Abstract
The World Health Organization (WHO) has been recommending the directly observed
treatment short course (DOTS) for the management of tuberculosis since 1994.
Vachira Phuket Hospital has strengthened its education of health-care workers (HCW)
and family members to become directly observed treatment (DOT) observers in order to
improve the success rates of the treatment. This study was conducted to evaluate the
treatment outcomes that the HCW DOT or family member DOT provided to patients.
We prospectively collected epidemiologic data on TB patients treated at the TB clinic
in Vachira Hospital from 2004 to 2006. We limited our analysis to pulmonary TB patients
never previously treated for TB. We analyzed the proportion of the patients, stratified by
type of drug administrator. We used chi-square to analyze the association of successful
treatment with the type of DOT, and multivariate analysis for controlling other factors
associated with treatment success. A total of 506 TB patients were included in this analysis,
364 (72%) had treatment success, compared with 142 (28%) of patients experiencing
non-successful treatment, 90 percent received HCW DOT, and 10 percent family/other or
self-administered therapy (SAT). Smear-positive TB was diagnosed in 72 percent of the
cases, and 24 percent were infected with HIV. The type of drug administered had a
significant impact on treatment success (P<0.001). Using multivariate analysis, controlling
for confounding factors, HCW DOT was significantly associated with successful treatment
(OR 2.1, 95% CI 1.1-4.3).
Based on the results of this study, TB patients who received HCW DOT achieved
treatment success rates higher than patients receiving family member DOT.
