<![CDATA[Introduction: Delays in tuberculosis (TB) diagnosis remain a persistent challenge to TB control across the care cascade in low- and middle-income countries (LMICs). Community-based active case finding (ACF) and contact investigation provide opportunities to expand diagnostic services beyond healthcare facilities. However, evidence of their effects at different stages of the TB care cascade varies considerably across studies. This systematic review aimed to assess the effects of community-based TB screening interventions at different stages of the care cascade in LMICs, with behavioural frameworks applied to interpret the findings after synthesis. Methods: This systematic review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261288243). We searched Scopus, PubMed, and ProQuest for studies published from January 2016 to March 2026. We included randomised controlled trials (RCTs) and quasi-experimental studies on community-based TB screening in low- and middle-income countries (LMICs). Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The findings were summarised narratively according to TB care cascade outcomes and study design. Results: The 13 included studies comprised seven randomised controlled trials (RCTs) and six quasi-experimental studies. The findings varied according to study design and stages of the TB care cascade. Although evidence directly evaluating outcomes at the early stages of the TB care cascade remained limited, a few studies reported improvements in screening participation and progression to diagnostic evaluation. Positive effects on TB case detection, notification, and population-level outcomes were also reported in several studies. However, studies with control groups showed varied findings; some reported favourable effects, while others found no statistically significant effects. Evidence on the initiation of tuberculosis preventive treatment (TPT) was limited and mainly came from studies involving children who were household contacts of TB patients. Conclusion: Community-based TB screening may improve access to diagnosis and support TB case detection in some settings. However, the results vary by study design, population, intervention, and implementation context. Evidence on improved screening participation and completion of diagnostic evaluation remains limited. Therefore, the effects of community-based TB screening across the TB care cascade should be interpreted carefully based on the outcomes assessed at each stage.]]>
