Accountability of Directly Observed Treatment (DOT) for tuberculosis in lower part of southern Thailand

Pannee Pungrasami, Asst. Prof., D. of Microbiology, F. of Sci., PSU.
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, F. of Medicine, PSU.
Corresponding e-mail : petch@hatyai.inet.co.th

Grant : Royal Golden Jubilee Ph.D. Program and Health Systems Research Institute
Presented : The European Regional Meeting of the International Epidemiological Associa- tion, Kaunas-Lithuania, 24-26 August 2000
Key words : Directly Observed Treatment (DOT), tuberculosis, southern Thailand, TB patient

Background : Directly Observed Treatment (DOT) requires a specific person to observe and ensure that a TB patient swallow all the anti-TB drugs as scheduled. In Thailand, DOTS strategy has been started since 1996. However, cure rate has been below WHO target of 85%. There is a need to check the accountability of supervision.
Objective : To validate the practice of Directly Observed Treatment (DOT) for tuberculosis and to verify the effect of DOT on treatment outcome in lower part of southern Thailand.
Methods : The study setting was DOTS areas in 7 provinces. New, smear positive TB patients started treatment during February-September 1999 at 22 TB clinics and their DOT observers were interviewed during clinic attendance or home visit. Patient and DOT information were extracted from TB related registers and treatment records.
Results : Of 337 patients, 77% were male, aged from 7 to 92 years, 57% were Muslim. 
			Initial observer

	Final observer	SA	FM	CM	HP

	SA	19	38	4	28
	FM	22	130	1	32
	CM	0	0	22	20
	HP	0	0	0	21
Initial DOT observers were 168 (57%) family members (FM), 101 (34%) health personnel and 27 (9%) community members (CM). Type of observer was later changed toward closer members or even ended without observer (SA) (shown in the Table). Cure rate was 71%. Among173 cured patients, 32% took anti-TB drugs without strict DOT; compared to 58% among the uncured (odds ratio = 1.52, 95% CI 0.86-2.68).
Conclusion : Within the same patient, DOT observers changed over time mostly towards self-administered scheme. Lack of strict DOT observers may explain this low cure rate.
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