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INTRODUCTIONClimate change increasingly threatens human health, ecosystems, and food systems worldwide. Extreme weather events, associated with climate change, such as floods, droughts, and typhoons, disproportionately affect vulnerable populations, worsening sociodemographic risks and limiting healthcare access. Tuberculosis (TB) care is especially vulnerable due to complex diagnostics and long treatment (6–18 months), yet evidence on program adaptation and geospatial solutions remains scarce. This study examines how climate-related disasters disrupt TB services in low- and middle-income countries and how geospatial tools can strengthen resilience.METHODSWe conducted a scoping literature and desk review, followed by a qualitative exploratory study comprising 10 semi-structured interviews (2 online, 8 in-person) with purposefully selected TB program implementers experienced in climate-related disaster events across eight high TB burden countries: Bangladesh, Ethiopia, Kenya, Nigeria, Pakistan (2), the Philippines, Zambia, and Zimbabwe (2). The interview tool was guided by concepts from the Saunders Climate Change & TB Analytical Framework such as climate-related impact, TB program consequences and health system challenges. Synthesized Narrative Exploration, an interview method entailing the further exploration of summarized findings from a desk review to build on prior knowledge, was employed. All interviews were transcribed, coded and analyzed using NVivo software.RESULTSReported disasters included flooding, drought, heat waves, typhoons/cyclones, rising lake water levels, silting and landslides. Participants explained that vulnerable populations experience major disruptions during disasters including displacement and isolation among others, directly impacting access to TB services. They noted TB risk increased due to overcrowding in displacement camps, malnutrition, and psychological stress. At the same time, TB care and treatment can be disrupted during disasters due to damaged infrastructure, supply chain issues, staff reallocation to other (emergency) services, etc., leading to suspension of screening and testing, while treatment adherence is affected by longer travel distances and increased costs. In addition, TB medication is poorly tolerated on an empty stomach, and thus treatment interruptions occur when loss of crops and daily income leads to missed meals.Participants describe needing timely, granular and integrated information on patients, services, risks and resources to keep TB care functioning and effective during disasters. Specific information needs highlighted include more location‑specific information on TB patients and vulnerable groups, as well as near‑real‑time information on health facility functionality and service availability to support adaptive planning and continuity of essential health services during emergencies. However, critical information is often fragmented across siloed, non-interoperable databases, that are not always accessible to the TB program for timely decision-making.CONCLUSIONClimate-related disaster events disrupt TB diagnosis, treatment continuity and success, and increase transmission risk. During crises, data needs, and especially spatial granularity, rise sharply, yet existing health information systems do not provide the information that is needed. Integrating interoperable geospatial platforms within current systems can support mapping displaced patients, monitor facility functionality and accessibility, and align climate risk with TB burden. Further research is needed to define data needs across health-system levels and practical solutions within existing infrastructure.