Introduction: Tuberculosis is still a concern in developing countries. With proper managemen can control the incidence of TB cases and transmission. Disruption at one stage of management due to the COVID-19 pandemic has the potential to affect other stages of TB treatment. Objective: Determine the challenges that occur in TB patient management in developing countries amidst pandemic and recommend effective strategies to overcome those. Method: The literature search was carried out systematically by PRISMA protocol, using keywords on 6 online databases during 2020-2022. Assessment of study quality to obtain selected studies used JBI critical appraisal checklist. Result: 10 selected studies were obtained with the results of TB management challenges in developing countries amidst pandemic including limited resources, disruption of treatment continuity, decreased notification of new TB cases, difficulties in accessing health facilities, public stigmatization of TB and COVID-19 patient, misdiagnosis of TB with COVID-19, decreased coverage of children BCG vaccination and increased risk of TB transmission. Conclusion: The biggest challenges in TB management in developing countries that many have encountered during pandemic were limited resources and treatment discontinuity, as a result of the lockdown policies. The recommended strategies were innovation in existing TB services with cross-sectoral collaboration, changes in OAT delivery methods, increased education and optimizing the utilisation of virtual media. © 2023 MPPKI. All rights reserved.