Drug-resistant tuberculosis: a priority pathogen for enhanced public health research and practice

Drug-resistant tuberculosis (DR-TB) causes substantial morbidity and mortality and has hindered progress toward TB elimination. This slowed progress toward the WHO End TB Strategy’s targets was exacerbated by lower TB detection during the COVID-19 pandemic. To inform research and development priorities, we conducted a narrative review of global DR-TB epidemiology and strategies for DR-TB prevention, diagnostics, and treatment. Gaps remain in DR-TB diagnosis, TB drug susceptibility testing (DST), and treatment. The review also shows that DR-TB causes significant post-disease disability, particularly chronic lung disease, impacting quality of life. Newer oral regimens for multidrug-resistant TB are shorter and more effective than traditional regimens. New antibiotics under development may help overcome remaining safety and tolerability issues, while novel advanced therapeutics and precision medicine offer hope to those failing treatment. Emerging diagnostics include rapid DST for second-line drugs, but a paradigm shift is needed to ensure novel DSTs become available as new drugs are introduced. Person-centered research is urgently needed to accelerate the response to DR-TB amidst the global threat of antimicrobial resistance, yet global investment in TB prevention and care currently falls short of need. A holistic approach to interventions to improve DR-TB prevention and care is needed, encompassing all health system components and their interactions, including a One Health approach and consideration of the wider determinants of health.