WHO estimates two billion people are infected with Mycobacterium tuberculosis, with approximately 8 million becoming ill annually and nearly two million deaths. In Guatemala, TB has become a serious public health problem; the current rate of new TB infections is estimated to be 63 cases per 100,000 inhabitants1. TB control programs are challenged even when simple diagnostic techniques and effective treatments are available. For successful TB control, global priorities aim for better and earlier detection of TB cases. However, in many resource-poor settings, merely acquiring adequate samples and their subsequent processing in the laboratory can be a challenge due to inadequate patient education, communication between healthcare personnel, and quality control in sample processing. The International Emerging Infections Programs (IEIP) will strategize efforts to evaluate the TB control program and laboratory diagnostics at two hospitals located in Guatemala: Quetzaltenango and Santa Rosa. Methods will include the coordination of efforts with hospital epidemiologists, medical personnel and laboratory staff to systematically evaluate (1) current capacities, resources and needs for improving TB specimen collection and diagnostics; (2) establish baseline data on positivity of specimens collected for TB testing; (3) develop a strategy to increase laboratory capacity and the number of positive sputum samples; (4) evaluate and monitor programmatic and laboratory progress upon implementation of efforts; and (5) package the intervention to improve TB diagnostics for wider implementation at the national level.