Clinical Decision-Making and Factors in the Diagnosis and Management of Clinically Diagnosed Tuberculosis

Introduction Tuberculosis (TB) remains a major public health challenge globally and in the Philippines. Despite national and WHO guidelines emphasizing bacteriological confirmation, reliance on Clinically Diagnosed TB (CDTB) remains common. This study aims to explore the factors and decision-making processes among healthcare providers in public and private settings in the Philippines. Methods This qualitative descriptive study explored diagnostic pathways and decision-making processes among healthcare providers in public, private, and public–private mix (PPM) facilities across four sites in the Philippines (Manila, Cavite, Mindoro, and Cagayan de Oro) from April to June 2025. Semi-structured interviews were conducted with 33 healthcare providers. Data were analyzed thematically using Braun and Clarke’s framework, and facilitated by NVivo version 15 software. Results Providers reported several common diagnostic pathways for CDTB. Decisions in diagnosing CDTB were influenced by health system-related barriers, patient-related factors, and facilitating factors. Conclusion Clinical and radiological diagnosis continues to play a significant role in TB care in the country. While CDTB diagnosis has become the pragmatic solution to the various health system gaps and patient barriers, strengthening diagnostic capacity, addressing systemic and patient-related barriers, and supporting providers through training and education are essential to ensure appropriate TB care.