Decentralised management of drug-resistant tuberculosis (MDR- and XDR-TB) in South Africa: an alternative model of care.

SETTING: A growing number of cases of extensively drug-resistant tuberculosis (XDR-TB) have been reported from KwaZulu-Natal, South Africa. OBJECTIVE: To propose an alternative model to centralised care that can be implemented to alleviate the current emergency. DISCUSSION: The current failing TB programme could be improved by borrowing strategies such as decentralisation of care, treatment expertise, high levels of treatment adherence and successful outcomes, all of which have been successfully implemented in the human immunodeficiency virus programme. Patients with multidrug-resistant or XDR-TB could be admitted to institutions closer to their homes for treatment with subsequent discharge to home-based care. CONCLUSION: The longer we support a failed system or wait for a perfect solution, the more the current devastation will continue to grow.