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Has directly observed treatment improved outcomes for patients with tuberculosis in southern Thailand?

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OBJECTIVE To validate the practice of directly observed treatment (DOT) and evaluate its effect on treatment outcomes.

METHODS This follow-up study conducted in 24 districts in southern Thailand included 411 new, smear-positive, pulmonary tuberculosis (TB) patients who started treatment between February and September 1999. Patients and/or their observers were interviewed about their actual DOT practice during the first 2 months of treatment. Treatment outcomes were evaluated at the end of the second month and at the end of treatment.

RESULTS Of 411 patients, 379 were assigned to DOT but only 68 practised strict DOT for every dose during the first 2 months. Adjusted odds ratios (ORs) for `no sputum conversion' and `unsuccessful treatment' were 1.1 (95% CI 0.6–2.1) and 1.3 (95% CI 0.6–2.8), respectively, for those who practised strict DOT vs. the rest.

CONCLUSIONS Actual practice of DOT was quite different from what was intended at the assignment. Practice of strict DOT during the first 2 months was not associated with sputum conversion or treatment success in this study area.
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Keywords: Thailand; compliance; directly observed treatment; treatment outcome; tuberculosis

Document Type: Original Article

Affiliations: 1: Zonal Tuberculosis Centre, Yala, Thailand, 2: 2 Department of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aarhus, Denmark, 3: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand, 4: The Danish Epidemiology Science Centre, University of Aarhus, Aarhus, Denmark

Publication date: March 1, 2002

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