landscape of infections is not representative of all Myanmar. Another limitation is that the study timeframe and size make it unlikely that we captured a full spectrum of MDR TB strains in the population and, as noted earlier, we might have missed identification of some transmission links, thus overestimating the proportion of resistant isolates that are independent. Our study has major implications for clinical practice in Myanmar. First, effective treatment for MDR TB cases requires identification of the high proportion of pre-XDR and XDR TB, which cannot be achieved by current Xpert MTB/RIF testing (27,28). The drug resistance‒conferring mutations reported in this study can be detected by first-line and second-line LPA, such as GenoType MTBDRplus and MTBDRsl (Hain Lifescience GmbH, https://www.hain-lifescience.deExternal Link), or the recently launched Xpert MTB/XDR (28,29). These platforms can provide clinicians with an expanded drug-susceptibility report without the need for culturing and WGS. Recently, the Myanmar National Tuberculosis Programme diagnostic algorithm has been updated to extend first-line LPA for patients with a history of previous treatment. Second, several new or repurposed drugs (i.e., bedaquiline, delamanid linezolid, and pretomanid) are drugs already available in Myanmar. The apparent absence of preexisting mutations that confer resistance to these drugs justifies their introduction into treatment regimens for drug-resistant TB in Myanmar, as per WHO recommendations. Our study is useful for public health officials in designing interventions for an evidence-based approach for early detection of cases (active case finding) with optimized diagnosis and treatment. Introducing additional diagnostic methods, such as routine LPA or Xpert MTB/XDR in tandem with Xpert MTB/RIF, and treatment regimens with new oral drugs would further assist in controlling and containing MDR TB in Myanmar. In addition, this study underscores the need for local data, rather than being based on general information from similar studies that have different healthcare delivery systems to drive public health policies for effective intervention.Dr. Htin Lin Aung is a molecular biologist in the Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand. His major research interests are antimicrobial resistance and health inequalities. We thank Aung San, Latha, North Oakkalapa, and the National Tuberculosis Reference Laboratory in Yangon for providing assistance.This study was supported by the New Zealand Health Research Council through the e-ASIA funding scheme. H.L.A. is a Health Research Council Sir Charles Hercus Health Research Fellow. ReferencesWorld Health Organization. Global tuberculosis report 2020 [cited 2020 Oct 15]. Health Organization. Third nationwide drug-resistance survey 2012–2013; 2014 [cited 2021 Jun16]. https://www.who.int/docs/default---2018.pdfExternal LinkMeehan CJ, Goig GA, Kohl TA, Verboven L, Dippenaar A, Ezewudo M, et al. Whole genome sequencing of Mycobacterium tuberculosis: current standards and open issues. Nat Rev Microbiol. 2019;17:533–45. DOIExternal LinkPubMedExternal LinkGoogle ScholarExternal LinkPankhurst LJ, Del Ojo Elias C, Votintseva AA, Walker TM, Cole K, Davies J, et al.; COMPASS-TB Study Group. Rapid, comprehensive, and affordable mycobacterial