Introduction Afghanistan is affected by one of the world's longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows Mé decins Sans Frontières' experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes. Methods This is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome. Results Out of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free

Management of rifampicin-resistant tuberculosis (RR-TB) remains one of the main obstacles in reaching the goal of TB elimination by 2035 [1]. There are multiple reasons for unfavourable outcomes, including suboptimal, long or toxic treatment regimens, but also a 'one-size-fits-all' approach to treatment delivery. In 2016, WHO recommended a second-line injectable-containing short regimen for treating multidrug-resistant TB (MDR-TB) [2]. In 2018, building on lessons learnt from experiences with the new and repurposed antituberculosis drugs (such as bedaquiline, delamanid, linezolid and clofazimine), all-oral regimens were recommended [3][4][5]. As the performance of regimens also depends