Discussion group 1 Barriers to implementation of IPT Alasdair Reid THD unit Stop TB department WHO

Introduction Strong evidence base IPT established in global policy WHO policy statement 1998 Interim policy 2004 Minimal implementation in high TB/HIV burden settings Policy in 10/41 highest TB/HIV burden countries Less than 9000 reported on IPT in 2003

Barriers to implementation Consider at different levels External factors Policy environment, governance, political instability, global policy environment Cross cutting policy factors Macroeconomic policy, PRSPs, Legal and social reforms Health policy factors Political commitment, confidence in policy, resource allocation, partner coordination Health system factors Inequity, PPM, infrastructure, supplies, HR,C&T, technology, adherence, M&E Community factors Social mobilisation, INH resistance, stigma Individual factors Socioeconomic, gender, health seeking behaviour, access, knowledge, hu. rights v PH Many as relevant to CPT as IPT

Potential levers to overcome barriers Strengthen evidence base Adopt GRIPP approach Involve policy makers, implementers and users in developing research questions Know the target audience Communicating results Facilitate uptake Improved diagnostics and simplified drug regimens Advocacy messages

Potential levers to overcome barriers (2) TB/HIV collaboration Community involvement and activism Targeted interventions Uptake and adherence Health system strengthening Resource requirements Stigma

Points to consider in prioritisation Which are the most important elements to address Changeable Potential impact