NTEP Modernized Training Strategy

NTEP Modernized Training Strategy

This book talks about the revised modern training strategy that is under development with the support of the iDEFEAT TB project.

The modernized training system would incorporate of modern methods of training material creation, training delivery and monitoring and evaluation of training while including the best practices of traditional methods. It would also incorporate the expanded and continuously evolving training needs of the National TB Elimination Program.

 

 

ManuMathew

The Need to modernize training in NTEP

The Need to modernize training in NTEP

National Tuberculosis (TB) Elimination Program (NTEP) of India is one of the largest public health programs in the world. It has over 30,000 peripheral health institutions providing diagnostic and treatment services in the public sector, with a huge workforce of  Medical Officers, Paramedical staff, Multi Purpose Health Workers, and other frontline health workers. Putting this together with incentivised volunteers and a huge private sector, the quantity and variety of human resources is at a scale that is unparalleled. Trained Human Resource (HR) is critical for ensuring TB patients receive quality diagnostic, treatment and other patient support services.

The program has considerably expanded in the last five years into many new technical areas such as Direct Benefit Transfers and TB Preventive Therapy. There has been a corresponding increase in the amount training is needed. These areas are continuously evolving, with very frequent updates and changes. As a result of this there is a regular need for training, to rapidly disseminate changes and additions in program operations. The current training system primarily consists of 9 printed modules which are delivered in a modular reading fashion; updates over and above these modules are disseminated using guidelines/ other documents. In addition a variety of training material is also created by a multitude of development partners operating in different geographies in specific thematic areas. This material is used for training in the form of formal training, orientation workshops and sensitization meetings. The training status of core NTEP staff is monitored using aggregate reports collected manually from the TU level.

There is a felt need to better organize, increase the pace and efficiency at which program evolution is communicated to the field in the form of training. This revision of the training system should:

  1. Upgrade the current paper based training material to use a combination of electronic multimedia, organizing efforts of many stakeholders into one uniform system of content development.
  2. Use modern methods of knowledge and skills transfer including e-learning and adult learning principles. This would also need to leverage the increased acceptance to electronic modes of training, a change brought about by the COVID19 pandemic.
  3. Have a low effort monitoring system that can be applied across the country.

With these needs in mind NTEP had decided to revise and modernize its training system. The subsequent sections discuss the various components of the system and the various standard processes and guidelines related to them.

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Strategy for Modernizing Training

Strategy for Modernizing Training

The modernized training system has to find strategic ways to address felt needs. The needs described in the previous section can be fit into three themes. These are:

  1. Content Development
  2. Training operations
  3. Monitoring and evaluation of training

 

To address these needs effectively, the Modernized Training system needs to have separate sub-systems and protocols in place for each of them. Thus the Modernized Training Strategy in NTEP would have three pillars, each having a separate, but inter-linked IT enabled sub-systems. These are:

  1. Training content creation: This is first part, where there are systems and processes to create, update and maintain a repository of various training concepts and related standardized training content, along with other documents (guidelines, directives, etc). This would involve an online system called the Knowledge Base. This would be operated by a central team of experts and content creators, who maintain the knowledge base and its contents.
  2. Training Operations: This component is where the actual training is performed using content prepared. It will include processes such as planning and execution of training and certification. It would include an online Learning Management System (LMS) such as Swasth-eGurukul. This would be operated by trainers and trainees from across the country to deliver and receive training.
  3. Monitoring and evaluation of training: This component allows the monitoring of the ongoing training in real-time against the general goal of all human resources related to NTEP are "Trained". This would require the maintenance of training information of all related personnel and generate reports or dashboards to monitor the progress/ current status. This would need an online tool for managing the training information of all personnel, including training history and certifications and a dashboard where data can be visually explored to understand the status of training across the country. This system would also include process of training supervision and evaluation and identifying which personnel requires re- or update training.

 

Modernized Training Strategy

ManuMathew

Pillar 1. Content Creation

Pillar 1. Content Creation

The first component of the modernized training system is the machinery to develop standardized training material that can be used for training all personnel across the country. The material developed needs to be:

  1. standardized (to ensure consistent messaging/ practices) accessible openly in an electronic form
  2. reusable (the same training content can be used for overlapping needs for different cadres) 
  3. easily updatable (to allow easy change of standardized content)

This component will involve a large number of stakeholders ranging from national institutions, technical and programmatic experts, to instructional learning experts and digital media creators. All the stakeholders need to follow uniform processes to interact and produce training material, spanning all of NTEP operations, in a consistent manner, maintaining a high level of quality.

