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

Abstract

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.