The study evaluated the accuracy of a urine lipoarabinomannan (U-LAM) test for diagnosing active tuberculosis (TB) in HIV-positive patients admitted to hospitals in South Africa with presumptive TB. Patients underwent testing for TB including sputum smear microscopy, mycobacterial culture, and the U-LAM test. The U-LAM test had a sensitivity of 59% for confirmed TB cases. Sensitivity was higher in HIV-positive versus negative patients and highest in those with CD4 counts below 50. Combining U-LAM and sputum smear identified 75% of confirmed TB cases. The U-LAM test shows potential as a simple, inexpensive test for TB