Satisfaction of patients with directly observed treatment strategy in Addis Ababa, Ethiopia: A mixed-methods study

BACKGROUND: Directly observed treatment, short course (DOTS) strategy has been a cornerstone for Tuberculosis (TB) control programs in developing countries. However, in Ethiopia satisfaction level of patients’ with TB with the this strategy is not well understood. Therefore, the study aimed to assess the satisfaction level of patients with TB with the DOTS. METHOD: Explanatory sequential mixed method design was carried out in Addis Ababa, Ethiopia. Interviewer-administered questionnaire with 601 patients with TB who were on follow-up was employed in the quantitative approach. In the qualitative approach telephonic-interview with 25 persons lost to follow-up and focus group discussions with 23 TB experts were conducted. RESULT: Sixty seven percent of respondent was satisfied with the DOTS. Rural residency (AOR = 3.4, 95% CI 1.6, 7.6), having TB symptoms (AOR = 0.6, 95% CI 0.4, 0.94) and treatment supporter (AOR = 4.3, 95%CI 2.7, 6.8) were associated with satisfaction with DOTS. In qualitative finding, all persons lost to follow-up were dissatisfied while TB experts enlightened lack of evidence to affirm the satisfaction level of patients with DOTS. Explored factors contributing to satisfaction include: on time availability of health care providers, DOTS service delivery process, general condition of health care facilities, nutritional support and transportation. CONCLUSION: DOTS is limited to satisfy patients with TB and lacks a consistent system that determines the satisfaction level of patients with TB. Therefore, DOTS strategy needs to have a system to captures patients’ satisfaction level to respond on areas that need progress to improve DOTS service quality.