Mortality from tuberculosis (TB) remains high among people living with HIV, accounting for nearly half a million cases and 32% of AIDS-related deaths in 2017.1 Underdiagnosis of TB, especially in places without widespread health care access, is a principal barrier to combatting the disease. In resource-limited settings, microscopy often remains a primary diagnostic method despite its poor sensitivity. Improved molecular diagnoses such as Xpert MTB/RIF have good sensitivity and excellent specificity but are still not widely available. An additional challenge is that these techniques rely on sputum samples that can be difficult to produce, especially for very ill HIV-positive patients. Transferring sputum samples from peripheral health facilities to laboratories for testing can additionally cause delays or losses. As a result, clinicians in low-resource, peripheral facilities often rely on their clinical judgement to diagnose TB. Consequently, the emergence of easier to use, point-of-care (POC) tests using urine to identify TB [detecting the mycobacterial lipoarabinomannan (LAM) antigen] have been a welcome addition to the TB diagnostics environment.2,3 The lateral-flow TB LAM Ag [(lateral-flow lipoarabinomannan assay (LF-LAM)] assay has shown encouraging sensitivity and specificity (45% and 92%),4 and 2 large trials have shown a substantial reduction in mortality among hospitalized patients who immediately initiated treatment after a positive result.5,6 International guidance currently recommends that LAM may be used to assist TB diagnosis in HIV-positive ambulatory outpatients with signs and symptoms of TB who are severely immunocompromised (CD4 count ≤100 cells/µL) as well as those who are seriously ill.7 Yet, for most outpatients (who are not seriously ill), these recommendations are based on the assumption that a patient's CD4 cell count is readily available, when in fact this is often far from certain. Many resource-limited contexts still struggle with limited and inconsistent access to CD4 testing, an issue which may be compounded as viral load is the preferred technology to monitor ART efficacy in patients with HIV. Thus, we investigated the diagnostic yield of urine LF-LAM in HIV positive, outpatients with symptoms of TB regardless of whether patients had a CD4 cell count immediately available. We assessed these test results by level of immunosuppression and the risk of mortality at 6 months. We also explored whether clinical signs could be used as a proxy for CD4 count to determine LAM testing eligibility.