Table 2.

Main findings on user-experience themes for quality of TB care.

Theme	Key findings
Provider-related factors (n = 26) Availability (n = 8) Technical capacity (n = 14) Respect (n = 16)	• A majority of patients in 5 quantitative studies experienced positive or acceptable provider behaviour or attitude ■ 298/300 (99%) in UP viewed attitude of DMC staff as cooperative [57] ■ 105/117 (90%) in UP listed good behavior of DOTS providers as an advantage [58] ■ 327/400 (82%) in UP said Yes to satisfaction with behaviour of DOT provider [59] ■ 116/220 (52.7%) in UP perceived attitude of DOTS staff as fully sympathetic and 55 (25%) as somewhat sympathetic [60] ■ 304/337 (90%) in MP were satisfied with behavior of DOTS centre staff [61] •Patients appreciated flexibility in DOTS schedule and understanding by providers •Those that stopped treatment sometimes blamed rude and unhelpful staff behaviour •Some found poor counselling support, especially for managing side-effects, while others were motivated due to health worker communication • Providers were largely reported as available in 2 quantitative studies ■ 115/117 (98%) listed regular availability of DOTS provider as an advantage in UP [58] ■ 317/400 (79%) said Yes to regular availability of DOTS provider in UP [59] •However, several patients that stopped treatment viewed non-availability of DOTS provider as a barrier •In 12 studies, provider performance and inability to detect and treat TB efficiently often resulted in poor user-experiences with diagnosis and initiating treatment, including being refused treatment
Convenience (n = 25) Ease of use (n = 24) Continuity of care (n = 6)	• In most [22] studies, regular DOTS viewed as inconvenient and time-consuming due to frequent visits and unsuitable timings that conflict with daily work and life activities ■ 34/62 (55%) patients in UP dissatisfied due to non-suitable opening time of DOTS centres [58] ■ 60/201 (30%) cited attendance of DOTS as most common problem in availing treatment in UP [60] ■ 17/39 (44%) identified difficulty to come on alternate days as reason for dissatisfaction in UP [57] ■ 125/337 (37%) were not satisfied with frequency of visits to DOTS centre in MP [61] • In contrast, a majority of patients in 2 studies in rural areas found DOTS convenient ■ Of 117 patients in UP, 107 (92%) report DOTS was not time consuming and 82 (70%) report it did not affect their work [59] ■ Of 337 patients in MP, 314 (93%) were satisfied with timing of DOTS centre, 317 (94%) with location, and 212 (62.6%) with frequent visits [61] •Data on vulnerable populations was very limited, however some studies reported poor patients feared missing work due to regular DOTS attendance and people with physical or mental disabilities that had trouble physically attending frequent visits • DOTS was often interrupted when social events, emergencies, travel arise, particularly for patients working in urban regions with homes in rural areas ■ 12/40 (30%)(62) and 12/50 (22%) [63] patients in Delhi interrupted DOTS due to returning to their home village ■ 58/160 (36%) in Gujarat delayed treatment due to having to attend social events [64] ■ 38/160 (24%) in Karnataka stopped treatment as they had to go out of station [65]
Supplies and Equipment Availability (n = 12)	• A reliable supply of medicines and diagnostics was important to patients and caused positive and negative experiences ■ 130/150 (87%) faced delays in treatment initiation due to lack of smear microscopy in the original clinic in rural West Bengal and Andhra Pradesh [66] ■ 175/261 (67%) were satisfied due to availability of free medicines in UP [57] •Only 2 studies mentioned experiences with amenities such as drinking water and seating
Confidence (n = 10)	• Patients primarily lacked faith or trust in their treatment or in the RNTCP/government providers and cited lack of confidence as a reason for not completing treatment ■ 44/98 (44.8%) of patients who stopped treatment attributed it to limited trust in the curative ability of DOTS in Uttarakhand [67] ■ 19/47 (40.4%) that faced barriers initiating treatment lacked confidence in their provider [68] ■ 87/262 (33%) first chose a private provider due to faith in them in Tamil Nadu [69] •Others were confident in their chosen provider (public or private) and in the services of the DMC
Information and Communication (n = 10)	• Information and awareness on the disease, prevention, tests, results, treatment, transfer facilities and particularly side-effects were not always readily available, but desired by patients ■ 7/12 (58%) of MDR-TB patients in UP missed follow-up examinations because they were not informed about the monitoring schedule [70] • Provider communication facilitated information-giving for several patients ■ 277/400 (69%) in UP were explained by health staff about the disease [58]
Waiting time (n = 8)	• Waiting times were generally positively rated, usually less than 10 min for receiving DOTS medicines ■ 290/337 (86%) satisfied with waiting time to get medical care in MP [61] ■ 26/30 (87%) satisfied with duration to wait in Karnataka [71] •A small number of patients found long waiting time to be a barrier
Stigma enabled by health system (n = 4)	•Taking medicines and coughing to produce sputum in front of others made patients feel stigmatized •Patients labelled as “defaulters” also faced stigma from health workers and were rejected from re-entry into treatment
Confidentiality (n = 4)	•Confidentiality was important to maintain during DOTS and diagnosis •Some patients preferred far away places and non-community-based DOTS providers to protect confidentiality

RNTCP = Revised National TB Control Program; DMC = Designated Microscopy Centre; DOTS = Directly Observed Therapy, Short course; MDR-TB = Multi-Drug Resistant TB; MP = Madhya Pradesh; UP = Uttar Pradesh.