Implementation fidelity of direct observation treatment and shorst-term treatment for tuberculosis in public health centers in the Kembata Tembaro Zone, Southern Nations Nationalities and People Region, Ethiopia

Introduction: Ethiopia is one of 30 countries with a high tuberculosis (TB) burden, with an incidence of 140 per 100,000 people. The Kembata Tembaro Zone (KTZ) had lower TB case notification and treatment success rates (60% and 82%, respectively) in 2019 than did the National and World Health Organization (WHO) targets. The aim of the present study was to evaluate the implementation fidelity of short-term direct observation treatment for tuberculosis. Methods: A case study evaluation design with a mixed method was employed from May 10 to June 4, 2021. A total of 91 patients were interviewed. Similarly, a document review of 384 patients, 16 key informant interviews, and a resource inventory were conducted. The quantitative data were entered into Epi-Data (V4.0.64) and exported to the Statistical Package for the Social Sciences version 26 (SPSS 26) for analysis. The qualitative data were transcribed, translated, coded, categorized, and analyzed using thematic analysis. The overall implementation fidelity was measured based on predetermined criteria. Results: The overall level of TB direct observed treatment short-course (DOTS) implementation fidelity was 73.9%, and the overall availability of resources was 81%, the provider’s adherence to the national guidelines was 73.1%, the quality of TB DOTS delivery was 75.9%, and the participant responsiveness contributed 63.9%. Conclusion: The overall level of implementation fidelity of TB DOTS services in public health centers was low based on the predetermined set of judgment criteria. Training should be provided to providers, acid-fast bacillus (AFB) reagents should be supplied, standard updated guidelines should be made available, and providers should strictly comply with the standard guidelines. There should also be a full-time assigned TB DOTS provider in the TB units.