The system of content development will be made of three parts. These are:

  1. Knowledge map: It is a list of ideas that require to be included in training and will encompass all training needs in NTEP. Each item/ idea will detail out the messages/ learning objectives that need to be conveyed.
  2. Page Library: Based on the list of ideas on the knowledge map, training content using different media (Text, images, videos, animation etc) are prepared as Content Pages. Content Pages will also include linked questions based on the various learning objectives. The list of Content Pages are available in the Page Library.
  3. Training Courses: Based on the training need for each cadre the Content Pages are organized in to Courses consisting of modules and chapters along with quizzes (based on questions of each node).

These three different parts are explained in more detail in the subsequent sections.

ManuMathew

Conceptual Framework for Content Creation

Conceptual Framework for Content Creation

The Framework for training content creation has three parts:

Image
Parts of Content Development System

1. The Knowledge Map:

Image
Knowledge Map Concept

The entire universe of ideas/ concepts required for training in NTEP has been visualized as a map or list called the ‘Knowledge map’. The knowledge map will drive the content development of standardized e-training content in a defined structure, help plan, prioritize and achieve parallelization of content development by multiple partners. Each unique idea/unit in the Knowledge Map is called a ‘node’, which serves as a building block to the entire training content development process. 

The knowledge map will enable defining the overall training requirement in NTEP and will drive continuous development of training content. It will also permit multiple partners / agencies to divide the overall training content development requirement and co-ordinate with each other.

Further specifications of the knowledge map and related process are described in a subsequent section.

2. Standardized Training Content Development: 

Based on the entire network of nodes, every node will require standardized training content to be developed. The training content will exist in an e-training platform (currently Swasth eGurukul, or SeG) as ‘pages’. A page is expected to impart training related to that idea/node in 2-3 mins on an average.

Development of pages will include:

  1. Understanding learning objectives and gathering technical material
  2. Designing/ redesigning the instruction/ digital content for each page using various media (Text+/- images, Audio/ Videos, interactive animations etc) based on feedback from the end-users.
  3. framing questions associated to the various learning objectives and adding them along with the page 
  4. translation of select pages according to need/feedback from the end-users

Pages for all the knowledge map nodes, are to be developed and published on the e-training platform and will be available as a “Page Library”.

3. Curriculum Development:

Pages drawn from the Page library will serve as building blocks for designing training curriculum or “Courses”. Any number of Courses can be prepared  by grouping/ structuring the pages from the Page Library in a sequence. The grouping/ selection of various pages and their sequencing will address all varieties of training needs for different cadres.  Pages are organized under chapters in a sequence; chapters are in turn organized under modules and later modules are organized into Courses. Courses will be used to implement training.

 

This model where the training content development is divided into three parts, allows adherence to the initial principles of reusability, standardization and ability to be kept updated. Through the knowledge map there is a comprehensive understanding of the various current knowledge/ training needed in NTEP and becomes a repository of the same. The content in pages is standardized for use across the country. The availability of individual pages allows it to be reused in multiple training courses for different cadres; and allows individual pages to be updated, whereby the courses using these pages can be automatically updated with the latest information  or upgraded into a more engaging and prioritised way.

The Pre-test , intermediate quizzes and post-test also constitute an important component of the course curriculum. These quizzes are composed of selected questions drawn from the question bank generated from the pool of questions linked to each page added to the course.

ManuMathew

1.1 The Knowledge Map

1.1 The Knowledge Map

This section describes the various concepts, principles, roles and processes related to maintaining and updating the knowledge map.

Concepts

  1. KMNodes(knowledge map nodes) :

    A KMnode may be a unique concept, process, idea, definition, algorithm, or any other aspect with a specified learning objective.

  2. Relationships:

The KMnode will have defined relationships with other KMnodes which may further detail or explain the concepts or describe a higher-level concept. 

For example, there will be a node defined for the concept of ‘ZN microscopy’ and it will be related to further nodes such as ‘staining’, ‘smear preparation’ and so on, or link ZN microscopy and Fluorescent microscopy through the overall concept of ‘Microscopy’ in general. Thus, the nodes and their relationship will exist as a network / map where there is no defined hierarchy. The hierarchy will dynamically be identified when a trainee or training need is defined.

The KMnodes have the following attributes:

Table 2: List of Attributes of the KMnode

Attribute

Description

ID

This is a unique identifier for tracking the nodes in the knowledge map database.

Name

Title of the page. This should be able to identify the unit sufficiently and its difference to other pages should be clearly evident.

Description/ Learning Objective

Provides short synopsis of what the content associated with the unit should cover.

Maintainer

Name/ UserName of the expert who is currently responsible for the maintenance of the node and its related training content. The maintainer has to ensure that the node and its content are in line with the principles of the knowledge map and with the current guidelines/ directives.

