Nkosi, DeliweJanssen, SaskiaPadanilam, XavierLouw, RiannaMenezes, Colin N.Grobusch, Martin P.2014-02-042014-02-042013-07-09Nkosi et al.: Factors influencing specialist care referral of multidrug- and extensively drug-resistant tuberculosis patients in Gauteng/South Africa: a descriptive questionnaire-based study. BMC Health Services Research 2013 13:268.1472-696310.1186/1472-6963-13-268http://hdl.handle.net/2263/33285BACKGROUND: 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.en© 2013 Nkosi et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution LicenseDelay of referralDrug-resistant tuberculosis (DR-TB)Multidrug-resistant tuberculosis (MDR-TB)Extensively drug-resistant tuberculosis (XDR-TB)Tuberculosis -- Mortality -- South Africa -- GautengTuberculosis -- Diagnosis -- South Africa -- GautengMedical referral -- South Africa -- GautengMultidrug-resistant tuberculosis -- South Africa -- GautengArticle