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Patients' perceptions and experiences of directly observed therapy for TB

07 July 2022
19 min read
Volume 31 · Issue 13



To understand patients' perceptions and experiences of directly observed therapy (DOT) for tuberculosis treatment in the UK.


Patients receiving DOT as part of their TB treatment participated in semi-structured and audio-recorded interviews. Data were analysed using a framework approach.


Non-adherence was driven by socio-cultural, mental health, employment and discrimination factors. Patients valued DOT for its support and social connection but those in employment feared it could lead to disclosure and social discredit.


TB patients experience social isolation and fear discrimination. DOT offers a degree of social connection and support for marginalised patients but fails to tackle fundamental barriers to adherence such as mental health issues, addictions, housing and discrimination. Practice implications: Flexible patient-centred methods of DOT should be offered throughout patients' treatment. Research into multi-agency responsibility for promoting adherence needs to be commissioned, implemented and evaluated. Telemedicine and nurse-led clinics may improve access to care and improve patient experience.

Tuberculosis (TB) is caused by a bacterium (Mycobacterium tuberculosis). When people with active TB in their lungs or throat cough, sneeze or spit, they can propel TB germs into the air which can be breathed in by others. A person need only inhale a single bacterium to become infected. TB usually affects the lungs, causing consolidation and tissue destruction, but can spread from the lungs to other parts of the body such as the spine, other organs and lymph nodes, causing serious infection. People with active TB in their lungs can infect 5–15 other people through close contact over the course of a year. Without proper treatment, 45% of people with active TB who are HIV negative and nearly all people with active TB who are HIV positive will die (World Health Organization (WHO), 2021).

Drug-sensitive TB is treated with a combination of antibiotics, usually 6 months of rifampicin and isoniazid augmented with ethambutol and pyrazinamide for the first 2 months. Severe cavitary pulmonary disease may need a longer course of treatment (9–12 months) and nearly all patients will experience undesirable side effects ranging from fatigue, nausea and vomiting through to rashes and liver toxicity. Drug-resistant strains of TB, however, require longer courses of treatment of between 9 and 24 months and include the use of second-line antibiotics with profound side-effects such as ototoxicity, gastrointestinal and central nervous system disturbances, dermatological changes and arthralgia.

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