Saluzzo, FrancescaCabibbe, Andrea MaurizioAnthony, RichardAubry, AlexandraDrobniewski, FrancisHolicka, YenLillebaek, TroelsMacedo, RitaMansjö, MikaelSzél, ViktoriaŽmak, LjiljanaCirillo, Daniela M.Groenheit, Ramona2026-02-202026-02-202025-11-15Lancet Reg Health Eur. 2025 Nov 15:60:101516. doi: 10.1016/j.lanepe.2025.101516. eCollection 2026 Janhttp://hdl.handle.net/10400.18/10960The reported poor treatment outcomes for extensively drug-resistant tuberculosis (TB) in the European region highlight the urgent need for effective and context-appropriate diagnostic strategies. While the World Health Organisation (WHO) provides model algorithms, these require adaptation to the European Union/European Economic Area (EU/EEA) context, a setting with low TB incidence but high resources. This viewpoint from the European Reference Laboratory Network for TB (ERLTB-Net) proposes a tailored diagnostic algorithm that prioritises the universal use of WHO-recommended molecular rapid diagnostic tests, systematic culture, and whole genome sequencing (WGS). This approach integrates phenotypic drug susceptibility testing strategically and outlines the possible role of targeted next-generation sequencing (tNGS) in the EU/EEA setting. The algorithm also addresses the importance of diagnostic harmonisation, cross-border collaboration, and sustained investment in sequencing capacity. By aligning diagnostic practices with the regional epidemiology and laboratory infrastructure, this stepwise, resource-sensitive approach aims to strengthen TB control, improve treatment outcomes, and guide public health action in the EU/EEA.enTuberculosisDiagnostic AlgorithmsDrug ResistanceEU/EEAWhole-genome SequencingEuropeInfecções RespiratóriasResistência aos Antimicrobianosjournal article10.1016/j.lanepe.2025.1015162666-776241323364