Is directly observed tuberculosis treatment strategy patient-centered? A mixed method study in Addis Ababa, Ethiopia.

Belete Getahun,Zethu Zerish Nkosi,Madhukar Pai

doi:10.1371/journal.pone.0181205

Belete Getahun, Zethu Zerish Nkosi + Show 1 more

Open Access

https://doi.org/10.1371/journal.pone.0181205

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Journal: PloS one	Publication Date: Aug 1, 2017
Citations: 14	License type: CC BY 4.0

Affiliation: University of South Africa, Addis Ababa University

Abstract

IntroductionThe directly observed treatment, short course (DOTS) strategy has been considered as an efficacious approach for better tuberculosis (TB) treatment adherence and outcome. However, its level of patient centerdness has not been studied and documented well. Hence, the study aimed to determine the level of patient centeredness’ of the DOTS.MethodThe study used explanatory sequential mixed method design in Addis Ababa, Ethiopia. The study employed an interviewer-administered questionnaire with 601 patients with TB, focus group discussions with 23 TB experts, and telephonic-interview with 25 persons lost to follow-up from TB treatment. Descriptive and multivariable analyses carried out for the quantitative data while thematic analysis was used for the qualitative data.ResultForty percent of patients with TB had not received patient-centered TB care (PC-TB care) with DOTS. Male gender (AOR = 0.45, 95% CI 0.3, 0.7), good communication (AOR = 3.2, 95%CI 1.6, 6.1), and health care providers as a treatment supporter (AOR = 3.4, 95% CI 2.1, 5.48) had significant associations with PC-TB care. All persons lost to follow-up and TB experts perceived that DOTS is merely patient-centered. The identified categories were patient preferences, treatment supporter choice, integration of DOTS with nutritional support, mental health, and transport services, provider’s commitment and communication skills.ConclusionDOTS is limited to provide patient-centered TB care. Hence, DOTS needs a model that enhances effectiveness towards patient centeredness of TB care.

Highlights

The directly observed treatment, short course (DOTS) strategy has been considered as an efficacious approach for better tuberculosis (TB) treatment adherence and outcome
The DOTS strategy encompasses political and administrative commitment, case detection primarily by microscopic examination of sputum of patients presented to health facilities, standardized short course chemotherapy given under direct observation, adequate supply of good quality drugs and systematic monitoring for every patient diagnosed [1]
The study aimed to determine the level of patient centeredness and associated factors with the DOTS strategy using World Health Organization (WHO) people centered health care policy framework in Addis Ababa Ethiopia

Summary

Introduction

The directly observed treatment, short course (DOTS) strategy has been considered as an efficacious approach for better tuberculosis (TB) treatment adherence and outcome. The study aimed to determine the level of patient centeredness’ of the DOTS. In the mid-1990s, World Health Organization (WHO) developed and recommended directly observed treatment, short course (DOTS) for the treatment of TB. The DOTS strategy encompasses political and administrative commitment, case detection primarily by microscopic examination of sputum of patients presented to health facilities, standardized short course chemotherapy given under direct observation, adequate supply of good quality drugs and systematic monitoring for every patient diagnosed [1]. The DOTS has been considered as a cornerstone and efficacious for better treatment adherence of TB control programme in developing countries [2,3,4]. Daily observation of patients with TB at health facilities while taking the treatment is exposing the majority of patients with TB for catastrophic cost especially in developing countries [8,9,10,11]

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