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Background: China incurs an extremely low treatment coverage of multidrug-resistant tuberculosis (MDR-TB).This study aimed to understand the experience of MDR-TB patients on quality of health care,and the clinical impact through an up to six-year follow-up.Methods: Cohorts of MDR-TB patients were built in TB/MDR-TB designated hospitals in four regions of China from 2014 to 2015.Patients were followed up during treatment course,and yearly confirmation afterward until 2019.Delay in MDR-TB diagnosis and treatment was calculated upon bacteriological confirmation and treatment initiation.Risk factors for unfavourable outcomes were identified by multivariate logistic regression.Results: Among 1168 bacteriological-positive TB patients identified from a 12-million population,58 (5.0％) MDR-TB cases were detected.The median delay for MDR-TB diagnosis was 90.0 days,with 13.8％ having a delay above 180.0 days.MDR-TB treatment was only recommended to 19 (32.8％) participants,while the rest continued with regimen for drug-susceptible TB.In MDR-TB treatment group,36.8％ achieved treatment success,while the others had incomplete treatment (21.1％),loss to follow-up (36.8％) and TB relapse (5.3％).For non-MDR-TB treatment group,33.3％ succeeded,25.6％ relapsed,2.6％ failed,23.1％ died,and 15.4％ were lost to follow-up.Overall,only 35.7％ (20/56) of detected MDR-TB patients had favourable outcomes and higher education level was positively associated with it (adjusted odds ratio[aOR]: 3.60,95％ confidence interval[CI]: 1.04-12.5).Conclusions: A large proportion of patients did not receive MDR-TB treatment and had unfavourable outcomes.Delayed MDR-TB diagnosis resulted in poor quality of MDR-TB care.Rapid diagnosis,regulated patient management and high-quality MDR-TB treatment should be enhanced in China.