Mengistu Handiso Nunemo,1 Kassa Daka Gidebo,2 Eskinder Wolka Woticha,2 Yohannes Kebede Lemu3 1Department of Public Health, Wachemo University, Hossana, Central Region, Ethiopia; 2Department of Public Health, Wolaita Sodo University, Wolaita, South Region, Ethiopia; 3Department of Health, Behaviour and Society, Jimma University, Jimma, Oromia Region, EthiopiaCorrespondence: Mengistu Handiso Nunemo, Department of Public Health, Wachemo University, Po.Box: 667, Hosanna, Centeral Region, Ethiopia, Tel + 251 916357401, Email [email protected]: Non-communicable diseases are comorbid with tuberculosis, however only a few record review based studies have been conducted, which are more concentrated on elevated glucose levels. This study aimed to assess non-communicable disease comorbidity and its predictors among tuberculosis patients.Methods: A prospective cross-sectional study design was used and the data were collected by a previously validated tool from a sample of 443 tuberculosis patients using cluster random sampling methods. Multinomial logistic regression was interpreted by relative risk to predict the association of comorbidity status with independent variables.Results: The majority (87.81%) of TB patients were not comorbid with NCDs. The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55%, and 5.64%, respectively. The people who had a risk score > 8 were 6.47 times more likely to have tuberculosis comorbid with one non-communicable disease compared to those with a risk score ≤ 8. The relative risk of tuberculosis patients with BMI > 25 is 3.33 times compared to those with a BMI < 23 of being comorbid with one non-communicable disease vs tuberculosis patients without non-communicable diseases. Those tuberculosis patients with an awareness of non-communicable disease comorbidities are 9.33 times more likely to have tuberculosis with multi-comorbidities compared to those who are unaware.Conclusion: The majority of TB patients were not comorbid with NCDs. The person’s weight, family size of more than five, monthly income > 3000 birr, risk score > 8 and BMI > 25 significantly predict comorbidity with one non-communicable disease compared to those without a comorbidity. The presence of non-communicable disease comorbidity, treatment awareness, and being aged 50+ years significantly predict the presence of multi-comorbidities compared to those without comorbidity. For early detection and management of both diseases, establishing bidirectional screening platforms in tuberculosis care programs is urgently required.Plain Language Summary: Non-communicable diseases are comorbid with tuberculosis, however, only a few record review based studies have been conducted, which are more concentrated on elevated glucose levels.This is a former prospective cross-sectional study of non-communicable disease comorbidities and their predictors among tuberculosis patients using the two stages of the WHO step-wise screening procedure.The majority (87.81%) of TB patients were not comorbid with NCDs, 7.22% were comorbid with one NCD and 4.97% were multi-comorbid. The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55%, and 5.64%, respectively. The person’s weight, family size of more than five, monthly income > 3000 birr, risk score > 8 and BMI > 25 significantly predict the comorbidity with one non-communicable disease related to those without comorbidity. The presence of non-communicable disease comorbidity, treatment awareness, and being aged 50+ years significantly predicted the presence of multi-comorbidity compared to those without comorbidity. For early detection and management of both diseases, establishing bidirectional screening platforms in tuberculosis care programs is urgently required.Keywords: comorbidity, non-communicable disease, tuberculosis, prevalence, predictor