Dissertation (MMed Pediatrics and Child Health)Background: Tuberculosis is the most common opportunistic infection and the major cause of deaths among HIV and AIDS patients. Data reports highest prevalence of TB and HIV infection in sub Saharan Africa. Mycobacterium culture is the gold standard test for diagnosis of tuberculosis though not widely available, takes longer to get results and cannot help in management of patients hence clinical or scoring system is widely used to aid in diagnosis and management of TB in children and in areas where laboratory confirmation is not feasible. The study aims to determine performance of TB scoring chart in diagnosis of TB in children aged 1 to 15 years living with HIV in Dodoma Municipal. Methods: Cross sectional study, 252 children aged 1 to 15 years living with HIV were enrolled from November 2018 to March 2019. Participants were assessed by using Modified Keith Edward TB score chart, either of the following samples gastric aspirates, lymphnode aspirates or sputum were collected for gene expert and culture. Results: Out of 252 HIV positive children investigated for TB, probable TB were 34(13.5%) and 10 (29.4%) were bacteriological confirmed TB. Sensitivity of TB score was76.9% and specificity of 90%. Clinical features associated with culture positive TB were lymphadenopathy (AOR 13.74 (3.86 – 48.86) p value< 0.001), weight loss (AOR 3.19 (1.38 – 7.36) p value 0.007) and difficulty in breathing (AOR 7.25 (1.54 – 34.16) p value 0.012). Conclusion: Tuberculosis in children and adolescent living with HIV is still common. Difficulty in breathing, lymphadenopathy and weight loss were independently associated with culture positive TB.TB score chart in its present form should be used cautiously as a diagnostic tool in children with HIV and malnutrition as it has low positive predictive value can lead to over diagnosis (high false positive rates) of TB and unnecessary use of anti TB drugs.