SETTING: Tuberculosis (TB) control in rural China is of high priority in health policy making. OBJECTIVE: To investigate treatment success among rural TB patients and the determinants of patient and case management and to explore the current status of DOTS implementation in rural China. METHODS: A patient-based study was conducted in six counties of Shandong Province, China. Study sites were selected by multi-stage random sampling. Subjects were rural smear-positive pulmonary TB patients registered with the county TB dispensaries at study sites who completed treatment during the period October 2006 to September 2007. RESULTS: This study observed a success rate of 74.5% among 501 participants. The cure rate, of 50.5%, was much lower than the national level. There was a difference in treatment success rates across counties. Factors independently affecting treatment success were patient income, study site, and home visits and supervision by town and village health workers. CONCLUSIONS: Enhancing financial resources for TB control and effective involvement of human resources are crucial to achieving success with the DOTS strategy in rural China. © 2010 The Union.