Global scale-up of the programmatic management of multidrug-resistant tuberculosis.

Worldwide, an estimated 8.6 million people develop tuberculosis (TB) each year resulting in 1.3 million deaths. Although rates of TB are declining in many areas of the world, the emergence of drug-resistant strains of M. tuberculosis threatens to undermine TB control programmes. Multidrug-resistant TB (MDR-TB), strains that are resistant to at least isoniazid and rifampicin, are more difficult to diagnose and treat than other forms of TB and are associated with a higher mortality rate. Unfortunately, most countries with a high burden of MDR-TB detect less than 25% of the estimated MDR-TB cases and among those detected only 82% are treated. Of the estimated 300,000 MDR-TB patients among notified TB cases, only 6% are eventually detected and treated successfully. There are many gaps in the programmatic management of drug-resistant TB (PMDT) that must be closed in order for us to successfully control TB and additional financing will be required. Through these new efforts, we hope to see more rapid scale up of PMDT activities and ultimately control and prevention of drug-resistant TB.