Level of Optimization of Turnaround Time Among the TB DOTS Team and Treatment Compliance Experiences of Pulmonary Tuberculosis Patients in RHU-Sagñay
DOI:
https://doi.org/10.5281/zenodo.22131332Keywords:
turnaround time, TB DOTS, pulmonary tuberculosis, treatment adherence, diagnostic delay, mixed methodsAbstract
This study assessed the level of optimization of turnaround time (TAT) among the Tuberculosis Directly Observed Treatment Short-Course (TB DOTS) team and explored the treatment-compliance experiences of confirmed pulmonary tuberculosis (PTB) patients in the Rural Health Unit of Sagñay, Camarines Sur. A concurrent parallel mixed-methods design was employed. Quantitative survey data were obtained from 40 confirmed PTB patients, eight of whom were purposively selected for semi-structured interviews, while six TB DOTS team members participated in a focus group discussion. Quantitative data were summarized using weighted and average means, whereas interview and focus-group data were examined through content and thematic analysis and integrated with the quantitative findings. The TB DOTS team demonstrated a very high overall level of TAT optimization (M = 4.29), with screening (M = 4.24), diagnostics (M = 4.27), treatment initiation (M = 4.31), and follow-up (M = 4.36) all rated very high. Important service gaps nevertheless emerged in timely communication of diagnostic results (M = 2.63, Moderate), treatment initiation within five working days of sputum collection (M = 3.85, High), and attendance at scheduled follow-up visits (M = 3.65, High). Patients described symptom recognition, transportation and financial barriers, prolonged waiting for diagnostic results, treatment side effects, and family or healthcare-worker support as central to adherence. Staff identified awareness, knowledge of diagnostic TAT, and appropriate communication as facilitators, while distance and limited schedules, insufficient staffing, and inadequate budget were hindering factors. These findings informed the proposed REACH TB Project, a patient-centered program designed to strengthen decentralized specimen transport, community outreach, adherence support, and sustainable financing. The study concludes that RHU-Sagñay has a strongly functioning TB DOTS system, but targeted improvements in result communication, logistical access, staffing, and follow-up are needed to make timely TB care more consistent and sustainable.
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Ahmad, Z., Zubair, I., Ahmad, S., Zuber, N., & Salar, W. (2024). Reasons and extent of delay in the diagnosis of pulmonary tuberculosis after the appearance of symptoms. Journal of Family Medicine and Primary Care, 13(5), 1683–1687. https://doi.org/10.4103/jfmpc.jfmpc_1246_23
Albert, H., Rupani, S., Masini, E., Ogoro, J., Kamene, M., Geocaniga-Gaviola, D., Sistoso, E., Garfin, C., Chadha, S., Kumar, N., Kao, K., & Katz, Z. (2023). Optimizing diagnostic networks to increase patient access to TB diagnostic services: Development of the diagnostic network optimization (DNO) approach and learnings from its application in Kenya, India and the Philippines. PLOS ONE, 18(11), e0279677. https://doi.org/10.1371/journal.pone.0279677
Burke, R. M., Nliwasa, M., Feasey, H. R. A., Chaisson, L. H., Golub, J. E., Naufal, F., Shapiro, A. E., Ruperez, M., Telisinghe, L., Ayles, H., Corbett, E. L., & MacPherson, P. (2021). Community-based active case-finding interventions for tuberculosis: A systematic review. The Lancet Public Health, 6(5), e283–e299. https://doi.org/10.1016/S2468-2667(21)00033-5
Chilala, S. B., Silumbwe, A., Zulu, J. M., Tetui, M., Bulawayo, M., Chewe, M., & Hangoma, P. (2024). Individual, community and health systems factors influencing time to notification of tuberculosis: Situating software and hardware bottlenecks in local health systems. BMC Health Services Research, 24, 1241. https://doi.org/10.1186/s12913-024-11697-3
