 The study will be conducted in 10 districts which fully implemented the DOTS program in all their health facilities in order to determine whether better patient quality of care and convenience using three TB care options could improve treatment outcome. In the study districts there are 149 tabias and 1163 kushets with 1.2 million residents representing 30 of the total population of the region. All public health facilities 8 hospitals, 11 health centres and 48 health posts in these districts will be included. District hospitals and health centres provide TB diagnostic services. The study districts comprise 2316 volunteer community health workers CHWs who are functional and accountable to the public health system. 