In resource-limited settings, national tuberculosis (TB) control programmes are highly dependent on external funds, which may pose a challenge to programme sustainability. There is a recognized need for developing guidance around sustainable programming of current TB control initiatives. The aim of this study was to explore public health practitioners' perspectives on the sustainability of TB control initiatives in Pakistan at the primary health care (PHC) level. Guided by an interpretive epistemology, online in-depth interviews were conducted with 10 public health practitioners who had experience as resource planners in the TB control programme in Pakistan. Thematic content analysis was employed to the textual data as the analytical approach. Three themes were inductively derived from the thematic analysis: community involvement, stakeholder engagement and efficient use of the PHC system. Community involvement was a determinant in sustaining TB control initiatives. This was attributed to the nature of the disease and prevalent health seeking behaviour. Stakeholder engagement was associated with funding arrangements between public and private partners and considered important in how new initiatives can be made part of the routine structure. Overall, having an efficient PHC system was deemed critical in sustaining current TB control initiatives at the PHC level in Pakistan. Fostering an enabling operational environment through regulations, supporting the utilization of existing resources, expanding the network of providers, inclusive planning, increasing spending on research and cost-effective testing are pivotal for sustaining the TB control initiatives.