Scaling Up Programmatic Management of Drug-Resistant Tuberculosis: A Prioritized Research Agenda

With increasing recognition of MDR/XDR-TB worldwide the time has come to move PMDT in resource-limited settings beyond the limited pilot project phase. Successful scale-up of PMDT and integration into existing tuberculosis control programs require the following: new and improved tools for drug resistance testing; clinical trials to test the efficacy and effectiveness of simplified and shorter second-line treatment regimens as well as of candidate second-line drugs; new and improved strategies for identifying patients with drug-resistant disease promoting treatment adherence and improving infection control; better epidemiological data to explain geographic variations in occurrence of drug resistance and to identify the greatest contributors to development of drug resistance in specific settings; and finally clinical trials to test the efficacy and effectiveness of new regimens for prophylactic treatment of contacts of patients with DR-TB. (excerpt)