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.