IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 11, Issue 1 Ser. I (Jan. – Feb. 2022), PP e12-e17 12 ADHERENCE INTERVENTIONS AND OUTCOMES OF TUBERCULOSIS TREATMENT IN LOW- AND MIDDLE- INCOME COUNTRIES (LMIC): A SYSTEMATIC REVIEW PROTOCOL BADEMOSI ADETOMI 1 , OSARO BENJAMIN 1 , OPARA CHIDINMA JUDITH 2 1 Department of Community Medicine, College of Medical sciences, Rivers State University Rivers state, Nigeria 2 Department of community medicine, PAMO university of medical sciences, Port Harcourt, Rivers state, Nigeria ABSTRACT Incomplete adherence to tuberculosis (TB) treatment increases the risk of delayed culture conversion with continued transmission in the community, as well as treatment failure, relapse, and development or amplification of drug resistance. We conducted a systematic review and meta-analysis of adherence interventions, including directly observed therapy (DOT), to determine which approaches lead to improved TB treatment outcomes. However, treatment outcomes for tuberculosis has been less than ideal in many high-burden countries especial countries with low socio-economic index. A systematic analysis of the adherence interventions and outcomes of tuberculosis treatment with be carried out using the referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols. The methodological quality of the RCTs will be assessed using the Jadad Scale. Where sufficient data are available, A meta-analysis will be conducted to confirm the relationship between treatment adherence and treatment outcomes. This systematic review will provide evidence in support or against the hypothesis that treatment adherence leads to better treatment outcomes in tuberculosis. This conclusion will stem from the reported outcomes of TB treatment among persons undergoing TB treatment in Low and middle-income countries. Keywords: tuberculosis, treatment, adherence, outcomes LMIC, 1. INTRODUCTION Treatment adherence is challenging, given the complexity, modest tolerability, and long duration of treatment regimens currently available for both drug-susceptible and -resistant tuberculosis (TB). In turn, low adherence increases the risk of poor outcomes, including treatment failure, relapse, and development or amplification of drug resistance(1,2). Public health programs have used a variety of strategies to improve adherence at the health system level via financial incentives or enablers to offset the cost of accessing treatment, improving coordination and logistics around TB treatment delivery, and training healthcare providers. Other strategies tackle barriers to completing TB treatment by addressing knowledge gaps, attitudes, and behaviors surrounding adherence to TB treatment(3–5). One of the most commonly used adherence interventions is directly observed therapy (DOT), in which a health worker, family member, or community member observes the patient taking TB medications(6). In recent years, video-observed therapy (VOT) has gained attention as an alternative way of delivering DOT(7,8). Other interventions aimed at supporting adherence through DOT include incentives, which are material or financial rewards provided to those adhering to treatment(9), and enablers, which are interventions that allow patients to overcome economic constraints associated with DOT, such as absence from work or the direct and indirect patient costs of accessing TB treatment. Other interventions focus on providing education on TB, its treatment, and prevention to help patients make informed