Are health personnel the best choice for directly observed treatment in southern Thailand? A comparison of treatment outcomes among different types of observers.

A prospective study was conducted in 24 districts in southern Thailand in 1999 with directly observed treatment, short-course strategy (DOTS) implemented to determine treatment outcomes in relation to the practical observer among 455 enrolled patients with tuberculosis. Health personnel (HP), community members (CM), family members (FM) and self-administration (SA) were initially assigned to be DOT observers in 43%, 5%, 44% and 8% of 411 analysed patients, respectively. In practice, 56% of the 379 patients with assigned observers changed their observers. The practical observer was the assigned observer among 17% of patients assigned to HP, 57% to CM, 75% to FM, and 34% to SA, respectively. There were no significant differences in treatment success between different types of main observers. Adjusted odds ratios (95% confidence interval) of treatment non-success were 1.1 (0.3-4.7), 0.7 (0.2-3.3), and 0.5 (0.2-1.1) for HP, CM, and FM, over SA groups, respectively. HP may not be the best choice in our setting due to poor sustainability and the availability of another promising choice (CM).