Table 4.

NGS implementation in resource-poor settings, feasibility, and challenges.

Challenges	Solutions
Cost	Generate economies of scale: high-throughput sample processing;
Instrument access	Use of core facilities; negotiations with suppliers.
Comparability	Using Sanger mimic conditions with conservative thresholds (20%) to report DRMs; Recommendations of the First “Winnipeg Consensus” [10].
Bioinformatics and data analysis	Specialized, freely available, or low-cost pipelines.
Personnel training/retention	Support of laboratories within WHO HIVResNet. Support from instrument manufacturers and suppliers.
Quality assurance	Support from WHO HIVResNet; Search for additional support from other leading international agencies, such as the Public Health Agency of Canada or the US Centers for Disease Control and Prevention.