To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among three provider settings in a high-incidence county.
A multicenter, retrospective observational study was performed across three sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health tuberculosis clinics (DPH). Patients initiated on TBI treatment age 1 months to 17 years between 2018 to 2020 were included. RBRs were defined as regimens 3HP, 4R and 3HR.
424 patients were included: 51 from AC, 327 from DPH, and 46 from FQHC. RBR usage nearly doubled during the study period (43% in 2018 to 82% in 2020; p<0.001). FQHC had the shortest time to chest X-ray and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared with the FQHC (95% CI: 2.1-7.8). AC and DPH had similar completion rates (73%) and were 2.6 times as likely to complete treatment compared with FQHC (95% CI: 1.4-4.9).
Use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.

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