Patients' perceptions and experiences of directly observed therapy for TB.

Aim: To understand patients' perceptions and experiences of directly observed therapy (DOT) for tuberculosis treatment in the UK.
Method: Patients receiving DOT as part of their TB treatment participated in semi-structured and audio-recorded interviews. Data were analysed using a framework approach.
Results: Non-adherence was driven by socio-cultural, mental health, employment and discrimination factors. Patients valued DOT for its support and social connection but those in employment feared it could lead to disclosure and social discredit.
Conclusion: TB patients experience social isolation and fear discrimination. DOT offers a degree of social connection and support for marginalised patients but fails to tackle fundamental barriers to adherence such as mental health issues, addictions, housing and discrimination. Practice implications: Flexible patient-centred methods of DOT should be offered throughout patients' treatment. Research into multi-agency responsibility for promoting adherence needs to be commissioned, implemented and evaluated. Telemedicine and nurse-led clinics may improve access to care and improve patient experience.