**Background:** Tuberculosis (TB) has killed more people than any other infectious disease globally. TB is strongly associated with poverty, and the costs of TB—including direct out-of-pocket expenditures and indirect costs of lost income—can worsen poverty, impair quality of life, and increase the risk of adverse treatment outcomes. Costs due to TB are typically defined as catastrophic if they exceed 20% of pre-illness annual household income. The WHO End TB Strategy and the UN Sustainable Development Goals both include the target that zero TB-affected families should face catastrophic costs due to TB by 2035 and 2025, respectively. Despite this global priority, there is limited evidence and policy clarity concerning how to achieve this goal. This systematic review and meta-analysis aims to rigorously assess the evidence for strategies to eliminate catastrophic costs due to TB.
**Methods:** This protocol follows the PRISMA-P checklist and is registered in the PROSPERO database (CRD42022292410). Three electronic databases (PubMed, Scopus, and Web of Science) will be searched, along with reference lists from pertinent publications. The search strategy includes terms for tuberculosis combined with catastrophic cost terms. Inclusion criteria encompass studies concerning the elimination of catastrophic household costs due to TB, including any type of TB (pulmonary or extrapulmonary; drug-susceptible or drug-resistant; with or without comorbidities such as HIV). Exclusion criteria include studies that only quantified out-of-pocket expenditure costs without considering indirect costs of lost income, monetary costs without assessing them as a proportion of household income, or catastrophic costs at a population level without considering individual households. The population is TB-affected households. Interventions include any strategies aiming to mitigate or eliminate catastrophic costs (e.g., active case finding, socioeconomic support, home-based care). The comparison is standard of care. The primary outcome is the proportion of households with catastrophic costs due to TB. Two reviewers will independently screen titles, abstracts, and full texts, with discrepancies resolved by discussion. Data extraction will capture the proportion of households with catastrophic costs, study characteristics, cost quantification strategies, intervention types, and study designs. Risk of bias will be assessed using the NHLBI quality assessment tool (or an alternative such as the Cochrane risk-of-bias tool for randomized trials, depending on pilot work). The main measure of effect will be the proportion of households with catastrophic costs. For dichotomous data, odds ratios, relative risk, and/or absolute risk will be used. For continuous data, weighted or standardized mean differences will be used, all with 95% confidence intervals. If sufficiently similar and suitable intervention studies are found, a meta-analysis will be performed using Stata version 16.0, with heterogeneity assessed using I² statistics and Forest plots. All types of studies will be included (observational, interventional, reviews, editorials, modeling studies).
**Key Results:** This is a protocol paper; therefore, no results are reported. The authors note that the COVID-19 pandemic is believed to be markedly increasing TB disease, adverse TB outcomes, catastrophic costs due to TB, and poverty, while impairing TB case finding and cure.
**Clinical Implications:** This systematic review aims to inform public health policy by identifying effective strategies to eliminate catastrophic costs due to TB. The findings could guide the implementation of TB-specific socioeconomic interventions, active case finding, and other approaches to reduce the financial burden on TB-affected households. Achieving the WHO and UN targets of zero catastrophic costs requires evidence-based strategies, which this review seeks to identify and synthesize.