UNDERSTANDING PATIENTS' PERCEPTIONS AND EXPERIENCES OF DIRECTLY OBSERVED THERAPY (DOT) FOR TUBERCULOSIS TREATMENT WITHIN THE UNITED KINGDOM

Introduction Patient adherence to medical intervention is vital for tuberculosis (TB) management to be effective. For patients with difficulty adhering to treatment, directly observed therapy (DOT) is commonly used. However, no single DOT protocol is known to be optimal and evidence suggests that as adherence to DOT is poor, it does not currently provide a solution. Calls have been made for TB policy makers to address the wider barriers to adherence and consider approaches that motivate patients. The first step to either improving the effectiveness of DOT or identifying more effective solutions is to understand the patient experience and issues surrounding adherence to DOT. Objective To explore patient’s perceptions and experiences of DOT in TB treatment within the UK. Method A qualitative, semi-structured interview design was employed. Eight patients from across Wessex who had received DOT as part of their TB treatment were purposively selected. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis and NVivo 11. Negative case analysis and peer review were used to enhance rigour. Results Adherence and non-adherence to TB treatment was influenced by socio-cultural, mental health, employment and discrimination factors (figure 1). DOT seemed to be valued by socially marginalised patients‘ for the support and social connection it afforded. However, those in employment feared DOT could lead to disclosure and social discredit. Patients perceived observing the swallowing of medication without additional elements of support to be of limited value. Patient accounts suggest TB Specialist Nursing teams evolved DOT to provide highly individualised expert care. Conclusions DOT offers a degree of social connection and support for marginalised patients but often fails to tackle fundamental barriers to adherence such as mental health, addictions, housing and discrimination. Practice implications All TB patients should be offered a choice of flexible patient-centred support. It is unrealistic for one team to address all the barriers to treatment adherence. Multi-agency responsibility for TB control needs to be commissioned and evaluated across the UK and not just in high TB incidence areas. A multi-agency approach should include mental health, housing, homeless, addictions, social and TB teams.