title: Factors influencing specialist care referral of multidrug- and extensively drug-resistant tuberculosis patients in Gauteng/South Africa: a descriptive questionnaire-based study.
abstract: BACKGROUND
  Sizwe Tropical Diseases Hospital is the only specialized Hospital for the management of multidrug-resistant (MDR)-TB and extensively drug-resistant (XDR)-TB cases in Gauteng Province. In South Africa, there is a mismatch between numbers of individuals with a laboratory diagnosis of drug-resistant tuberculosis (TB) and those being referred for the initiation of specialist treatment. We determined reasons for non-referral of MDR-TB and XDR-TB cases.
  
  
  METHODS
  We conducted a descriptive questionnaire-based study amongst provincial primary health care facilities (PHC) and hospitals providing routine care for (drug-susceptible) TB, regarding specialist care referral of patients whose TB culture and susceptibility testing confirmed MDR-TB or XDR-TB diagnoses in the first half of 2008.
  
  
  RESULTS
  In total 148 cases were analyzed; 144/148 (97%) had MDR-TB and 4/148 (3%) had XDR-TB. The main reason for non-referral to specialist care was loss to follow up, for patients diagnosed in-hospital (74/97; 76%) as well as in PHCs (11/21; 52%). Nineteen per cent (18/97) of patients diagnosed in hospital versus 33% (7/21) of patients diagnosed in PHCs deceased before referral.
  
  
  CONCLUSIONS
  A significant problem in the fight to control DR-TB is follow-up after diagnosis with a delay in patient tracing. TB Focal Points in hospital need to be strengthened in order to improve on patient follow-up and care, and tracer teams should assist with community follow up.
authors.affiliation: South African Field Epidemiology and Laboratory Training Programme (SAFELTP), Johannesburg, South Africa.
authors.forename: Deliwe
authors.initials: D
authors.lastname: Nkosi
authors.forename: Saskia
authors.initials: S
authors.lastname: Janssen
authors.forename: Xavier
authors.initials: X
authors.lastname: Padanilam
authors.forename: Rianna
authors.initials: R
authors.lastname: Louw
authors.forename: Colin N
authors.initials: CN
authors.lastname: Menezes
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D054908:Extensively Drug-Resistant Tuberculosis / Q000628:therapy*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult