Programmatic versus personalised approaches to managing the global epidemic of multidrug-resistant tuberculosis.

The push to end tuberculosis as a global public health threat received a major boost from the first UN General Assembly high-level meeting on tuberculosis in 2018.1 To end tuberculosis by 2035, however, hurdles need to be overcome in detection, provision of care, and treatment of drug-resistant tuberculosis. In 2018, an estimated 500 000 people had rifampicin-resistant (RR) tuberculosis, of whom 78% had multidrug-resistant (MDR) tuberculosis.2 Prevalence of RR or MDR tuberculosis is higher in people who have previously been treated than in those who have never had tuberculosis treatment.3 Care cascade analyses show major gaps in the continuum of care from diagnosis to treatment completion for individuals with RR or MDR tuberculosis. The current global treatment success rate of RR or MDR tuberculosis is unacceptably low at 56%,3 and patients in rural areas are probably at an increased risk of poor outcomes.4 These constraints continue to fuel the ongoing transmission of RR and MDR tuberculosis as well as the emergence of additional drug resistance.