||BACKGROUND: In Nepal, 45% of general population is infected with tuberculosis (TB) and 49,000 new TB cases occur every year.
Latest anti-tuberculosis drug resistance survey 2006-2007 showed that prevalence of multi drug-resistant tuberculosis (MDR-TB)
is 2.9% among new cases and 11.7% among previously treated cases. Until July 2011, 1026 MDR-TB and 27 extensively drug-resistant
TB (XDR-TB) cases have been registered for treatment. Emergence of MDR-TB with XDR-TB poses a new challenge for effective
TB control in Nepal. OBJECTIVE: To explore the challenges for programmatic management of drug-resistant tuberculosis in Nepal
in order to make recommendations.
METHOD: Literature review was done by internet search. Relevant articles, reports and information were collected in relation
to MDR-TB in Nepal. FINDINGS: Service related challenges for programmatic management of drug-resistant tuberculosis are very
low MDR-TB detection, unclear patient tracing mechanism, narrow high risk targeted case findings, lacking MDR-TB rapid diagnostic
tool, relatively inflexible directly observed treatment (DOT), inadequate patient support services, poor responsiveness and
lack of adequate operational research in relation to MDR-TB. The possible patient related factors are social stigma and discrimination,
misconception about TB, financial and geographical inaccessibility and poor awareness that TB services are free. CONCLUSIONS
AND RECOMMENDATIONS: Emergence of MDR-TB in Nepal is posing a threat which requires an urgent public health response. Recommendations
are introduction of rapid diagnostic test, wider high risk targeted case finding Strategy, individualized and flexible DOT,
scaling up patient support services, stigma and discrimination reduction strategy, patient tracing mechanism and operational