In this week's PLoS Medicine, a group of MDR-TB experts outlines its recommendations on conducting research that would help in the scale up.

MDR-TB can be effectively treated using second-line TB drugs, though these drugs are more expensive, less potent, and less well tolerated than first-line drugs. Fewer than 2% of all patients with MDR-TB are receiving appropriate second-line treatment. The WHO has therefore called for a dramatic scale up of MDR-TB treatment as a routine component of TB control, setting a target of treating 1.6 million patients with MDR-TB by 2015. Pilot projects of MDR-TB management (known as "programmatic management of drug-resistant TB" or PMDT) in five low income settings showed treatment success rates of 59%-83%.

Frank Cobelens (KNVC Tuberculosis Foundation) and colleagues, writing on behalf of the Working Group on MDR-TB of the Stop TB Partnership, lay out their "prioritized research agenda." The agenda identifies the most important barriers to scaling up the treatment of MDR-TB and prioritizes the research questions to be addressed to overcome these barriers.

Their research priorities include:

new and improved tools for testing patients to see if they have drug-resistant TB
clinical trials of simplified and shorter second-line treatments for MDR-TB
new and improved strategies for diagnosis of drug-resistant TB, for helping patients complete the whole course of drug treatment, and for controlling the spread of the infection
understanding geographic variations in the occurrence of drug resistance
clinical trials to test whether giving TB drugs to people who came into contact with patients with drug-resistant TB prevents them from developing resistant TB.

With increasing recognition of drug-resistant TB worldwide, say Cobelens and colleagues, "the time has come to move PMDT in resource-limited settings beyond the limited, pilot project phase."-Public Library of Science