next generation sequencing for drug-resistant tuberculosis feasible in a high-burden setting: a qualitative study from Indonesia"],"prefix":"10.1136","volume":"16","author":[{"given":"Salma N.","family":"Annisa","sequence":"first","affiliation":[{"name":"Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almira","family":"Alifia","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alamanda N.","family":"Larasmanah","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurlaila S.","family":"Ramadhani","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvi","family":"Indriani","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arto Yuwono","family":"Soeroto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Respirology and Critical Care Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia"},{"name":"Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6233-6410","authenticated-orcid":false,"given":"Reinout","family":"van Crevel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Radboud Community for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Netherlands"},{"name":"Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip C.","family":"Hill","sequence":"additional","affiliation":[{"name":"Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-2034","authenticated-orcid":false,"given":"Bony Wiem","family":"Lestari","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia"},{"name":"Faculty of Medicine, Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081105051332000_16.8.e117319.1","unstructured":"WHO . WHO Consolidated Guidelines on Tuberculosis: Module 3: Diagnosis. Geneva: World Health Organization, 2025."},{"key":"2026081105051332000_16.8.e117319.2","unstructured":"World Health Organization . Use of Targeted Next-Generation Sequencing to Detect Drug-Resistant Tuberculosis. Geneva: World Health Organization, 2023."},{"key":"2026081105051332000_16.8.e117319.3","doi-asserted-by":"publisher","DOI":"10.5588\/pha.22.0041"},{"key":"2026081105051332000_16.8.e117319.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.lansea.2026.100783","article-title":"Targeted next-generation sequencing for direct drug-resistant tuberculosis detection in sputum samples in Indonesia: an implementation study (2024-25)","volume":"49","author":"Lestari","year":"2026","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"2026081105051332000_16.8.e117319.5","unstructured":"WHO . Global tuberculosis report 2025. Geneva, 2025."},{"key":"2026081105051332000_16.8.e117319.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.lansea.2023.100294","article-title":"Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis","volume":"22","author":"Lestari","year":"2024","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"2026081105051332000_16.8.e117319.7","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s15010-024-02411-w","article-title":"Targeted next-generation sequencing - a promising approach in the diagnosis of Mycobacterium tuberculosis and drug resistance","volume":"53","author":"Wu","year":"2025","journal-title":"Infection"},{"key":"2026081105051332000_16.8.e117319.8","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1206056","article-title":"Direct detection of drug-resistant Mycobacterium tuberculosis using targeted next generation sequencing","volume":"11","author":"Murphy","year":"2023","journal-title":"Front Public Health"},{"key":"2026081105051332000_16.8.e117319.9","doi-asserted-by":"crossref","DOI":"10.1080\/22221751.2024.2392656","article-title":"Targeted next-generation sequencing of Mycobacterium tuberculosis from patient samples: lessons learned from high drug-resistant burden clinical settings in Bangladesh","volume":"13","author":"Uddin","year":"2024","journal-title":"Emerg Microbes Infect"},{"key":"2026081105051332000_16.8.e117319.10","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.22.0138"},{"key":"2026081105051332000_16.8.e117319.11","unstructured":"Engel N , Ochodo EA , Karanja PW , et al . Web Annex B.13. User Perspectives on NAATs to Detect TB and Resistance to Anti-TB Agents: Results from Qualitative Evidence Synthesis (Systematic Review). WHO Consolidated Guidelines on Tuberculosis: Module 3: Diagnosis. Geneva: World Health Organization, 2025."},{"key":"2026081105051332000_16.8.e117319.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-066651","article-title":"Complexities and benefits of adopting next-generation sequencing-based tuberculosis diagnostics: a qualitative study among stakeholders in low and high-income countries","volume":"13","author":"Grandjean Lapierre","year":"2023","journal-title":"BMJ Open"},{"key":"2026081105051332000_16.8.e117319.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0004718","article-title":"Healthcare providers\u2019 knowledge, attitudes, and perceptions from using targeted sequencing to diagnose and manage drug-resistant tuberculosis (DR-TB) in Eswatini","volume":"5","author":"Madison","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"2026081105051332000_16.8.e117319.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-017-2031-8","article-title":"Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework","volume":"17","author":"Sekhon","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"2026081105051332000_16.8.e117319.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-07577-3","article-title":"Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions","volume":"22","author":"Sekhon","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026081105051332000_16.8.e117319.16","unstructured":"Gates Foundation . Genomic surveillance of drug-resistant tuberculosis in Indonesia. 2023. Available: https:\/\/gcgh.grandchallenges.org\/grant\/genomic-surveillance-drug-resistant-tuberculosis-indonesia"},{"key":"2026081105051332000_16.8.e117319.17","unstructured":"Indonesian ministry of health . In: Indonesian Tuberculosis Information System (SITB). 2024."},{"key":"2026081105051332000_16.8.e117319.18","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1204064","article-title":"Implementation of targeted next-generation sequencing for the diagnosis of drug-resistant tuberculosis in low-resource settings: a programmatic model, challenges, and initial outcomes","volume":"11","author":"de Araujo","year":"2023","journal-title":"Front Public Health"},{"key":"2026081105051332000_16.8.e117319.19","doi-asserted-by":"crossref","unstructured":"Wang H , Chen X , Wu X , et al . Combined multiplex polymerase chain reaction-based targeted next\u2212generation sequencing and serum 1, 3-\u03b2-D-glucan for differential diagnosis of Pneumocystis pneumonia and Pneumocystis colonization. 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