The Médecins Sans Frontières (MSF) programme in Mumbai, India, has been providing treatment and care for HIV-infected MDR-TB patients since 2006. Of 174 patients enrolled in the clinic over the 10 years from 2006 to 2015, 36 (20%) did not have bacteriological confirmation of MDR-TB. These patients received presumptive treatment based on a clinical diagnosis of MDR-TB and their TB treatment history, including history of exposure to second-line anti-tuberculosis drug and history of contact with a confirmed MDR-TB case. Of the 36 patients, 19 (53%) had a successful treatment outcome. These 36 patients would not have met the criteria for MDR-TB treatment in the RNTCP. In this correspondence, the authors propose a set of recommendations to promote presumptive treatment that would assist in reducing the global burden of MDR-TB.