Relationships

Describes the relationships of the node to other entities. This will include entities such as 

  1. KMnodes (Child/parent or links) 
  2. Training content (link to Page- described below)

The current version of the Knowledge Map can be viewed from the link. The knowledge map here is represented as a list of nodes linked with other units in the knowledge map. 

 

Principles of the knowledge map

  1. Idea/ concept centric- Non audience dependent: The KMnodes and their learning objectives linked to it represent one defined idea/ concept. 

  2. Unique Unit Based:  A learning objective will only be represented in one and only one node. 

  3. Complexity in division: In cases where the concept or topic to be discussed has many aspects, a single node may be used to represent the overall concept in brief, while specific details or in depth concepts may be presented in other nodes.  

  4. Dynamicity, Organic and iterative evolution: The knowledge map is meant to be a dynamic collection of nodes, where new nodes are constantly added with new program areas/ expansion, older nodes updated with changes in program structure and deleted with outdated concepts/ideas being removed. These changes are to be made  in real time as and when the program update/ change happens.

Roles

  1. Maintainer: The maintainer is a person/ expert who is responsible for maintaining the integrity, comprehensiveness and quality of the knowledge map and ensuring adherence to the above described principles. The maintainer may perform additions, modifications, and depreciations(Deletions) of nodes on the knowledge map. There may be many maintainers organized into a committee/ group and may be collectively responsible for the knowledge map. Each maintainer may be assigned a group of nodes to maintain. All nodes will mandatorily need to be assigned to a maintainer. 

  2. Content Creator: Content creators are people who develop training content for each KMnode on the knowledge map. A content creator may be assigned a node to develop content against. However, they only have view permissions on the knowledge map; but may be able to respond to comments made by anyone on the nodes assigned to them. 

  3. Others: The knowledge map being open content, all users(including the above two) may have access to view the entire knowledge map. They may suggest new nodes on the knowledge map and add comments/ suggestions on existing nodes. New nodes will need to be approved by the assigned maintainer before it is published on the knowledge map. Each newly added node will also be assigned to any one of the maintainers. 

Processes

  1. Add new node:
    1. Submit draft node: Any visitor on the knowledge map may suggest addition of a new node. New nodes need to be linked to any one existing “Parent” node and will be first added in a Draft mode. The maintainer of the parent node will be assigned to the new node. The visitor adding the node needs to fill in all the attributes of the nodes mandatorily.
    2. Review by Maintainer: New nodes added in Draft mode will be notified to the Maintainer, who will review the node and will perform the following actions
      1. Approve the new addition after it passes the following checklist. If the node does not pass it; the maintainer may outright reject the draft node or modify the attributes till it passess the checklist.
        1. The name of the node and the learning objective are clear and precise. For example, “Burden” is an unclear title; while “Burden of TB in India” is clear and precise.
        2. There are no other nodes in the knowledge map with overlap/ have duplicate learning objectives with the new node added.
        3. There is a training need that is attributable to the new node. For, example; in NTEP training, “Manufacture of 3FDC” may be considered as out of scope of training.
      2. Assign a different maintainer. The existing maintainer may judge that the node is better dealt with by a different maintainer, he/she may assign it to a different maintainer in the maintainers group.
    3. Publish the node: Approved new nodes get published on the knowledge map.
  2. Update existing node:
    1. Maintainers of the node may update any of its attributes except the unique identifier. All changes to a node will be tracked as different versions of the node. The update may be performed for the reasons such as:
      1. Update in Name/ Learning objective: The update may be triggered by various needs/ events, such as change in policy/ guidelines; any error identified on the learning objective or better understanding of the purpose of the node.
      2. Adding/ changing node relationships: The maintainer may identify new connections with existing nodes on the knowledge map. 
      3. Re-assigning maintainers: The existing maintainer may assign a node to any other maintainer on the maintainers group.
  3. Depreciate existing node: Any existing node may be depreciated when the node/ learning objective becomes outdated or no longer relevant. Such depreciated nodes effectively get removed from the published knowledge map.
  4. Commenting/ Discussions: Any visitor on the knowledge map may comment/ provide suggestions on any of the existing nodes. Comments may be reviewed/ replied to by the node maintainer/ the content creator assigned to that node.
ManuMathew

1.2 Content Development

1.2 Content Development

Concepts

  1. Page:

    A page is a unit of training content that expresses the content related to a KMnode on the Knowledge map. There will be one and only one page of training content for every node in the knowledge map; where the knowledge map node is representing the learning objective, while the page is expressing the corresponding content. The content on each page is based on technical training material / SOPs / guidelines of NTEP and may explain or demonstrate it in more detail. 