de Morais, M., Sousa, S., Marques, J., Moniz, M., Duarte, R., Leite, A., & Soares, P. (2023). Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal. BMC Public Health, 23, 2421. https://doi.org/10.1186/s12889-023-17319-7
Department of Health. (2023). National Tuberculosis Control Program. https://doh.gov.ph/national-tuberculosis-control-program
Endo, Y., Jaramillo, J., & Yadav, R. P. H. (2022). Patient- and health-system-related barriers to treatment adherence for patients with drug-resistant tuberculosis in the Philippines: A mixed-methods study. Tuberculosis Research and Treatment, 2022, 6466960. https://doi.org/10.1155/2022/6466960
Foster, I., Sullivan, A., Makanda, G., Schoeman, I., Tisile, P., van der Westhuizen, H.-M., Theron, G., & Nathavitharana, R. (2022). The role of counselling in tuberculosis diagnostic evaluation and contact tracing: Scoping review and stakeholder consultation of knowledge and research gaps. BMC Public Health, 22. https://doi.org/10.1186/s12889-022-12556-8
Ge, R., Zhu, G., Tian, M., Hou, Z., Pan, W., Feng, H., Liu, K., Xiao, Q., & Chen, Z. (2024). Analysis on time delay of tuberculosis among adolescents and young adults in Eastern China. Frontiers in Public Health, 12, 1376404. https://doi.org/10.3389/fpubh.2024.1376404
Hambir, Y., Joshi, H. J., Khadse, M. V., Phadtare, T., Bharati, M., & Mali, N. D. (2026). ICT-enabled community engagement models for early tuberculosis detection. Indian Journal of Tuberculosis. https://doi.org/10.1016/j.ijtb.2026.02.016
Han, E., Nabity, S. A., Dasgupta-Tsinikas, S., Guevara, R. E., Moore, M., Kadakia, A., & Flood, J. (2024). Tuberculosis diagnostic delays and treatment outcomes among patients with COVID-19, California, USA, 2020. Emerging Infectious Diseases, 30(1), 136–140. https://doi.org/10.3201/eid3001.230924
Hayudini, M. A., Pangandaman, H., Mai-Alauya, S. A., Macarambon, R., Macalaba, S., Ali, N., Mukattil, N., Salve, M., Abdulhan, M., Asid-Daud, F., Uddin, T., & Tan, N. (2025). Effectiveness of the DOTS program in enhancing management of pulmonary tuberculosis: A systematic review. Frontiers in Digital Health, 14, 44–51.
Ileye, U. M., Odero, V. O., Hassan, M. S., et al. (2025). Determinants of tuberculosis treatment adherence among patients taking anti-TB drugs in Borama, Somaliland. BMC Public Health, 25, 3788. https://doi.org/10.1186/s12889-025-25151-4
Lee, J. H., Garg, T., Lee, J., McGrath, S., Rosman, L., Schumacher, S. G., Benedetti, A., Qin, Z. Z., Gore, G., Pai, M., & Sohn, H. (2022). Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: A systematic review and meta-analysis. BMC Infectious Diseases, 22, 940. https://doi.org/10.1186/s12879-022-07855-9
Leyto, S. M., Digesa, L. E., Lakew, S., Wondmagegn, H., Mare, K. U., Hadaro, T. S., Tariku, E. Z., & Glagn, M. (2024). Tuberculosis patients’ satisfaction with directly observed treatment short course strategy and associated factors in Southern Ethiopia: A mixed method study. BMC Public Health, 24, 2452. https://doi.org/10.1186/s12889-024-19940-6
Limenh, L. W., Kasahun, A. E., & Sendekie, A. K. (2024). Tuberculosis treatment outcomes and associated factors among tuberculosis patients treated at healthcare facilities of Motta Town, Northwest Ethiopia: A five-year retrospective study. Scientific Reports, 14, 7695. https://doi.org/10.1038/s41598-024-58080-0
Malik, T. Z., Roy, S., Ahmed, F., Agarwalla, R., & Pathak, R. (2025). Delay in the diagnosis and treatment of tuberculosis among tuberculosis patients in South-East Delhi, India. Indian Journal of Public Health, 69(3), 286–291. https://doi.org/10.4103/ijph.ijph_414_23
Mardlaniah, S., Medison, I., & Julizar, J. (2025). The relationship between the characteristics of directly observed treatment and the implementation of directly observed treatment tasks and adherence to treatment for pulmonary TB patients at the Andalas Health Center, Padang City. International Journal of Research and Review, 12(6), 216–221. https://doi.org/10.52403/ijrr.20250626
