The failure to use isoniazid (INH) preventative therapy (IPT) in HIV-infected individuals in Sub-Saharan Africa represents one of the single biggest implementation gaps between evidence and practice in today's response to the HIV epidemic. The proposed study will evaluate the effectiveness of a multi-component intervention to improve IPT uptake across the country of Uganda. The overall objective of this study is to determine if a multi-component implementation intervention (SPIRIT) that targets District Health Officers (DHOs) can increase IPT initiation and completion among HIV-infected persons, and decrease tuberculosis (TB) incidence, as compared to country standard practices, in a cluster randomized trial in Uganda.