BACKGROUND Regardless of their HIV status, injection drug users (IDUs) are at increased risk of developing active tuberculosis (TB) if they have latent TB infection (LTBI). We quantified the prevalence and predictors of LTBI and level of adherence to medical evaluation in a population of IDUs in Montreal. METHODS Participants were recruited from an ongoing dynamic cohort of IDUs followed for HIV seroconversion risk behaviour. Subjects with a tuberculin skin test (TST) of > or =5 mm were referred to designated TB clinics for medical evaluation. A financial incentive was provided for TST readings. RESULTS Of the 262 subjects tested, 246 (94%) returned for TST reading. The overall prevalence of positive TSTs was 22% (5% in HIV-positive, 28% in HIV-negative participants). Older age at first injection drug use (OR per 10 year increase in age 1.4, 95%CI 1.2-1.8), duration of injection drug use (OR per 10 year increase 1.6, 9.5%CI 1.5-2.2) and negative HIV status (OR 11.2, 95%CI 3.2-4.0) were independent predictors of a positive TST. Nine per cent of all TST-positive participants completed LTBI treatment. CONCLUSION TB screening activities with incentives can be successful in detecting TST-positive individuals, but better strategies are needed for medical follow-up in this high-risk group.