Pakistan's path forward in DR-TB management: insights from global implementation of BPaL/BPaLM regimen

Drug-resistant tuberculosis (DR-TB) is a serious public health threat, and Pakistan is one of the most impacted nations. The long treatment duration of traditional regimens puts a great burden on healthcare systems, especially in resource-constrained environments. Accordingly, the World Health Organization launched the Bedaquiline, Pretomanid, and Linezolid (BPaL)/Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin (BPaLM) regimen - a 6-month, all-oral therapy consisting of BPaLM. With stated success rates as high as 90%, these regimens present an exciting alternative to traditional treatments. Yet, their integration into current treatment programs is hindered by policy lags, poor diagnostic infrastructure, and difficulty in maintaining patient compliance. This brief communication explores the promise of BPaL/BPaLM to enhance DR-TB cure rates while pinpointing major hurdles to its use in Pakistan. Enhancing diagnostic capacity, upgrading healthcare infrastructure, and accelerating policy adjustment are crucial steps toward maximizing DR-TB management in high-burden countries.