Table 2.

Levels of decision-making and examples of public health application of M tuberculosis whole genome sequencing (WGS). Adapted from Denholm JT, et al. Developing best practice public health standards for whole genome sequencing of Mycobacterium tuberculosis. Lancet Regional Health-Western Pacific. 2024;46:101014.

	Levels of decision-making	Potential implications of decision shift	Considerations for decision-making
Macro-level implications (health policy)	• Formulation of national policy and strategic plan	• Monitor program effectiveness through review of relapse/reinfection	• Undertake periodic multisectoral review to prioritise and contextualise response.
	• Monitoring and evaluation of performance and progress	• Consider whole-of-system engagement eg migration screening, labour protections
Meso-level implications (TB programmes)	• Plan targeted interventions based on apparent transmission	• Optimise treatment plans and isolation requirements for drug resistance	• Regular and active community engagement for planning and implementing case finding and educational interventions
	• Support laboratory accreditation	• Improved understanding of epidemiological context, including isolation and contact tracing requirements
		• Enhanced awareness of TB risk factors
Micro-level implications (individual cases/clusters)	• Therapeutic decision-making	• Improved understanding of local risk factors for recent transmission	• Ensure equity is prioritised in responses
	• Contact investigation	• Enhanced capacity and better-informed participation in community activities for TB risk reduction	• Human rights-based approach to promoting health and reducing stigma