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Background: Tuberculosis (TB) remains a major cause of morbidity and mortality in Ethiopia despite the increased availability of effective treatments. Trend analysis of issues and priorities affecting TB programs across different regions of the country is critical to ensure equitable and sustainable TB outcomes. We aimed to analyze the trends of TB in Bahir Dar, Northwest Ethiopia, over 5 years from 2015 to 2019. Methods: An institution-based, retrospective cross-sectional study was conducted in Bahir Dar, the capital city of the Amhara Region in Ethiopia. Five-year data and records of individual TB cases were reviewed from all public and private health-care facilities and health bureaus in Bahir Dar. Using a standard checklist adapted from the World Health Organization, data were abstracted relevant to sociodemographic characteristics of the patients, year and type of TB infection, and HIV status. SPSS version 20 software was used for data analysis. Results: Data of 4275 patients with TB were identified, of which 929 (21.7%) were smear-positive pulmonary TB, 1195 (28%) were smear-negative pulmonary TB, and 2151 (50.3%) were extrapulmonary TB patients. TB was more prevalent in the age group 15–34 years (51.2%), and females (55.5%). In the years from 2015 to 2019, the prevalence of all forms of TB was 922 (21.6%), 812 (19.0%), 843 (19.7%), 876 (20.5%), and 822 (19.2%), respectively, demonstrating a decreasing trend though inconsistent. The variables sex (adjusted odds ratio [AOR]: 1.734, 95% confidence interval [CI] [1.390–2.187]), HIV co-infection (AOR: 1.875, 95% CI [1.553–2.265]), and age <15 years (AOR: 1.372, 95% CI [1.121–1.680]) showed a significant association with TB infection. Conclusions: The prevalence of TB in Bahir Dar, Northwest Ethiopia, demonstrated a decreasing trend over the years from 2015 to 2019 but with inconsistencies. HIV co-infection significantly increased the risk of developing TB, and productive age groups and females were at the greater prevalence of TB, highlighting the importance of strengthening sustainable TB care and prevention interventions toward these groups of people.