Background: Tuberculosis (TB) prevalence is closely associated with poverty in China. The China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients. This study aims to assess the program effects on service use across different income groups. Methods: 788 and 775 patients were surveyed at baseline and final evaluation. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. Findings: After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5% to 70.7%) and moderate poverty group (45.0% to 68.1%), compared to the non-poverty group (52.9% to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by 10 percentage points in the other groups. Satisfaction rates were high in all groups. Interpretation: Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor. Funding Statement: The Melinda and Bill Gates Foundation (Grant No. 51914) Declaration of Interests: All authors declare no conflict of interests. Ethics Approval Statement: The study obtained ethical approval from the China CDC Institutional Review Board. Informed consent was obtained before each survey and qualitative interview