<sec><title>BACKGROUND</title>In February 2022, the U.S. Centers for Disease Control and Prevention (CDC) recommended a 4-month rifapentine-moxifloxacin based regimen (4-HPMZ) for treating drug-susceptible pulmonary TB. We describe 4-HPMZ implementation, treatment outcomes, and regimen tolerability at New York City (NYC) Health Department TB clinics.</sec><sec><title>METHODS</title>A multidisciplinary workgroup developed a 4-HPMZ implementation plan and protocol based on CDC patient eligibility guidance. Treatment outcomes were classified as 'completed' when 4-HPMZ was completed within 5 months or 'discontinued' when 4-HPMZ was stopped due to clinical or programmatic reasons. Adverse events (AEs) included abnormal lab results, or any medication-related concern reported by patients.</sec><sec><title>RESULTS</title>Between April 2022 to December 2023, 617 patients with TB visited NYC Health Department TB clinics; for 4-HPMZ, 333 (54%) were ineligible and 284 (46%) were eligible. Of the eligible patients, 40 (14%) were prescribed 4-HPMZ; of these, 36 initiated 4-HPMZ treatment, 13 (36%) completed treatment, and 23 (64%) discontinued. A total of 15 patients (42%) discontinued due to AEs.</sec><sec><title>CONCLUSION</title>Significant programmatic and clinical challenges were associated with initiation and completion of 4-HPMZ treatment. As a result, few patients completed treatment. Further assessment is needed to identify populations most likely to initiate and complete 4-HPMZ.</sec>.

During 2018–2019, the Ohio Department of Health (ODH) reported three cases of multidrug-resistant tuberculosis (MDR TB)* in persons who worked in two food processing facilities. The National Tuberculosis Molecular Surveillance Center† performed whole genome sequencing of a Mycobacterium tuberculosis isolate from each patient; phylogenetic analysis revealed the isolates were genetically identical. Prompted by concern for MDR TB transmission associated with these workplaces and surrounding communities, ODH began an investigation in February 2019. CDC was invited to assist with the investigation and deployed a team to Ohio on April 14, 2019.