After diagnosis, providing each tuberculosis (TB) patient with the right drugs at the right dose for the right duration in the right combination is important to effectively reduce transmission, prevent relapse and control the risk of development of drug resistance. A better understanding of the relationship between drug exposure and antimicrobial kill and acquired drug resistance has helped to design more appropriate dosing regimens for antituberculosis drugs. Despite the success of TB treatment programs, patients still experience side effects, slow response to treatment, or acquire drug resistance. Therapeutic drug monitoring (TDM) is intended to optimize treatment efficacy and reduce side effects by performing drug concentration guided dose adjustments. Such individualised strategy clashes with current programmatic TB treatment which recommends general dosing strategies. Identifying patients receiving programmatic TB care who are at risk for suboptimal treatment is key to improve treatment outcomes. The use of new technology and new approaches to TDM can help overcome hurdles for implementation of TDM. In this presentation a TDM framework feasible to be implemented in programmatic care will be presented as well as the evidence required for uptake of TDM in TB treatment guidelines.