Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
BMJ Open. 2020 Jun 16;10(6):e035272. doi: 10.1136/bmjopen-2019-035272.
Drug-resistant tuberculosis (DR-TB) is one of the major public health threats in low-income countries such as Ethiopia. It is intertwined with larger socioeconomic and political factors that complicate its management and control. Whether directly observed therapy (DOT) is serving its purpose-better patient adherence and treatment outcome-still remains a debatable issue. To contribute to this discussion, this study explored health workers' field experiences tinkering with DOT in patients with DR-TB in Addis Ababa, Ethiopia.
A qualitative study using in-depth interviews and focus group discussion.
Ten public healthcare facilities: eight health centres at Addis Ababa Health Bureau level and two TB-specialised hospitals at the Federal Health Bureau level in Ethiopia.
18 healthcare providers working with DR-TB patients.
Three findings emerged from the analysis. First, the purpose of DOT is to ensure that patients go to healthcare facilities and swallow pills under the observation of a healthcare provider. Thus, its rigid application could lead to the emergence of more DR-TB. Second, DOT should be tinkered with and its practice improved by incorporating more counselling and health education, with more flexibility towards, and attentiveness of, patient context. Third, there exists a family-like patient-provider relationship, and providers do understand their patients and empathise with them to provide better healthcare services.
If rigidly implemented, DOT could lead to more DR-TB-a problem DOT was invented to resolve. Front-line healthcare providers are sensitive to the tragic experiences of DR-TB patients and empathise with them. Thus, they do not strictly implement DOT and are willing to take any blame resulting from tinkering with it. It is high time to shape the practice of DOT for DR-TB patients, with meaningful contributions from front-line healthcare providers.
耐药结核病（DR-TB）是埃塞俄比亚等低收入国家的主要公共卫生威胁之一。它与更大的社会经济和政治因素交织在一起，使其管理和控制变得复杂。直接观察治疗（DOT）是否达到了提高患者依从性和治疗效果的目的，仍然是一个有争议的问题。为了对此进行探讨，本研究探索了埃塞俄比亚亚的斯亚贝巴的卫生工作者在治疗耐药结核病患者时对 DOT 的现场经验。
使用深入访谈和焦点小组讨论的定性研究。
10 家公共卫生保健机构：埃塞俄比亚亚的斯亚贝巴卫生局的 8 个卫生中心和联邦卫生局的 2 个结核病专科医院。
与耐药结核病患者合作的 18 名医疗保健提供者。
分析得出了三个发现。首先，DOT 的目的是确保患者前往医疗机构并在医疗保健提供者的观察下服药。因此，其严格的应用可能导致更多的 DR-TB 出现。其次，应通过纳入更多的咨询和健康教育来调整和改进 DOT 的实践，对患者的情况更具灵活性和关注度。第三，存在一种类似家庭的医患关系，提供者确实了解他们的患者并与他们产生共鸣，以提供更好的医疗保健服务。
如果严格执行，DOT 可能会导致更多的 DR-TB，而这正是 DOT 发明的目的。一线医疗保健提供者对耐药结核病患者的悲惨经历很敏感，并对他们表示同情。因此，他们不会严格执行 DOT，并且愿意承担因调整 DOT 而产生的任何责任。现在是时候为耐药结核病患者塑造 DOT 的实践了，一线医疗保健提供者应该为此做出有意义的贡献。
