necessary before a patient could be started on treatment for multidrug-resistant tuberculosis,

5which is longer, more expensive, more toxic, and less eff ective than is fi rst-line therapy. Thus strengthening and scale-up of laboratory capacity needs to go hand-in-hand with implementation of the MTB/RIF test. Finally, scaling up of testing needs to be accompanied by a rapid increase in access to treatment. In the past decade, about 5 million people developed drug-resistant tuberculosis but less than 1% had access to appropriate treatment, and 1·5 million died. 4 The positive results with the MTB/RIF test are an urgent wake-up call to the international community that a substantial increase in capacity to manage multidrug-resistant tuberculosis at scale is needed, together with major improvements in the availability of high-quality aff ordable treatment.