Background: Tuberculosis (TB) remains a global health challenge, particularly with the emergence of drug-resistant strains. This study examines TB case detection and rifampicin resistance across different demographic categories in two healthcare institutions over two consecutive years. Methods: A retrospective analysis of TB cases reported by AIMS for 2023 and 2022, and MIMS for 2022, was conducted. Data included MTB detection and rifampicin resistance among PLHIV, pediatric populations, and private sector cases. Results: AIMS reported low rates of MTB detection (5.26% for PLHIV, 1.52% for pediatric cases in 2023) and no rifampicin resistance in 2023. MIMS reported higher overall TB cases with a 0.9% MTB detection rate among PLHIV and a 0.48% rate in pediatric cases, with a 10% rifampicin resistance among detected cases in 2022. No significant seasonal trends were observed at AIMS (p > 0.05), while MIMS showed a non-significant increase in detection during the monsoon months (p = 0.06). Newly diagnosed DRTB patients had higher detection rates (p < 0.01), and pulmonary TB was more frequently detected than extrapulmonary TB (p < 0.001). Conclusions: The low prevalence of rifampicin resistance suggests effective treatment and management strategies. However, the continued presence of MTB cases, especially in vulnerable populations, emphasizes the need for ongoing surveillance and improved diagnostic methods. Reinforced TB control programs and integrated healthcare strategies for high-risk groups are essential.