ArticleBMJ open2020
Bridging the gap between policy and practice: a qualitative analysis of providers' field experiences tinkering with directly observed therapy in patients with drug-resistant tuberculosis in Addis Ababa, Ethiopia.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed, 41 citations in OpenAlex.
- Effectiveness of a digital medication event reminder and monitor device for patients with tuberculosis (SELFTB): a multicenter randomized controlled trial.BMC medicine · 2022Trial
- Trial
- Beyond the Algorithm: Artificial Intelligence, Clinical Decision-Making, and the Moral Ecology of Care in Africa.Science and engineering ethics · 2026Article
- "We Do Not Seem to Have Geriatric Wards": A Qualitative Analysis of Gaps in Healthcare Access Among Older Patients in Addis Ababa, Ethiopia.Health science reports · 2025Article
- Prevalence of pulmonary tuberculosis and its associated factors among people who ecprience homelessness living in selected towns in Wolaita zone, southern Ethiopia.Journal of health, population, and nutrition · 2025Article
- Perceptions and experiences of directly observed treatment in tuberculosis: insights from a mixed-methods cross-sectional study.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2025Article
- "I Do Not Believe We Should Disclose Everything to an Older Patient": Challenges and Ethical Concerns in Clinical Decision-Making in Old-Age Care in Ethiopia.Health care analysis : HCA : journal of health philosophy and policy · 2024Article
- Tuberculosis patients' satisfaction with directly observed treatment short course strategy and associated factors in Southern Ethiopia: a mixed method study.BMC public health · 2024Article
- Ethical Challenges in Oral Healthcare Services Provided by Non-Governmental Organizations for Refugees in Germany.Journal of bioethical inquiry · 2024Article
- Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework.Journal of the International AIDS Society · 2024Article
- Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study.Journal of clinical tuberculosis and other mycobacterial diseases · 2023Article
- Mapping digital health ecosystems in Africa in the context of endemic infectious and non-communicable diseases.NPJ digital medicine · 2023Article
- Response to COVID-19 recommended preventive behavioral messages among Guraghe zone communities, South Ethiopia: using constructs of the Extended Parallel Process Model (EPPM).BMC infectious diseases · 2023Article
- Patient-reported usability and satisfaction with electronic medication event reminder and monitor device for tuberculosis: a multicentre, randomised controlled trial.EClinicalMedicine · 2023Article
- Cause-Specific Mortality Fraction (CSMF) of adult mortality in Butajira, South Central Ethiopia.PLOS global public health · 2023Article
- Prevalence of pulmonary tuberculosis in homeless individuals in the Addis Ababa City, Ethiopia.Frontiers in public health · 2023Article
- The Influence of Age-Associated Comorbidities on Responses to Combination Antiretroviral Therapy Among People Living with HIV, at the ART Clinic of Jimma Medical Center, Ethiopia: A Hospital-Based Nested Case-Control Study.HIV/AIDS (Auckland, N.Z.) · 2023Article
- Bioethical Implications of Vulnerability and Politics for Healthcare in Ethiopia and The Ways Forward.Journal of bioethical inquiry · 2022Article
- Mathematical modeling for COVID-19 transmission dynamics: A case study in Ethiopia.Results in physics · 2022Article
- Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia.Frontiers in digital health · 2022Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 3 countries.
Funding
Abstract
objectivesDrug-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.
designA qualitative study using in-depth interviews and focus group discussion.
settingTen 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.
participants18 healthcare providers working with DR-TB patients.
resultsThree 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.
conclusionIf 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.
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