After 40 years of using the same six-month regimen, a landmark study found that the treatment of drug-sensitive tuberculosis (TB) could be reduced to four months by replacing rifampicin with rifapentine and ethambutol with moxifloxacin. For people with TB, shortening the time on treatment by a third means less time away from work or school, a faster return to life without TB, and less healthcare visits and out-of-pocket costs along the way. The World Health Organization (WHO) endorsed the four-month “HPMZ” (isoniazid, rifapentine, moxifloxacin, pyrazinamide) regimen in 2021, but its use has been limited by pill burden, price, and tolerability concerns.

In its prioritization guidance for TB in grant cycle eight (GC8), the Global Fund signaled its willingness to support the use of the four-month regimen in “specific populations where programmatic needs justify the additional costs compared with the standard six-month regimen”. The concurrence of the GC8 application window with the availability of new fixed-dose combination tablets (more on this below) presents National TB Programs (NTPs) with a fresh opportunity to introduce the four-month regimen. 

Here we review barriers to the adoption of the four-month regimen and how they might be addressed and offer a narrative framework communities can use to advocate for the regimen in GC8 and beyond.