Practice of directly observed treatment (DOT) for tuberculosis in southern Thailand: comparison between different types of DOT observers.

SETTING: A government health system in southern Thailand where the directly observed treatment, short-course (DOTS) strategy has been implemented. OBJECTIVE: To compare the practice of actual directly observed treatment (DOT) and the observer sustainability for different types of observer. METHODS: During 1999-2000, 411 patients with new smear-positive pulmonary tuberculosis were followed up. The patients and/or their observers were interviewed about the presence of any person with the patient during drug intake and the practice of watching the patient swallowing the medicine (actual DOT). Data were recorded monthly and analysed by Cox and logistic regression models. RESULTS: For health personnel (HP), community member (CM), and family member (FM) observers, the proportions who did not practise actual DOT were respectively 11%, 23%, and 35%, and the proportions who changed to no observer or self administration were respectively 11%, 1%, and 2%, during the first 9 months of treatment. Health personnel had the lowest risk of not practising actual DOT (odds ratio HP/FM 0.1, 95%CI 0.1-0.2; CM/FM 0.9, 95%CI 0.5-1.6) but the highest risk for change to self administration. CONCLUSION: To increase the coverage of actual DOT, strategies are needed to maintain health personnel as the DOT observers and to promote actual DOT among family member observers.