We conducted a prospective cohort study of 306 HIV-1-infected women, followed from seroconversion for median 6.4 years in Uganda (UG) and Zimbabwe (ZM) to describe the incidence of major clinical outcomes (MCOs), defined as World Health Organization stage 4 conditions and any tuberculosis (TB). In Uganda, 19 MCOs occurred in 13 participants at median 4.6 years and a median CD4 count of 213 cells/mm(3). In Zimbabwe, 29 MCOs occurred in 27 participants at median 4.0 years (P < 0.001 versus UG) and median CD4 count of 219 cells/mm(3) (P = 0.83 versus UG). MCO incidence was not statistically different (UG: 2.82 cases/100 person-years versus ZM: 2.45; P = 0.64) except for TB (UG: 0.59 versus ZM: 2.02 cases/100 person-years; P = 0.02). This significant difference in TB incidence is primarily due to a TB screening and isoniazid prevention therapy programme that was implemented in Uganda, but not in Zimbabwe, highlighting the importance of integrated TB screening and treatment within HIV programmes.