Is Tunisia ready for precision medicine? Challenges of medical genomics within a LMIC healthcare system

Abstract

As one of the key tools on the precision medicine workbench, high-throughput genetic testing has enormous promise for improving healthcare outcomes. Tunisia has made tremendous progress in acquiring and implementing the technology in the clinical context. However, current utilization does not ensure the whole range of benefits that high-throughput genomic testing provides which impedes the country's ability to move forward into the new era of precision medicine. This issue is primarily related to the current state of Tunisia's healthcare ecosystem and the sociological attributes of its population, creating numerous challenges that must be addressed. In the current review, we aimed to identify and highlight these challenges that may be prevalent in other low and middle-income countries. Essentially, they fall into three main categories that include the socio-economic landscape in Tunisia, which prevents citizens from engaging in precision medicine activities; the current settings of the healthcare system that lack or miss key components for the successful implementation of precision medicine practices; and the inability of the current infrastructure and resources to handle the various challenges related to genomic data and metadata. We also propose five pillar solutions as a framework for addressing all of these challenges, which could strengthen Tunisia's capability for effective precision medicine implementation in today's clinical environment.

Keywords: Genomic testing; High-throughput genetic analysis; Low and middle-income countries; Next generation sequencing; Precision medicine.

Fig. 1

Genomic medicine history and landscape in Tunisia. (A) Timeline of the major events that marked the history of genetic diagnosis. (B) Mapping the primary national public organizations spearheading genetic diagnostic efforts in Tunisia. (C) Assessing the representation of human genetics scientific publications among all Tunisian publications indexed in Medline (n=31,435). In-House text-mining scripts were used for data mining and analysis

Fig. 2

Summary of the challenges related to the social attributes of the Tunisian population

Fig. 3

Summary of the challenges related to the Tunisian clinical setting

Fig. 4

Summary of the challenges related to data management and analysis

Fig. 5

Mapping the relationship between the five pillar solutions and reviewed challenges