Background: Community outreach Tuberculosis screening is key role of Health Extension Workers (HEWs) for early case detection and timely treatment. However, evidence on their screening practice within the national TB program is limited. This study aimed to assess TB screening practice and its factors among HEWs in the North Gondar Zone and adjacent districts.

Methods: A community-based cross-sectional study with concurrent triangulation mixed-methods approach was conducted from 01/01/2026 to 28/02/2026. A simple random sampling technique was used to select 431 study participants. Data were entered into EpiData 4.6 and analyzed in SPSS 25 using bivariable and multivariable logistic regression. P-value <0.05 was used to assert statistical significance in multivariable analysis.

For the qualitative component, participants were selected purposively. Data were collected through key informant interviews and focus group discussions using a pretested questionnaire. Data were collected via audio recording, then transcribed and translated. Data were imported into Open Code version 4.02 and analyzed using a thematic content analysis approach.

Result: Among 430 respondents, the prevalence of good TB screening practice was 65%. Receiving supportive supervision (AOR: 3.99; 95%CI: 1.92, 7.74), having updated TB guideline packages (AOR: 2.13; 95% CI: 1.46, 3.98), having discussions with Health Development Army(HDA) (AOR: 2.58; 95%CI: 1.37, 4.86), TB training (AOR: 2.20; 95%CI: 1.31, 3.70), and having good knowledge of tuberculosis (AOR: 2.53; 95%CI: 1.57, 4.09) were identified factors. Weak referral linkage system and poor feedback from TB focal person emerged as a key theme negatively influencing good TB screening practice.

Conclusions: Two-thirds of HEWs had good TB screening practice. Supportive supervision, access to updated TB guidelines, having discussions with HDA, TB training, and good knowledge were key associated factors with good TB screening practice. These findings show that system support and individual knowledge are essential to improve Community outreach TB screening practice.

To be Updated