Introduction: This thesis aims to address whether community-wide Universal Testing and Treatment for HIV (UTT) and systematic TB screening (TB screening), implemented by community health-workers, could control TB in high TB/HIV burden communities in sub-Saharan Africa and could improve the clinical outcomes of people with TB. Methods and results: HPTN 071 (PopART) was a 3-arm cluster-randomised trial (CRT) conducted between 2013-2017 in 21 Zambian and South African communities. The intervention included UTT and TB screening in arm A. Arm B, received universal HIV testing with antiretroviral therapy (ART) according to national guidelines and TB screening. Arm C, the control, received the standard-of-care through routine services. A population cohort (PC) was established to measure the primary outcome of the trial (intervention impact on HIV incidence). This PhD, embedded within HPTN 071 (PopART) used the PC and routine TB notification data to address the study objectives. A literature review found 18 observational studies which consistently showed increasing ART coverage was associated with decreased measures of population-level TB, and that TB notifications and diagnoses decreased coincident with increasing ART coverage. Decreases were greater among people living with HIV (PLHIV) than those who were HIV negative. In post-hoc analysis of a CRT of UTT, TB notification rates among PLHIV was 59% lower in the UTT arm compared to the control. While findings were consistent, study limitations prevent causal inferences. A systematic review identified seven general-population TB screening studies which suggested that TB screening was associated with initial increases in TB notifications. Among 38,474 PC-participants there was an ~45-50% decrease in self-reported TB incidence among PLHIV at the population-level in arm A compared to C, following the roll-out of the HPTN 071 (PopART) intervention. There was also some evidence that this translated to an ~50% decrease in incidence in the population overall. Incidence in arm B and C was similar. No initial increases in self-reported TB in intervention arms were observed. A systematic review found nine general-population studies (eight observational, one trial), which showed treatment success and case fatality were similar among individuals identified through screening and through routine care. In the Zambian arm A and B HPTN 071 (PopART) communities only 15% of people with TB starting treatment were identified through screening. Mode of diagnosis (community-wide TB screening versus through routine care) was not associated with treatment success or case-fatality. The odds of treatment success was 48% lower and case-fatality three times higher among PLHIV compared to those HIV-negative. Conclusion: This thesis contributes to knowledge on the effect of UTT and TB screening on TB epidemiology. The data suggest that UTT could contribute to TB control. But, despite community-wide UTT, case-fatality among PLHIV with TB was high, highlighting their continued need for TB-prevention interventions.