1. Diagnosis Delays: Limited access to rapid diagnostic tests leads to delays in identifying and treating MDR TB. 2. Treatment Complexity: The long and complex treatment regimens can lead to poor adherence and further drug resistance. 3. Cost: Second-line treatments are expensive, posing a financial burden on healthcare systems and patients. 4. Side Effects: The side effects of second-line drugs can be severe, impacting patients' quality of life and willingness to continue treatment.