ObjectiveThe current COVID-19 pandemic in Ethiopia could cause severe dysfunction in tuberculosis (TB) treatment, diagnostic services, and prevention and control efforts. In this study, we evaluated the effect of COVID-19 on TB service indicators in Addis Ababa, where more than two-thirds of the country’s COVID-19 morbidity was recorded.DesignWe performed a comparative retrospective study to evaluate the impact of COVID-19 on TB services during the pre-COVID-19 era (from April 2019 to March 2020) and the COVID-19 era (from April 2020 to March 2021) in Addis Ababa, Ethiopia. We extracted data on total TB detection rate, TB treatment success rate, isoniazid prophylaxis therapy, and drug susceptibility tests and others from the health information system. Using Poisson regression, we estimated the incidence rate ratios and the absolute number difference of the indicators (number per quarter and year) in the COVID-19 and pre-COVID-19 eras.ResultsCompared with the pre-COVID-19 era, the total TB detection, bacteriologically confirmed TB, TB treatment success rate, latent TB infection treatment and community health workers’ engagement in TB detection decreased, respectively, by 11%, 11.8%, 17%, 44.7% and 77.2% during the COVID-19 period. Rifampicin resistance increased by 27.7% during the same period. Comparative analysis showed a significant decline in these TB service indicators (p<0.001)ConclusionThe COVID-19 pandemic has had a negative impact on TB service indicators in Addis Ababa. This highlights the importance of reinforcing TB services, including adopting alternative digital health technology to screen for TB and integrating TB and COVID-19 services to mitigate COVID-19’s challenges to TB prevention and care.