Introduction <p>Anxiety among TB patients can influence quality of life, treatment adherence, and outcomes. Understanding the prevalence and contributing factors of anxiety in TB patients can assist programme managers in improving patient outcomes.</p> Objectives <p>This systematic review and meta-analysis aimed to identify factors associated with anxiety and to estimate the pooled prevalence of anxiety among Indian TB patients.</p> Methods <p>Data extraction and screening were conducted between February and March 2025 using four databases: Scopus, PUBMED, DOAJ, and EMBASE, along with cross-references; a total of 13 articles were included. These articles underwent quality assessment using the Newcastle-Ottawa Scale (NOS), the Modified-NOS, and the Mixed Methods Appraisal Tool. Due to potential heterogeneity, a random effects model was applied to estimate the pooled prevalence of anxiety among Indian TB patients at a 95% confidence interval.</p> Results <p>From 160 identified articles, 13 were included for review, representing six Indian states. The combined sample in these 13 studies was 9368 (mean(SD) = 721(1910), median = 120, IQR = 100–272). The study estimated a pooled prevalence of anxiety of 34% (95% CI: 22%-47%), with substantial heterogeneity with I²=98.67%. Several factors contributing to anxiety in TB patients within the Indian population were identified and categorised under demographic, disease-related, social, psychological, and literacy factors.</p> Conclusions <p>The review outlined anxiety-associated factors and estimated the pooled prevalence among Indian TB patients; however, given the high heterogeneity, the pooled estimate should be interpreted cautiously. Considering the influence of anxiety at various stages of the treatment process, timely detection and management are crucial to improve TB outcomes.</p>