Implementation Fidelity of Directly Observed Therapy Provided in Dili, Municipality of Timor-Leste

Abstract

Background: The implementation of the DOTs strategy in Timor-Leste has not been going well even though the tuberculosis therapy strategy has been comprehensively implemented by the Ministry of Health  since 2002. Until now, the number of patients who fail to do therapy according to the time set for therapy is increasing with increasing numbers of patients. new cases and the number of new cases has not changed. The level of accuracy of implementation is determined by the patient's adherence to the therapeutic strategy, compliance with DOTs services in each existing health facility according to existing guidelines, exposure or dose, quality of delivery and participant response.

Objectives: To assess the implementation fidelity of DOTs Provided in all Community Health Center in Dili, district of Timor-Leste.

Method: The study uses mixed-method, sequential explanatory design. For quantitative research we conduct cross sectional survey of TB patients from all health facilities provided DOTs in the Dili district, with structure questioner from May to July 2021. For qualitative-in-depth interviews with the Key informants, medical doctor, nurses, and patient respondents from the eight health facilities in Dili, and TB program staff in each Health facility, and responsible for TB programs in Dili district to explore the inhibiting factors affecting patient adherence and provider compliance to DOTs guideline.

Result: The overall DOTs coverage was 26.5% (48/181), Most do therapy themselves or are observed by family members 56.9% (103/181), and a small proportion 18.2 (33/181) only apply DOT when visiting health facilities to take drugs with a frequency of every 15 days. More than 95% of patient received correct dosage and standard regimen of anti-TB drugs according to the guidelines. The factors that influence patient non-adherence to DOT are the distance from the health facility that provides DOT services, the financial implications and the lack of family and government support. however, patient satisfaction with the quality of TB treatment services reached 73.4%. Providing DOTs services at Health post will promote better adherence.

Conclusion: The implementation of the DOTs strategy in the Dili municipality was not reflected in compliance with TB control, which led to a low effectiveness of the program.