SETTING: India has a high tuberculosis (TB) burden, with 1.8 million new cases per year. Although an esti-mated 2.5 million people are infected with human immu-nodeficiency virus (HIV), the national HIV prevalence is 1%. India’s size and diverse TB-HIV epidemiology pose a major challenge to the implementation of links between TB and HIV/AIDS programme services. METHODS: A pilot cross-referral initiative was insti- tuted between voluntary counselling and testing centres (VCT) and the diagnostic and treatment facilities of the Revised National TB Control Programme (RNTCP) in four districts of Maharashtra, India. OBJECTIVE: To detect TB disease among VCT patients and selectively screen TB patients for referral to VCT services. RESULTS: Between July 2003 and June 2004, 336 (3%) of 9921 VCT patients were identified as TB suspects and 83 (29%) were diagnosed with TB disease. Of the 765 selectively referred TB cases, 181 (24%) were found to be HIV-positive, representing 11% of the newly detected persons living with HIV in the four districts. CONCLUSIONS: The pilot cross-referral initiative yielded significant numbers of active TB cases among VCT patients and HIV-positive persons among TB patients. Collaborative activities between HIV/AIDS and TB pro- grammes need to be rapidly scaled up to other states in India.