Aim 1: Determine if the SPIRIT intervention increases IPT initiation. The investigators will form 20-24 groups of 4-6 District Health Officers and randomize half to the SPIRIT intervention and half to control (country standard) in a cluster randomized trial. The primary outcome will be the proportion of HIV-infected adults initiating IPT within 12 months of being IPT-eligible in health facilities overseen by DHOs participating in the SPIRIT trial. In all DHO groups the primary outcome will be measured over two years. The investigators will use health information systems already in place to collect data about visits, IPT eligibility and IPT initiation. For secondary outcomes, the investigators will conduct pre-/post-intervention surveys and focus group discussions to assess changes in knowledge, attitudes and practices regarding IPT among the DHOs and front line health workers in intervention and control groups, to assess mechanisms through which the intervention achieves outcomes.