Scaling up multidrug-resistant tuberculosis care in China

Drug-resistant tuberculosis threatens to undermine advances in tuberculosis control worldwide. Multidrug-resistant tuberculosis (MDRTB), defined as resistance to isoniazid and rifampicin, requires treatment for up to 24 months with expensive diagnostics and second-line drugs. Fewer than 15% of patients diagnosed with tuberculosis worldwide receive drug susceptibility testing (DST); only 20% of the estimated 480 000 new cases of MDRTB annually are treated appropriately.¹ Of these, cure rarely exceeds 65%. Those on ineffective therapy risk acquiring additional resistance and spreading drug-resistant tuberculosis to others. In recent years, new molecular diagnostics and antituberculosis drugs promise an opportunity to improve outcomes for patients with drug-resistant tuberculosis, leading the WHO to prioritise universal access to prevention, diagnosis, and treatment of MDRTB.¹ However, identification of viable models for coordinating and financing scale-up of such services remains a major challenge for most middle-income and low-income countries.