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

2. 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

3. 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

4. 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

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

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