Building the world's evidence base to tackle drug-resistant tuberculosis

Oxford, UK, 8 September 2026: A new international programme, RESPECT-TB, coordinated by the Nuffield Department of Medicine at the University of Oxford in collaboration with the University of the Witwatersrand South Africa and Queen Mary University of London, will unite researchers and national tuberculosis programmes across five high-burden countries to build one of the world's richest evidence resources on drug-resistant tuberculosis (TB).

Supported by a £10 million award from Wellcome, RESPECT-TB brings together 15 research organisations, public health bodies and national TB programmes across India, Kazakhstan, Mozambique, South Africa and Vietnam. The programme will generate evidence to improve patient care, strengthen research capacity and inform national and global TB policy.

Tuberculosis remains the world's leading infectious disease killer, causing an estimated 1.23 million deaths each year. While new six-month, bedaquiline-based regimens have transformed treatment for drug-resistant TB, increasing cure rates to around 90%, resistance to these medicines is beginning to emerge, threatening one of the biggest advances in TB care in decades.

RESPECT-TB will investigate the population level prevalence of resistance to the new drugs used to treat drug-resistant TB, as well as asking why and how this resistance develops by combining genomic sequencing, laboratory science and detailed clinical data.

Building on the internationally recognised CRyPTIC Consortium led by Oxford, RESPECT-TB will deliver one of the most comprehensive datasets linking bacterial genomes, drug susceptibility and patient outcomes, and provide evidence to improve diagnosis, treatment and surveillance.

Professor Timothy Walker, Professor of Infectious Diseases at the Nuffield Department of Medicine, who leads the coordination of RESPECT-TB, said: "The introduction of bedaquiline-based treatment regimens has transformed care for people with drug-resistant tuberculosis but we are now seeing resistance to these medicines emerge in countries with high rates of the disease. RESPECT-TB will help us understand where resistance is emerging, how it develops and how we can preserve the effectiveness of these treatments."

Professor Nazir Ismail, a Professor of Clinical Microbiology and Infectious Diseases at Wits University and the National Health Laboratory Service in South Africa, and a co-lead said: “RESPECT-TB is a powerful example of how global collaboration can accelerate our understanding of emerging drug resistance and its clinical impact. By bringing together expertise from across multiple regions we can generate critical evidence that guides global policy and helps protect the gains we have made against drug-resistant TB.”

Professor Graeme Meintjes, Clinical Professor of Infectious Diseases at Queen Mary University of London and Professor of Medicine at the University of Cape Town, and a RESPECT-TB co-lead, said: “What is exciting about RESPECT-TB is the opportunity to answer questions that clinicians and TB programmes are facing every day. By bringing together data and expertise from across five countries, we can better understand why treatment works for some patients and fails for others, and use that knowledge to help improve treatment decisions and patient care.”

Dr Ana Cehovin, Research Lead at Wellcome, said: “Drug-resistance is continuously undermining decades of progress in tuberculosis treatment, and now threatens the new shorter, more effective bedaquiline-based regimens. Treatment decisions can rely on trial and error, while resistance may go undetected until it has already spread. By bringing together researchers across countries and disciplines, this international collaboration will deepen our understanding of how resistance emerges and evolves. This will be vital for developing better treatments, preserving the tools we already have, accelerating scientific progress and improving outcomes for those most affected.”

Professor Nguyễn Thụy Thương Thương, Head of the Tuberculosis Group at Oxford University Clinical Research Unit, Vietnam, said: "By creating one of the world's most comprehensive open-access resources linking Mycobacterium tuberculosis genomes, laboratory measurements of drug susceptibility and patient outcomes, RESPECT-TB will provide a lasting resource for researchers, policymakers and national TB programmes, accelerating discoveries and helping improve care for people affected by drug-resistant tuberculosis worldwide."

Alongside its scientific ambitions, RESPECT-TB will strengthen laboratory capability, genomic sequencing and research infrastructure through close partnerships with national TB programmes, helping countries expand surveillance and respond more rapidly to emerging drug resistance.

RESPECT-TB is funded by Wellcome and coordinated by the Nuffield Department of Medicine, University of Oxford, with Oxford University Clinical Research Unit (OUCRU) in Vietnam a key partner. The Ellison Institute of Technology, a project partner, is contributing in-kind technical resources through the development of the RESPECT-TB laboratory database.

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