Is directly observed TB treatment strategy patient-centered? A mixed method study in Addis Ababa, Ethiopia
Abstract
Introduction
The 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.
Method
The 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.
Result
Forty 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.
Conclusion
DOTS is limited to
provide patient-centered TB care. Hence, DOTS needs a model that
enhances effectiveness towards patient centeredness of TB care.
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Source:
PLOS ONE
