“If we cannot effectively detect and diagnose asymptomatic TB in community settings, we cannot hope to control TB transmission at a population level. The finding that asymptomatic TB includes individuals with substantial bacterial burdens and radiographic disease raises the likelihood that asymptomatic individuals could contribute meaningfully to TB transmission in communities. The findings also suggest that diagnostic biomarkers require optimisation specifically for asymptomatic TB screening rather than simple adaptation of existing TB tests developed for symptomatic TB. About asymptomatic TB in South AfricaSouth Africa has the highest TB burden globally and faces a dual epidemic of TB and HIV. Improving detection and management of asymptomatic TB is critical to achieving South Africa’s TB control goals and contributing to global TB elimination.