Copperbelt province of ZambiaIntroduction: Tuberculosis (TB) is a serious public health problem in Zambia. The long treatment (DOTS) patients have to undergo is challenging, and poor communication between TB patients and health workers in the DOTS program is in the literature described as a barrier to treatment adherence. There is little research on how patients experience participating in a DOTS program and on what the TB patients perceive as good and poor communication. More knowledge is needed on what patients perceive as problematic in the communication with health workers and what patients perceive as good communication. Objectives: The main objective of this study is to explore how TB patients experiences participating in a DOTS program in order to better understand how communication in a DOTS program influences the patients. Specific objectives are to explore how patients seek and receive information, advice and care in the DOTS program, and to explore how patients are participating in decision making regarding their own treatment schedule. Study design/methods: This is a qualitative exploratory study using semi-structured interviews, group interviews, focus group discussions and participant observation for data collection. A total of 37 TB patients participated as respondents in this study. Findings: Patients who were followed up at home by a treatment supporter (TS) during the whole or parts of the DOTS treatment had their needs for information, advice and care catered for by the TS. The patients’ right to dignity and autonomy was ensured and the patients were open about the disease to friends/community which resulted in positive reactions from friends and community. Few patients who were attending a health clinic on a daily or weekly basis had their needs for information, advice and care catered for. Problems with making sense of the information given, power structures and lack of involvement of family resulted in passivity and poor communication. Lack of openness resulted in judgement and discrimination from friends and community. On a public health level a good relationship and good communication between patients and HWs/TSs indicates that good treatment adherence is more obtainable and that TB detection rates are likely to increase as there is more openness regarding TB and HIV/AIDS in the communities. Better adherence and increased detection rate can help to control TB and slow down the development of drug resistant TB.