Background: Tuberculosis is a high-burden infectious disease requiring long-term treatment. Compliance is the key to cure; however, directly observed therapy (DOTS) is not always feasible. Telemedicine use in DOTS offers improved accessibility; however, its effectiveness has not been established. We aimed to investigate the effectiveness of telemedicine-based DOTS on treatment compliance in patients with tuberculosis. Methods: Databases including MEDLINE, Scopus, EMBASE, PubMed, and Cochrane were searched for studies implementing telemedicine-based DOTS until November 2nd, 2023. Studies were appraised for validity, importance, and applicability using the Oxford Centre of Evidence-Based Medicine tool, and the outcomes were graded based on their levels of evidence (LOE). Results: Our search yielded six systematic reviews. Telemedicine-based DOTS yielded favourable effects in improving adherence (LOE: I), treatment completion (LOE: II-III), and cure rates (LOE: II-III). Other outcomes, in terms of bacteriological resolution (LOE: II) and mortality (LOE: IV), were estimated to be non-inferior to those of DOTS. In terms of the telemedicine mode, the VDOTS yielded the highest LOE in improving adherence (LOE: I), followed by short messaging services (LOE: III) and medication monitors (LOE: III), which yielded similar effects. Results for phone reminders were contradictory, with the highest evidence suggesting that it might be ineffective for treatment completion (LOE: I-III) but may increase the cure rate (LOE: III). Conclusion: Telemedicine-based DOTS may improve adherence, treatment completion, and cure rate, and is non-inferior in terms of bacteriological resolution and mortality. Telemedicine-based DOTS can be considered for implementation; however, further high-quality studies in limited-resource settings are needed to strengthen the evidence. © 2025, Indonesian Society of Internal Medicine. All rights reserved.