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We sought to describe the prevalence and predictors of tuberculin skin test (TST) reactors in a high-risk sample of urban Aboriginal people, and to evaluate adherence to medical evaluation and latent tuberculosis infection (LTBI) treatment among those with TST reactivity. Of the 164 participants tested, 86% returned for TST reading. Positive TST reactions ($10 mm) were observed in 17.7% (25/141, 95% CI 11.4–24.0) of participants, and were associated with older age (OR per 10 year increase 1.8, 95% CI 1.2–2.7) and Inuit Aboriginal group (OR 2.8, 95% CI 1.1–7.3). Only four participants presented for evaluation, of whom one initiated and none completed LTBI treatment. Tuberculin screening in this population can be an effective strategy for identifying TST reactive individuals; however, screening efforts will have minimal impact without additional efforts in this high-risk group.