AIM: Evaluation of first experience of the directly observed therapy (DOT) programme for tuberculosis introduced in the Canton of Vaud in 1997. METHOD: Retrospective analysis of tuberculosis patients included in a DOT programme from October 1997 to March 2000 under the supervision of the TB Dispensary in Lausanne. RESULTS: 54 patients were included, 49 of whom were new cases and 5 relapses. 70% were asylum seekers and illegal immigrants. The indications for DOT were immigrant status, social problems, and physical or psychiatric comorbidities. Treatment was fully supervised in 67% and partially in 33%. The outcome was favourable (cure or treatment completion) in 88.9% and unfavourable in 11.1%. A similar success rate was observed in full and partial DOT and there was no difference in success rates between the various structures where DOT was administered. By comparison, the success rate in a historical group from the same institution was 70% in 1990. The biggest problem was communication with the patients and within the team. CONCLUSION: Treatment of tuberculosis under DOT in the Canton of Vaud resulted in improvement of the treatment success rate.