Key findings
TB
We found no evidence that the PopART intervention reduced TB prevalence through UTT for HIV and systematic symptom screening for TB, after 4 years of intervention delivery (2014 to 2017 inclusive) and with TB prevalence measured 2 to 4 years later in 2019 to 2021. This lack of evidence was found overall and also in subgroup analyses among men, women, older and younger individuals, HIV–negative and HIV–positive individuals, and among individuals who had been resident in the study communities for ≥5 years. Findings were also similar in sensitivity analyses that made different assumptions about TB prevalence among survey participants with missing data on whether or not they had TB on the day of the survey. Our findings were thus consistent across subgroups of the population and robust to alternative ways of accounting for missing data on prevalent TB. TB prevalence was on average high across the 21 study communities, at around 0.9% overall, around 1.6% averaging across South African communities, and around 0.5% averaging across Zambian communities. TB prevalence was also higher among men than women, among older than younger individuals, and around 2 times higher among HIV–positive compared with HIV–negative individuals. Most individuals who had prevalent TB were eligible to provide sputum samples for diagnostic testing only on the basis of an abnormal X-ray and not based on the TB symptoms they reported.