Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis
Resistance to tuberculosis (TB) drugs is a formidable obstacle to effective TB care and
prevention globally. Multidrug-resistant TB (MDR-TB) is multifactorial and fuelled by
improper treatment of patients, poor management of supply and quality of drugs, and airborne
transmission of bacteria in public places. Case management becomes difficult and the challenge
is compounded by catastrophic economic and social costs that patients incur while seeking
help and on treatment.
In 2006, MDR-TB strains with additional resistance to second-line drugs were described as
extensively drug-resistant TB (XDR-TB) strains, further compromising treatment options
available to patients infected with these strains. Since then, clinicians in some settings have
reported patients infected with strains in which virtually all treatment options have been
exhausted. This rapidly evolving landscape is a clarion call to policy-makers and practitioners
to respond with improvements in care delivery and introduction of innovative tools and
approaches. In 2009, the 62nd World Health Assembly urged WHO Member States to provide
universal access to care for drug-resistant TB patients. In that resolution, it was acknowledged
that national TB programme managers, clinicians, nurses, all care providers and affected people
themselves need guidance on how best to bring together different elements of health systems
and services needed to effectively address the MDR-TB challenge. Therefore, this Handbook
has been developed for the purpose of describing ways to implement established WHO
policies relevant for the management of MDR-TB. These WHO policy recommendations
have been produced using the GRADE methodology for evidence assessment, as adopted by
WHO in 2008.