Quality of tuberculosis care and its association with patient adherence to treatment in eight

Background Little is known about the quality of tuberculosis (TB) service delivery in public health facilities in Ethiopia and its association with patients ’ non-adherence to TB treatment. This study assessed the organization, management and processes of TB care delivery, and their effects on patients ’ adherence to TB treatment. Methods The quality of TB care was investigated in 44 public health facilities from three perspectives: structure, processes of TB care delivery and patient treatment outcome. Quality of care was determined by adherence to national TB guidelines. On-site observations of TB service delivery and interviews with health providers were conducted to evaluate structural factors. Patients (n 237) in the health facilities were interviewed prospectively at completion of their treatment to determine the quality of tuberculosis care delivered. Three measures of treatment adherence [treatment interruption (2 weeks), avail-ability of unused TB drugs and treatment default] were quantified from a review of patient treatment registers and an audit of unused TB drugs at patients’ homes. Effects were identified of poor quality structures and processes of servic