Experiences of patients having tuberculosis (TB) regarding the use of Directly Observed Treatment Short-Course (DOTS) in the North West Province, South Africa.
Maserapelo G Serapelwane, Mashudu Davhana-Maselesele, Gaboipolelwe M Masilo
PMID 27796102WHAT IT FOUND
15 TB patients described DOTS as ineffective: nurses did not directly observe tablets, education was irrelevant, and some shouted or quarrelled.
Long distances and hunger made daily clinic visits hard.
Key findings
01Patients described ineffective DOTS because of poor communication, poor nurse-patient relationships, lack of health education and lack of supervision.
02At the clinic, tablets were placed on a table and patients took them without nurses checking; at home, patients received 3 days of treatment without direct observation.
03Patients reported harsh nurse interactions, including being told they would die, and said education did not explain treatment phases or Rifafour side effects.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It is a small qualitative study of 15 patients at one community health centre, so the experiences are not generalisable. It excluded patients newly diagnosed or on treatment for less than 2 months and could not interview very ill patients, so it misses early treatment problems and the most unwell patients. It reports patient experiences and perceptions, not measured treatment outcomes, adherence rates or cure rates. The recommendations are proposed by the authors and were not tested in this study.
The easy way to misread this
Do not conclude that DOTS itself does not work or that nurses caused treatment failure. This study only describes 15 patients' experiences at one clinic and did not measure TB outcomes.