Marzban, S., Najafi, M., Agolli, A., & Ashrafi, E. (2022). Impact of patient engagement on healthcare quality: A scoping review. Journal of Patient Experience, 9, 23743735221125439. https://doi.org/10.1177/23743735221125439
Mtafya, B., Sabi, I., John, J., Sichone, E., Olomi, W., Gillespie, S. H., Ntinginya, N. E., & Sabiiti, W. (2022). Systematic assessment of clinical and bacteriological markers for tuberculosis reveals discordance and inaccuracy of symptom-based diagnosis for treatment response monitoring. Frontiers in Medicine, 9, 992451. https://doi.org/10.3389/fmed.2022.992451
Najati, T. I., Purnomo, I., & Irawan, T. (2025). Evaluation of tuberculosis control program with DOTS strategy at Pulosari Public Health Center, Pemalang Regency. International Journal of Educational and Life Sciences, 3(8), 2581–2588. https://doi.org/10.59890/ijels.v3i8.124
Nidoi, J., Muttamba, W., Walusimbi, S., Imoko, J. F., Lochoro, P., Ictho, J., Mugenyi, L., Sekibira, R., Turyahabwe, S., Byaruhanga, R., Putoto, G., Villa, S., Raviglione, M. C., & Kirenga, B. (2021). Impact of socio-economic factors on tuberculosis treatment outcomes in north-eastern Uganda: A mixed methods study. BMC Public Health, 21, 2167. https://doi.org/10.1186/s12889-021-12056-1
Noman, M. Z. I., Islam, S., Aktar, S., Parray, A. A., Amando, D. G., Karki, J., Atsna, Z., Mitra, D. K., & Hossain, S. A. S. (2024). Healthcare seeking behavior and delays in case of drug-resistant tuberculosis patients in Bangladesh: Findings from a cross-sectional survey. PLOS Global Public Health, 4(1), e0001903. https://doi.org/10.1371/journal.pgph.0001903
Omara, G., Bwayo, D., Mukunya, D., Nantale, R., Okia, D., Matovu, J. K. B., Wanume, B., Alunyo, J. P., & Olupot-Olupot, P. (2025). Tuberculosis treatment success rate and its predictors among TB-HIV co-infected patients in East and North Eastern Uganda. Scientific Reports, 15, 5532. https://doi.org/10.1038/s41598-024-85039-y
Opperman, M., & Du Preez, I. (2022). Factors contributing to pulmonary TB treatment lost to follow-up in developing countries: An overview. African Journal of Infectious Diseases, 17(1), 60–73. https://doi.org/10.21010/Ajidv17i1.6
Otero, L., Boldoo, T., Purevdagva, A., Borgil, U., Enebish, T., Erdenee, O., Islam, T., & Morishita, F. (2024). Delays in health seeking, diagnosis and treatment for tuberculosis patients in Mongolia: An analysis of surveillance data, 2018–2021. Western Pacific Surveillance and Response Journal, 15(1), 59–67. https://doi.org/10.5365/wpsar.2024.15.1.1074
Panda, A., Behera, B. K., & Mishra, A. (2024). Financial hardship of tuberculosis patients registered under the National Tuberculosis Elimination Programme in rural India: A longitudinal study. Indian Journal of Tuberculosis, 71(2), 191–199. https://doi.org/10.1016/j.ijtb.2023.10.006
Pongpeeradech, N., Kasetchareo, Y., Chuchottaworn, C., Lawpoolsri, S., Silachamroon, U., & Kaewkungwal, J. (2022). Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand. PLOS ONE, 17, e0271130. https://doi.org/10.1371/journal.pone.0271130
Prasad, R., Shamim, H., Singh, A. K., & Gupta, N. (2025). New frontiers in tuberculosis diagnosis: A systematic evaluation of current and emerging technologies. Indian Journal of Tuberculosis. https://doi.org/10.1016/j.ijtb.2025.09.002
Pratikto, H., & Peristiowati, Y. (2022). The effectiveness of the screening method with Significant (TBC Response Application) in improving the networking of suspects and case detection rate tuberculosis in Sumenep District in 2021. Journal for Quality in Public Health, 5(2), 649–654. https://doi.org/10.30994/jqph.v5i2.367
Restipa, L., & Suci, H. (2021). Efektivitas pelaksanaan strategi DOTS (Directly Observed Treatment Short Course) dalam penanggulangan TB paru di Puskesmas. Jurnal Keperawatan Abdurrab, 5(2), 41–47. https://doi.org/10.36341/jka.v5i2.2121
RHU-Sagñay TB DOTS Center. (2025). Integrated Tuberculosis Information System (ITIS) registry [Unpublished administrative record].
