Abstract
Tuberculosis (TB) screening often relies on cross-sectional symptom assessment. To determine the added value of longitudinal symptom monitoring, we conducted a prospective cohort study among 2,282 incarcerated men in Brazil without TB. Every four months, participants were assessed for symptoms and incident TB (Xpert or culture positive). At baseline, 23% of participants reported symptoms. Among those asymptomatic at baseline, 43% developed symptoms within two years. Compared to remaining asymptomatic, developing symptoms was associated with higher TB risk, while remaining symptomatic was not associated. Longitudinal symptom monitoring may provide value beyond cross-sectional symptom assessment and enhance TB screening in high-risk settings.