A systematic review of qualitative research on patient adherence to tuberculosis (TB) treatment identified eight major themes across 44 studies: treatment organization and care, illness and wellness interpretations, financial burden, knowledge, attitudes, and beliefs about treatment, law and immigration, personal characteristics and adherence behavior, side effects, and family, community, and household support. These themes were synthesized using meta-ethnography to understand how four major factors interact to affect adherence: structural factors (poverty, gender discrimination), social context, health service factors, and personal factors. The review found that adherence is a complex, dynamic phenomenon influenced by a range of factors, including access to healthcare, treatment side effects, financial constraints, and social stigma. Patients' adherence was influenced by their interactions with healthcare providers, their understanding of the disease, and their personal motivations. The findings highlight the need for patient-centered interventions and address structural barriers to treatment adherence. The review also emphasizes the importance of considering the social and economic environment in TB treatment strategies.A systematic review of qualitative research on patient adherence to tuberculosis (TB) treatment identified eight major themes across 44 studies: treatment organization and care, illness and wellness interpretations, financial burden, knowledge, attitudes, and beliefs about treatment, law and immigration, personal characteristics and adherence behavior, side effects, and family, community, and household support. These themes were synthesized using meta-ethnography to understand how four major factors interact to affect adherence: structural factors (poverty, gender discrimination), social context, health service factors, and personal factors. The review found that adherence is a complex, dynamic phenomenon influenced by a range of factors, including access to healthcare, treatment side effects, financial constraints, and social stigma. Patients' adherence was influenced by their interactions with healthcare providers, their understanding of the disease, and their personal motivations. The findings highlight the need for patient-centered interventions and address structural barriers to treatment adherence. The review also emphasizes the importance of considering the social and economic environment in TB treatment strategies.