Direct observation of tuberculosis treatment by supervised family members in Yasothorn Province, Thailand

SETTING: Yasothorn Province, Thailand. OBJECTIVE: To evaluate the effectiveness of a programme offering the option of direct observation of treatment (DOT) by a supervised family member. METHODS: Review of patient records and district registers in Yasothorn Prov ince after implementation of the revised tuberculosis control strategy. RESULTS: From 1 October 1996 to 30 September 1997, the programme registered 779 patients: 366 smear-positive pulmonary, 357 smear-negative pulmonary, and 56 extrapulmonary. DOT was given in 243 (66%) smear-positive, 83 (23%) smear-negative, and in 21 (38%) extrapulmonary cases; the observer was a fa mily member in 299 (86.2%) of the 347 cases. By December 1998, treatment ou tcomes were determined for the 695 new patients (326 smear-positive, 321 sm ear-negative, 48 extra-pulmonary) of the 779 registered during the period u nder study. In new smear-positive patients, cure rates were 184/216 (85.2%, 95% confidence interval [CI] 80.5-89.9) with DOT versus 78/110 (70.9%, 35% CI 62.4-79.4) with self-administration. CONCLUSION: The overall cure rate was 80.4% in a programme in which trained and supervised family members directly observed the treatment of two-third s of sputum smear-positive patients. Supervised family members may contribu te to more widespread effective implementation of the revised tuberculosis strategy in Thailand.