Background Uganda is one of the 30 countries with a high burden of TB in the world. According to the 2014–2015 National TB prevalence survey, 39% of people with cough for two or more weeks did not seek treatment. Similarly, there was an estimated 1500 people (range 820–2300) with Drug resistant TB (DR TB) in 2018 but only 34% were notified. While Ankole region in South-Western Uganda detected 36 DR TB cases from April 2022 to March 2023, Kazo District, a majorly pastoral community diagnosed 2. Additionally, in 2021/2022, Kazo District had a case detection rate of 46% (Target 90%). There was need to improve TB case finding and therefore pairing Health workers and village health teams (VHT) to screen for TB in community hotspots was initiated.

Methods Microplanning meetings were held with the District Health Team and USAID LPHS Ankole (TASO). A review of the District TB register was done. Hotspot mapping was done with community participation while prioritising areas with previously high TB notification. Buremba, Kyampangara and Nkungu were selected. In each hotspot, a professional health worker and a VHT were paired to do household health education, TB screening using MOH designed tools and sputum sample collection for 3 days. Samples were tested using Gene-Xpert. All diagnosed clients were started on respective treatment.

Results A total of 524 households were reached,1526 people were screened for TB. Presumptive TB was identified in 220/1526(14.4%) and 15/220 (6.8%) (8 male and 7 female) confirmed with TB. Of these, 13 (87%) were from Buremba. Out of the 13 clients,7(53.8%) (3 male and 4 female) had Rifampicin resistant TB.

Conclusion Pairing Village Health Teams with Professional Health workers in community hotspot screening leads to high TB yield. These data provide a paradigm for optimal active TB case finding in hard to reach communities.