1. TB infection control and prevention of XDR Group II

2. Barriers I Huge workload of staff prevents them from taking TB infection control as an issue Health workers (including home based carers) are ignored Poor infrastructures and dilapidated facilities. Closed areas and crowded inpatients. TB wards are now integrated into general medical wards. Revisit is needed. Dilemma is how to deal with the subsequent stigma. Improved communication between health worker and patient may help. It might not be a good problem

3. Barriers II Parallel structures (of TB and HIV programs and also those responsible for IC such as the Nursing Departments) Lack of clear guidelines, training and resources for infection control in hospitals Health Workers are reluctant to care for TB patients Lack of information to patients on the risks of/need for TB infection Control

4. Enablers for TB Infection Control Advocacy fro Commitment and Financing Policy Changes and Joint TB/HIV Action Planning/Implementation Capacity Development of Personnel Infrastructural Adjustments to enhance Infection Control Coordination of Joint TB/HIV Plan and Integration of services at Facility levels Efforts to avoid and reduce stigma Identify focal point for infection control

5. Critical national level policy changes Enhanced political commitment and funding Adaptation of global TB IC guidelines Development of a country-specific plan of action for TB IC Reflection of key TB IC elements in programme strategic plans Active engagement of all stakeholders and levels of care

6. Critical activities to assess magnitude of MDR XDR TB Establish presence of MDR XDR TB Disease mapping (extent and geographic spread) Strengthening the infrastructure for diagnosis and management Strengthen infection control measures Establish surveillance system for MDR XDR TB

7. Actions Coordination with National infection control committees wherever they are available (e.g. Malawi) Emphasise the importance of TB IC as one key activity for national TB/HIV coordinating bodies Focus on facilities and have focal point for IC Promote award schemes for best performers in IC (including TB IC) M and E is important (continuous evaluation) Emphasise the importance of TB IC into national IC policies. Joint plan on TB IC with TB, HIV and other stakeholders such as Nursing Divisions and strong national advocacy for their implementation

8. Actions Encourage the use of funding available for TB and HIV to TB IC. National trainings for IC and training manuals Information and education for patients Communication to patients to avoid stigma Triage of patients should be started as early as possible depending on country context. Expand availability of culture facilities and decentralisation. Provision of free MDR treatment and ensuring treatment adherence. Establish minimum standards for IC GLC more proactive in technical assistance to countries GDF to provide backup support for MDR and XDR diagnostic and treatment commodities