The Nurse Initiated Management of Drug-Resistant Tuberculosis (NIMDR-TB) programme was established to support decentralised management of DR-TB in South Africa by training nurses to initiate and manage uncomplicated RR/MDR and now, Pre-XDR-TB at primary healthcare (PHC) and sub-district levels. This rapid review evaluates the programme’s implementation, achievements, challenges, and opportunities for strengthening its impact on DR-TB care.