<![CDATA[Multidrug-Resistant Tuberculosis (MDR-TB) is a global health challenge because its treatment involves a long duration and severe drug-related adverse effects. Medication non-adherence is one of the major factors contributing to treatment failure and the development of further drug resistance. This study aimed to analyze the factors influencing medication non-adherence among patients with MDR-TB through a synthesis of evidence from cohort and case-control studies. A systematic review was conducted based on the PRISMA guidelines, with literature searches performed in PubMed, ScienceDirect, ProQuest, and SINTA. The included studies were cohort and case-control studies published between 2020 and 2026. Analysis of five primary studies from Asia identified four major groups of factors contributing to non-adherence: clinical factors, sociodemographic and economic factors, psychosocial factors, and healthcare system factors. Clinical factors and severe drug-related adverse effects showed a strong association with non-adherence (pooled OR = 3.45; 95% CI: 2.10–5.67). Transportation costs, distance to healthcare facilities, low educational attainment, social stigma, inadequate family support, smoking, and alcohol consumption also increased the risk of non-adherence. Healthcare-related factors included the absence of active treatment supporters, suboptimal communication with healthcare providers, and treatment fatigue. Medication non-adherence among MDR-TB patients is multifactorial and requires integrated interventions, including adverse-effect management, transportation subsidies, strengthened family support, and optimization of treatment supporters to improve treatment success and retention.]]>
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