Relationship Between Health Literacy Levels and Tuberculosis Treatment Adherence Among Patients at Specialist Hospitals in Niger State

Background: Tuberculosis treatment non-adherence enables drug resistance and treatment failure, with health literacy identified as a modifiable determinant in global settings but insufficiently studied in Niger State, North Central Nigeria. Aim: This study examined the relationship between health literacy levels and tuberculosis treatment adherence at specialist hospitals in Niger State. Methods: An analytical cross-sectional design recruited 170 confirmed pulmonary tuberculosis patients on directly observed therapy through systematic random sampling. The Newest Vital Sign health literacy tool and the Morisky Medication Adherence Scale were administered. Pearson's correlation and hierarchical regression were used. Results: Low health literacy was present in 47% of participants. Significant positive correlations were found between health literacy scores and adherence (r = 0.54, p < 0.001). Even after controlling for confounders, health literacy independently predicted adherence (beta = 0.39, p < 0.001). Pictorial medication guides improved understanding in low-literacy patients. Conclusion: Health literacy is an independent predictor of TB treatment adherence. Nurses should use health literacy-sensitive communication, simplified educational materials, and peer supporter systems to improve adherence among low-literacy TB patients in Nigeria. Keywords: health literacy, tuberculosis, treatment adherence, Niger State, directly observed therapy.