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The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective TB control. In India, the available information from the several drug resistance surveillance studies conducted in the past suggest that the rate of MDR-TB is relatively low in India.
However this translates into a large absolute number of cases and as yet the management of patients with MDR-TB is inadequate. Specific measures are being taken within the Revised National Tuberculosis Control Programme (RNTCP) to address the MDR-TB problem through appropriate management of patients and strategies to prevent the propagation and dissemination of MDR-TB.
Traditionally, DOTS-Plus refers to DOTS programmes that add components for MDR-TB diagnosis, management and treatment. These guidelines promote full integration of DOTS and DOTS-Plus activities under the RNTCP, so that patients with MDR-TB are both correctly identified and properly managed under the recommendations set out in this document.
Finally, the guideline introduces new standards for registering, monitoring and reporting outcomes of multidrug-resistant TB cases. This uniform information management system will allow systematic, consistent data collection and analysis which will facilitate appropriate supervision and monitoring of the DOTS Plus activities and will play an important role in shaping future policies and recommendations.