In response, the Gauteng Department of Health (DOH) introduced the policy of down-referral.
The themes were then categorized as being either an advantage or a disadvantage of down-referral.
A trained moderator used a discussion topic guide to investigate the main issues of interest including: advantages and disadvantages of down-referral, potential motivating factors and challenges of down-referral, assistance needs from the transferring clinic as well as from PHCs.
When asked about the advantages of down-referral, members of most of the focus groups mentioned that down-referral to local clinics would allow them to be able to access health-care closer to their homes.
Given this dearth of information we undertook this study to determine patients' perception of the benefits as well as obstacles of down-referral from the adult HIV clinic to PHC in Soweto.
2. What are motivating factors for down-referral? 3. What are the challenges of down-referral? 4. What help would patients need if they were down-referred? 5. What access to the initiating clinic would patients want?
The main advantage of down-referral expressed by focus group participants was that local clinics were closer to patients' homes and were usually easier to reach, especially when participants were ill.
However, with the lack of published studies on down-referral of patients with HIV or other chronic diseases in the current medical literature, information on how patients may perceive and ultimately respond to treatment once down-referred were greatly lacking.
Similar to another study in South Africa [ 22], providers highlighted haphazard movement of patients within the health system as one of the threats to the down referral program.
