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Correspondence to Jacob Bigio; jacob. bigio@ protonmail. com © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION In countries with a high burden of tuberculosis (TB), private pharmacies are often the first point of care seeking for individuals with TB symptoms, making them ideally placed to assist in the early detection of TB. However, the quality of TB care by pharmacies in lowincome and middleincome countries (LMICs) is often low, with lack of TB knowledge among pharmacy staff, inappropriate sales of antibiotics and antiTB medications, and lack of systems to facilitate referrals for TB testing. Most pharmacies are not linked to national tuberculosis programmes (NTPs) but establishing structured mechanisms for the referral of individuals with presumptive TB from pharmacies to private or NTPassociated facilities for testing could help to identify the estimated 4.1 million individuals who developed TB in 2020 but were not diagnosed and reported to NTPs. Between 2010 and June 2020, the Stop TB Partnership’s TB REACH initiative funded 26 interventions in 15 LMICs which engaged pharmacies to improve TB case detection, with the aim of demonstrating whether they are effective entry points to identify individuals with TB and whether they could subsequently be scaled up and transferred to a sustainable model either by other donor agencies or with monitoring and assistance from NTPs. An analysis of quantitative outcomes of the interventions will be published separately. For this publication, we discussed operational characteristics of the interventions with grantee implementors of 19 of these projects, and with members of the TB REACH initiative involved in providing technical support to the projects (table 1). We summarise the three main themes and operational lessons which emerged from these discussions as follows. The term pharmacy is used here broadly to refer to any provider engaged in the selling of Summary box