Rima, D. D., Legese, D., & Woldesemayat, E. M. (2024). Tuberculosis treatment delay and associated factors among pulmonary tuberculosis patients at public health facilities in Dale District and Yirgalem Town administration, Sidama Region, South Ethiopia. BMC Infectious Diseases, 24, 517. https://doi.org/10.1186/s12879-024-09397-8
Samal, J., Preetha, G. S., & Singh, H. (2026). Delays in tuberculosis care among the top-ten-tuberculosis-high burden countries in the world: A scoping review. Journal of the Egyptian Public Health Association, 101(1), 1. https://doi.org/10.1186/s42506-025-00204-z
Sazali, M., Syed Abdul Rahim, S. S., Mohammad, A. H., Kadir, F., Payus, A., Avoi, R., Jeffree, M., Omar, A., Ibrahim, M., Atil, A., Mohd Tuah, N., Dapari, R., Lansing, M., Asyraf, A., & Azhar, Z. (2023). Improving tuberculosis medication adherence: The potential of integrating digital technology and Health Belief Model. Tuberculosis and Respiratory Diseases, 86, 82–93. https://doi.org/10.4046/trd.2022.0148
Shah, H., Khatib, M. N., Syed, Z., Gaidhane, A., Yasobant, S., Narkhede, K., Bhavsar, P., Patel, J., Sinha, A., Puwar, T., Saha, S., & Saxena, D. (2022). Gaps and interventions across the diagnostic care cascade of TB patients at the level of patient, community and health system: A qualitative review of the literature. Tropical Medicine and Infectious Disease, 7, 136. https://doi.org/10.3390/tropicalmed7070136
Shaluhiyah, Z., Handayani, S., Sriatmi, A., Agushybana, F., & Rimawati, E. (2025). Understanding tuberculosis as a wicked problem: A qualitative study in coastal urban settlements of Semarang, Indonesia. Frontiers in Communication, 10. https://doi.org/10.3389/fcomm.2025.1719819
Sintayehu, K., Zeleke, E. D., Temesgen, B., Kifle, M., Assefa, D. G., Zenebe, K., Kassahun, A., & Yimer, B. T. (2022). Determinants of stock-outs of first line anti-tuberculosis drugs: The case of public health facilities of Addis Ababa city administration health bureau, Addis Ababa, Ethiopia. BMC Health Services Research, 22, 1047. https://doi.org/10.1186/s12913-022-08430-3
Sodhi, R., Goel, S., Baghel, R., Rade, K., Khaparde, K., Dabas, H., Mannan, S., & Singh, M. (2026). Strengthening TB care pathways: Integrating informal and AYUSH practitioners for early diagnosis and referral. PLOS Global Public Health, 6. https://doi.org/10.1371/journal.pgph.0004416
Tedla, K., Medhin, G., Berhe, G., Mulugeta, A., & Berhe, N. (2020). Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. PLOS ONE, 15(8), e0235411. https://doi.org/10.1371/journal.pone.0235411
Thomas, D., & Summers, R. H. (2022). Patients’ perceptions and experiences of directly observed therapy for TB. British Journal of Nursing, 31(13), 680–689. https://doi.org/10.12968/bjon.2022.31.13.680
Ting, N. C. H., El-Turk, N., Chou, M. S. H., & Dobler, C. C. (2020). Patient-perceived treatment burden of tuberculosis treatment. PLOS ONE, 15(10), e0241124. https://doi.org/10.1371/journal.pone.0241124
Tobin, E. H., & Tristram, D. (2024). Tuberculosis overview. In StatPearls [Internet]. StatPearls Publishing.
World Health Organization. (2021). The End TB Strategy. https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy
World Health Organization. (2022). Global tuberculosis report 2023. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2023
Zhang, L., Ma, X., Gao, H., Bao, C., Wu, Y., Wu, S., Liu, M., Liu, Y., & Li, L. (2024). Analysis of care-seeking and diagnosis delay among pulmonary tuberculosis patients in Beijing, China. Frontiers in Public Health, 12, 1369541. https://doi.org/10.3389/fpubh.2024.1369541
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