One of the jail systems was small and had a private jail medical provider. The other system was large and had a medically accredited and integrated medical and public health structure. The analysis used information from a sample of the jail populations and followed their medical services and the administration and clinical integration between jail medical services and public health services. Results revealed that early identification of active tuberculosis requires the development of integrated information systems or records within the jail and other health agencies, as well as careful system-wide planning and evaluation for the development of tuberculosis screening. Inmates with tuberculosis need to be tracked throughout the county public health agencies. Other needed actions include following offenders throughout the justice system, considering jail facilities as designated health care facilities, and making public health standards mandatory for accrediting jail medical programs. Tables, figures, footnotes, appended background information, and 31 references