Tuberculosis (TB) remains a significant public health challenge in urban settings of Ethiopia, with limited understanding of its epidemiology among youth. A cross-sectional survey design was employed, utilising structured questionnaires administered through a network of urban health clinics. Data collection spanned over one year with follow-up visits to evaluate long-term outcomes. In the initial cohort study, TB prevalence among surveyed youth aged 15-24 was found at 3.7% in Addis Ababa, with significant disparities noted between male and female populations (P < 0.05). The longitudinal impact assessment revealed that individuals who tested positive for latent TB infection had a higher incidence of active TB cases over the year. Implement targeted educational campaigns on TB prevention, particularly focusing on urban youth demographics and high-risk groups identified through this study. Strengthen surveillance systems to monitor and address emerging trends in TB prevalence among urban populations.