title: Programmatic Management of Drug-Resistant Tuberculosis: An Updated Research Agenda.
abstract: There are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through a literature review and survey.
  
  
  
  Publications citing the 2008 research agenda and normative documents were reviewed for evidence gaps. Gaps were formulated into questions and grouped as in the 2008 research agenda: Laboratory Support, Treatment Strategy, Programmatically Relevant Research, Epidemiology, and Management of Contacts. A survey was distributed through snowball sampling to identify research priorities. Respondent priority rankings were scored and summarized by mean. Sensitivity analyses explored weighting and handling of missing rankings.
  
  
  
  Thirty normative documents and publications were reviewed for stated research needs; these were collapsed into 56 research questions across 5 categories. Of more than 500 survey recipients, 133 ranked priorities within at least one category. Priorities within categories included new diagnostics and their effect on improving treatment outcomes, improved diagnosis of paucibacillary and extra pulmonary TB, and development of shorter, effective regimens. Interruption of nosocomial transmission and treatment for latent TB infection in contacts of known MDR-TB patients were also top priorities in their respective categories. Results were internally consistent and robust.
  
  
  
  Priorities retained from the 2008 research agenda include shorter MDR-TB regimens and averting transmission. Limitations of recent advances were implied in the continued quest for: shorter regimens containing new drugs, rapid diagnostics that improve treatment outcomes, and improved methods of estimating burden without representative data.
  
  
  
  There is continuity around the priorities for research in PMDT. Coordinated efforts to address questions regarding shorter treatment regimens, knowledge of disease burden without representative data, and treatment for LTBI in contacts of known DR-TB patients are essential to stem the epidemic of TB, including DR-TB.
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.|Partners In Health, Boston, MA, United States of America.
authors.forename: Carole D
authors.initials: CD
authors.lastname: Mitnick
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Carly A
authors.identifier: 0000-0003-0023-2111
authors.initials: CA
authors.lastname: Rodriguez
authors.affiliation: Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Marita L
authors.initials: ML
authors.lastname: Hatton
authors.affiliation: Access Campaign, Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Grania
authors.initials: G
authors.lastname: Brigden
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Cobelens
authors.affiliation: Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.|Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.affiliation: Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Horsburgh
authors.affiliation: Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany.|Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia.|Department of Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lange
authors.affiliation: Global Tuberculosis Program, World Health Organization, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Lienhardt
authors.affiliation: Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, United States of America.
authors.forename: Eyal
authors.initials: E
authors.lastname: Oren
authors.affiliation: Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Podewils
authors.affiliation: Heartland National TB Center, Texas Center for Infectious Diseases, San Antonio, TX, United States of America.
authors.forename: Barbara
authors.initials: B
authors.lastname: Seaworth
authors.affiliation: Central Office, KNCV Tuberculosis Foundation, The Hague, Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: van den Hof
authors.affiliation: Department of Medicine, National Jewish Health and the University of Colorado Denver, Denver, CO, United States of America.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
authors.affiliation: Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands.
authors.forename: Agnes C
authors.initials: AC
authors.lastname: Gebhard
authors.affiliation: Global Tuberculosis Program, World Health Organization, Geneva, Switzerland.
authors.forename: Fraser
authors.initials: F
authors.lastname: Wares
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000628:therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*