Tuberculosis detection is a huge challenge for Ethiopian prisons [7,16]. Because of lack of skilled health professionals and laboratory facilities, TB diagnosis relies on a referral of prisoners to health facilities outside prisons. As prisoners often do not recognize the symptoms of TB or use non-TB medicines to relieve symptoms, TB diagnosis is often severely late [17,18]. As a consequence, many prisoners with TB in the Ethiopian prisons remain undiagnosed [19]. Recently, we reported that at least half of symptomatic pulmonary TB cases were left undiagnosed and hence untreated in Northern Ethiopian prisons [20]. Some of these patients remained undiagnosed for more than two years [20]. This creates an opportunity for the transmission and dissemination of TB not only among prisoners but also to the general community. In addition, although accurate data is not available on TB treatment adherence, the conditions in Ethiopian prisons make the TB treatment supervision difficult and hence adherence to the full course of anti-TB drugs remains a challenge to TB patients [20]. This will lead to the emergence of drug-resistant strains, an important challenge for TB control. Thus, efforts are needed to improve TB case detection and treatment adherence in Ethiopian prisons. Epidemiological models show that employing active case finding through entry and exit screening, and frequent mass screening, using a combination of diagnostic tools (usually sputum smear microscopy and chest-X-ray), improves TB case detection in prisons [21]. However, resource constraints and lack of skilled health professionals limit its applicability in prisons of poor countries. Increasing the health service coverage and training health workers to fill the gap in short period seems a remote possibility. Therefore, there is a need to find alternative ways that could increase access to diagnostic and treatment services, ultimately increasing TB case detection and treatment success rate. In the current study, the investigators plan to undertake a cluster randomized controlled trial to assess whether empowering and involving inmate peer educators in the TB control improves TB case detection, treatment success rate, and pre-treatment symptom duration in a resource-limited prison setting.