Our meta-analysis showed a benefit from CB DOT compared to clinic DOT for treatment success, but no overall difference between the two DOT strategies for loss to follow-up. This result in favour of CB DOT for treatment success was also seen when only analysing data from prospective studies. The lack of high quality RCTs limits the strength of this result. However, based on the review result, we suggest that CB DOT can be considered as an alternative to clinic DOT for the treatment of TB patients, delivering at least equivalent treatment success. Future studies should also assess the cost-effectiveness of CB DOT compared to clinic DOT, which is essential for health policy makers, especially in resource-constrained settings.