COVID-19 may impact on tuberculosis (TB) diagnosis and care . We analysed a city-wide electronic TB register in Blantyre, Malawi and interviewed TB officers . Malawi had no official 'lockdown' but closed schools and borders on 23-March 2020 . In interrupted time series analysis, there was an immediate 35.9% reduction in TB notifications (95% CI 22.0 to 47.3 %) in April, which recovered to near pre-pandemic numbers by December 2020, but with 333 (95% CI 291 to 375) fewer cumulative notifications than anticipated . Women and girls were impacted (30.7% fewer cases , 95% CI 28.4 to 33.0 %) more than men and boys (20.9% fewer , 95% CI 18.5 to 23.3). Fear of COVID-19 infection, temporary facility closure, inadequate protective equipment and COVID-19 stigma with similar presenting symptoms to TB were mentioned . Public health measures could benefit both TB and COVID-19, but only if diagnostic services remain accessible and are considered safe to attend.