I don’t know how to make it work, but I do know at least one blind Twitch streamer, Cooking Without Looking who streams, as the name suggests, themselves cooking, and has it set up where her screen reader will read chat to her. You might be able to connect with her, and ask how she makes it work.

I stream my music sessions on Twitch. I use a hardware mixer to handle the audio side of things. To listen to chat, I use Twitch TTS from the Microsoft store. If you don't already know, the review cursor is your bestest friend when it comes to navigating the OBS window. If you struggle with it, you can try installing the ObjPad plugin for NVDA which provides a more intuitive key layout for the review cursor. OBS pushes you to signing in, but I find stream keys to be more accessible. Just copy and paste. No fiddling with text fields for MFA or whatever. The stream key is obfuscated by defaultl

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Oh, and make sure to close your porn tabs before clicking the stream button.

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I can talk tips on microphones and the like in PMs if you need that.

I'm a blind content creator. I'll write up a guide in the next few days and post it here :).

As a gamer without sight and streamer myself, regardless of what you want to do, I'd recommend Firebot as your chatbot of choice - it's screen reader friendly and lets you do pretty much everything most chatbots would let you do, including even more advanced things like integrating with Google Cloud TTS or Amazon Poly for speech (neither of which I've used myself). The dev team are also super helpful if you have accessibility feedback.

Would also recommend using OBS Studio as software, the only thing you may need assistance with is lining up visual sources etc.

Nice to encounter someone who wants to start streaming in this sub. I stream from time to time but unfortunately, I've used my remaining vision to set up some basic features on my streams, such as an alert box and an on-screen chat. However, there are some fully blind streamers in here that might be able to help you out.

Streamlabs is unfortunately involved with some drama right now, but if the website works for you I see no harm in sticking to it. I've been thinking about changing to Streamelements at some point if it's accessible, but until then I gonna use the Streamlabs website for my overlays.