Abstract— Tuberculosis (TB) is the 9th leading cause of death in the world. This disease requires a long treatment so it requires patient adherence. One of treatment evaluation is Acid Fast Bacilli ( AFB) microscopic examination. The purpose to determine an adherence of medication anti-tuberculosis drugs by TB patient influence AFB microscopic conversion. Observational analytic research with a cross-sectional research design held on 35 outpatient TB patients at Rumah Sakit Paru Respira Yogyakarta and Balai Kesehatan Paru Masyarakat Kota Pekalongan. TB patients are 60% men, 26-45 years old are 40%. Tuberculosis diagnosis category are 88.6% new TB patients and 11.4% recurrent TB. Adherence to anti-tuberculosis drugs medication is 74.3% obedient and 25.7% not obey. AFB Microscopic at an early treatment are 45.7 % +1, 22.9 % +2 and 31.4 % +3 , and at the end of the treatment AFB Microscopic are 82.9% negative and 17.1% +1. It means that there are 82.9% AFB microscopic conversion and 17.1% are not AFB microscopic conversion. Bivariate analysis between adherence of medication anti-tuberculosis drugs medication by TB patient and AFB microscopic conversion obtained p = 0.027 (p <0.05), there is a significant correlation between the adherence of anti-tuberculosis drugs medication by TB patient with AFB microscopic conversion, which the risk of unconversion AFB microscopic are 9 times fold on the not obey TB patient (OR values of 9,600 (95% CI = 1,363-67,596)). Acid Fast Bacilli (AFB) microscopic conversion depends on taking Anti-Tuberculosis drug medication adherence by TB patient.