Maybe uMatrix is blocking them somehow? I've never seen an ad, even on channels I don't follow or subscribe to. My rulesets are very strict, but you're right, if they really come through the video stream I don't know how I'm blocking it.
Maybe you buy a lot of subscriptions and currency? I bet they avoid annoying their most profitable users. While it might have been coincidental, I never got ads until I unsubbed from the vast majority of streamers I follow. Same for other things like gifted subs. I used to receive a ton of gifted subs until I started lowering my sub count. They are obsessed with performance metrics. Big spenders have a very different experience.
Now, whenever I get an ad, I immediately close twitch and find something on YT/Mixer to watch. I'm training their algorithms to leave me alone.
I get no ads on Twitch, and I currently don’t have Twitch Prime or any subscriptions. I’ve spent maybe 50 bucks on Twitch in the 3-4 year lifespan of my account. I’m running Vivaldi (which uses Chromium) with uBlock Origin, Ghostery (I know), and HTTPS Everywhere, on MacOS.
I get ads when I use Twitch, with the same account, on a stock installation of Chrome (which I use as my backup browser for when I don’t want to figure out which extension is breaking a website). So it’s not related to my account, ___location, etc.