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Abstract Introduction: Ethiopia is one of 30 countries with high tuberculosis (TB) burden, with an incidence of 140 per 100,000 people. Kembata Tembaro Zone (KTZ) has lower tuberculosis case notification and treatment success rates, 60% and 82% respectively in 2019, as compared to the national and World Health Organization (WHO) targets. The aim of the present study was to evaluate the implementation fidelity of the directly observed treatment, short-course for Tuberculosis. Methods: A Multiple case study evaluation design with a mixed method was employed from May 10 to June 4, 2021. A total of 91 patients were interviewed. Similarly, a document review of 384 patients, 16 key informant interviews, and a resource inventory were conducted. The quantitative data were entered into Epi-Data (V4.0.64) and exported to Statistical Package for the Social Sciences version 26(SPSS 26) for analysis. The qualitative data were transcribed, translated, coded, categorized, and analyzed using thematic analysis. The overall implementation fidelity was measured based on the predetermined criteria. Results: The overall level of TB Direct Observed Treatment Short-course (DOTS) implementation fidelity was 73.9%, to which availability of resources (81%), provider’s adherence to the national guideline (73.1%), quality of TB DOTS delivery (75.9), and participant responsiveness contributed (63.9%). Conclusion: The overall level of implementation fidelity of TB DOTS services in the public health centers was at a low level based on the predetermined set of judgment criteria. Training should be provided to the providers, Acid-fast bacillus (AFB) reagents should be supplied, standard updated guidelines should be made available, and providers should strictly comply with the standard guidelines. There should also be a full-time assigned TB DOTS provider in the TB units.
Masrie et al. (Wed,) studied this question.