MDR-TB and XDR-TB

Multidrug resistant tuberculosis (MDR-TB) is a strain of TB that cannot be treated with the two most powerful first-line treatment anti-TB drugs. Extensively drug resistant tuberculosis (XDR-TB) is a form of TB caused by bacteria that are resistant to several of the most effective anti-TB drugs. XDR-TB strains arose after the mismanagement of individuals with MDR-TB.

Today, MDR-TB and XDR-TB threaten to reverse the global progress made in TB care and control. Drug resistance occurs when drug-susceptible TB patients do not receive the correct treatment regimens or do not complete the full course of treatment. Nearly ten percent of the world’s TB patients have MDR-TB and nine percent of these patients also have XDR-TB. Although all forms of TB are highly contagious, drug-resistant TB can be particularly challenging to control due to the longer treatment period and more costly drug regimes.

To tackle MDR-TB and XDR-TB, MSH is supporting the ministries of health and national TB programs in Uganda, Ethiopia, Indonesia, Vietnam, Cambodia, and Nigeria. Within these nations, we are implementing MDR-TB activities through five PEPFAR- and USAID-funded projects: TB CARE I; Help Ethiopia Address Low TB (HEAL TB); TRACK TB; Strengthening TB and AIDS Response, Eastern Region (STAR-E); and Systems for Improved Access to Pharmaceuticals and Services (SIAPS).

MSH builds the capacity of national TB programs and ministries to implement decentralized MDR-TB programs that focus on:

  • An effective programmatic approach,
  • A strong clinical management strategy,
  • A well-functioning laboratory system, and
  • A sound drug management system.

Once these components of a MDR-TB program is in place, we then support the national TB programs and ministries of health to:

  • Train health workers to effectively screen for, diagnosis, and treat MDR-TB;
  • Expand MDR-TB prevention and care initiatives to include more women and children;
  • Establish an MDR-TB patient tracking system;
  • Implement the e-TB Manager to manage all TB program data;[1]
  • Improve health facility systems and expand community-based approaches for MDR-TB control; and
  • Conduct operational research on MDR-TB interventions, patient support, and treatment outcomes to inform future programming.

In partnership with Ethiopia’s Ministry of Health , the PEPFAR- and USAID-funded HEAL TB project has established MDR-TB patient wards at three hospitals and implemented an ambulatory MDR-TB treatment system. The project has also trained Ethiopian health workers in MDR-TB management and worked with local partners to design a specimen transport system that allows for timely TB diagnosis in facilities without laboratory capacity.


[1]MSH helps national TB programs to use the e-TB Manager to improve data management and informed decision-making. The e- TB Manager is a web-based tool that integrates data across all aspects of TB control, including information on patients, medicines, laboratory testing, diagnosis, treatment, and outcomes.