<p>Climate change increasingly threatens progress in tuberculosis (TB) control by exacerbating food insecurity, disrupting health systems, and driving population displacement, particularly in resource-constrained settings. Although a growing body of literature links climate stressors to adverse TB outcomes, most existing research remains descriptive and provides limited guidance on how TB programs can adapt service delivery under worsening environmental conditions. This review examines how implementation science can address this evidence-to-practice gap and advance a climate-adaptive TB agenda. Drawing on the recently published World Health Organization’s Climate Change and Tuberculosis Analytical Framework, we synthesize evidence on key climate-related pathways affecting TB vulnerability and highlight persistent gaps in data on the feasibility, acceptability, and effectiveness of adaptive interventions. We describe how implementation science frameworks and methods, including stakeholder-engaged approaches, mixed methods research, and evaluation of implementation outcomes, can guide the design, evaluation, and scale-up of climate-adaptive strategies. We conclude that embedding implementation science within climate–TB research is essential to move beyond documenting climate impacts toward actionable, equitable, and sustainable public health solutions, and to support resilient TB programs in the context of accelerating climate change.</p>