Biotechnology-Enabled Diagnosis and Treatment of Drug-Resistant Tuberculosis in the Philippines

Abstract Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in the Philippines, where a high disease burden is compounded by gaps in diagnosis, resistance testing, referral, treatment initiation, and continuity of care. This review examines how biotechnology-enabled advances can improve DR-TB detection and management, with particular attention to clinical utility, implementation readiness, affordability, scalability, and relevance to the Philippine health system. Drawing on recent World Health Organization guidance, Philippine policy and programme documents, clinical trials, diagnostic studies, and implementation evidence, the review evaluates established and emerging approaches across the DR-TB care pathway. Rapid molecular platforms, including Xpert-based assays, have expanded access to early resistance detection, while line probe assays, targeted next-generation sequencing (tNGS), and whole-genome sequencing provide complementary roles in expanded resistance characterisation and genomic surveillance. Therapeutic innovation has occurred in parallel, with shorter all-oral regimens such as BPaLM, BPaL, and delamanid-based strategies supported by randomised and operational evidence. Philippine experience indicates that these regimens can achieve high treatment success and reduce patient and provider costs, although toxicity monitoring, reliable medicine supply, and sustained patient support remain essential. tNGS is increasingly aligned with national diagnostic priorities but requires reference-level infrastructure, quality assurance, bioinformatics capacity, and careful specimen selection, whereas nanoparticle-based drug delivery remains predominantly preclinical. The greatest impact of biotechnology will depend on integrating rapid resistance detection, appropriate treatment selection, safety monitoring, referral, social support, and equitable access within a resilient DR-TB care pathway.