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Open Access Research article

Factors influencing specialist care referral of multidrug- and extensively drug-resistant tuberculosis patients in Gauteng/South Africa: a descriptive questionnaire-based study

Deliwe Nkosi12, Saskia Janssen46, Xavier Padanilam3, Rianna Louw3, Colin N Menezes5 and Martin P Grobusch456*

Author Affiliations

1 South African Field Epidemiology and Laboratory Training Programme (SAFELTP), Johannesburg, South Africa

2 University of Pretoria, Pretoria, South Africa

3 Sizwe Tropical Diseases Hospital, Sandringham, Johannesburg, South Africa

4 Department of Infectious Diseases, Division of Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands

5 Department of Medicine, Division of Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

6 Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany

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BMC Health Services Research 2013, 13:268  doi:10.1186/1472-6963-13-268

Published: 9 July 2013



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.


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.


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.


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.

Tuberculosis; Drug-resistance; Delay of referral; South Africa