Transcript Feasibility of routine HIV testing for TB patients

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
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