BackgroundPatient compliance is a key factor in treatment success. Satisfied patients are more likely to utilize health services, comply with medical treatment, and continue with the health care providers. Yet, the national tuberculosis control program failed to address some of these aspects in order to achieve the national targets. Hence, this study attempted to investigate patient satisfaction and adherence to tuberculosis treatment in Sidama zone of south Ethiopia.MethodsA facility based cross sectional study was conducted using quantitative method of data collection from March to April 2011. A sample of 531 respondents on anti TB treatment from 11 health centers and 1 hospital were included in the study. The sample size to each facility was allocated using probability proportional to size allocation, and study participants for the interview were selected by systematic random sampling. A Pre tested, interviewer administered questionnaire was used to collect the data. Collected data was edited, coded and entered to Epi data version 3.1 and exported to SPSS version 16. Confirmatory factor analysis was done to identify factors that explain most of the variance observed in most of the manifested variables. Bivariate and Multivariate analysis were computed to analyze the data.ResultThe study revealed 90% of the study participants were satisfied with TB treatment service. However, 26% of respondents had poor adherence to their TB treatment. Patient perceived on professional care, time spent with health care provider, accessibility, technical competency, convenience (cleanliness) and consultation and relational empathy were independent predictors of overall patient satisfaction (P < 0.05). In addition to this, perceived waiting time was significantly associated with patient satisfaction (Beta = 0.262). In multivariate analysis occupational status, area of residence, perceived time spent with health care provider, perceived accessibility, perceived waiting time, perceived professional care and over all patient satisfaction were significantly associated with adherence to TB treatment (P < 0.05). Moreover, patient waiting time at reception room (Adjusted OR = 1.022, 95% CI 1.009, 1.0035) and Patient treatment phase (Adjusted OR = 0.295, 95% CI 0.172, 0.507) were independent predictor of adherence to TB treatment.ConclusionThe finding of this study showed that patients’ perceptions on health care provider interaction had a significant influence on patient satisfaction and adherence to TB treatment. Moreover, absence of drugs and long waiting time had a negative outcome on patient adherence. Therefore, the problem needs an urgent attention from programme managers and health care providers to intervene the challenges.