    Along with the main page content, some material may be provided as attachments, downloadable and printable job aids and posters that learners can print and put up in their work areas for quick reference/ use. The page content will also reference/cite any source document/ reference material. Each page may also have more than one translated version into another language linked to it. Trainees that use a page may give feedback for individual pages by linking them to the corresponding knowledge node and commenting upon them.

    The page will have the following attributes.

    Content Page ID

    `This is the unique identifier assigned to a page at the time of creation.

    Title

    The page will have the title same as the name of the node linked to it.

    Type

    This is the type of the page that is currently used to develop training content. The page types (A0, A, B, C1, C2, F1, F2) and their descriptions are mentioned in the subsequent section.

    Status of the page

    Used for page development workflow management to track progress of the page from page entry approval, prioritization, development, configuration and publishing on the CTD approved e-learning platform.

  2. Page Types:

    The page may undergo evolution / upgradation with time based on changes in the program or based on need for better content representation. This need may be driven by the nature of the learning objective, which may be easy or difficult to train, and may require static or interactive methods of explanation. To accommodate this evolution of a page, several page “Types” have been defined as follows:

    1. A0: (Text & Images only): All pages are first built with only simple text and images, (base technical content) The text and images will be based on content available in any existing guidelines/ documents/ training content, which is re-organized as per the needs of the knowledge map node against which the page is being developed. This page type is expected to ensure technical accuracy of the training content to be developed and will serve as the basis for any future version of the page. The A0 Page should be useful for training delivered at least in an instructor led mode. Images and graphics that can be created easily using common tools such as Powerpoint may be created in addition to the content available in the existing material.
    2. A1 (Creatively reformatted technical content): Type A0 pages may sometimes need to be redone, to explain the concept in a better way using better graphics/ text. This is done either by changing the way of representation (infographics), or by including examples / cases etc. This would improve the ability of the page to deliver the learning objectives to a level such that the trainee may read and understand the concept without any instructor.  
    3. B  (Text/image with voice over / video inset of presenter): This may be done in cases where the content requires an expert/ teacher's touch where a presenter will explain the concept in his/her own words in alignment with the material that has been prepared earlier in relation to that page. The delivery of the training will rely on the expert's ability to present the content in an easily understandable way. The video/ voice of the expert/ teacher explaining the page content may be recorded and placed on the page.
    4. C1 (Simple Animation) : These are pages with simple animated content, and the user interacts with it only in terms of start, stop/pause and rewind/seek and the animation has a single start and end point. This page type may be used in cases where learning objectives may be delivered better using a schematic/ moving representation of the concept as opposed to other ones. For example, simple workflows involving different locations and people over time.
    5. C2 (Gamified / Interactive animation) : These are pages with many different types of user interactions, such as clicking, drag & drop, text entry and so on. It may have one start point, but may branch out into different scenarios based on user interaction, with many end-points that  may backtrack and re-join at different places. It may also include videos/ narration as needed. This page type may be used when the learning objectives are complex, with decisions/ judgements that need to be made. For example constituting a DR-TB Drug regimen for a given diagnostic scenario.
    6. F (Video Shots): These pages with video shots of actual locations where a procedure or a protocol is demonstrated. The videos may be prepared using Existing footage(Type F1) or may require New footage(Type F2) to be recorded.

    In cases where combinations are used, the higher type of content classifier will be applied, for example, a video recording of an expert with an animation will be classified as Type C1(animation).

  3. Question 

    Based on learning objectives of a page and the training content placed in it, one or more questions may be added/ linked to the page. These will serve to assess whether a trainee has acquired the necessary knowledge/ understanding expected. The questions will usually be of multiple-choice type.

Principles 

The broad principles that have to be followed while developing a page are as follows:

  1. Self contained/ independent: The training content on a page should be self contained and should not be built on the context of content available on any other page or continue from another page. 
  2. Specific to learning objectives: The page should be able to deliver the learning objective without having to refer to another page and should contain only content specific to the learning objective of the knowledge map node linked to the page. There should not be any content included for the purposes of introduction or conclusion.
  3. As simple as possible: It should be possible to use any page for the training of any personnel. Hence the technical content should be explained in simple language as far as possible.
  4. Delivered in 2-3 minutes: It should be possible for the average trainee to consume the training content present on a page in 2-3 minutes.   

Roles

  1. Content Creator: These are personnel that will create content against the Knowledge Map node assigned to them. 
  2. Maintainer: The maintainer for a page is the same as the maintainer for the corresponding knowledge map node. The maintainer reviews and approves pages before it is to be published. He/she also is responsible for deciding the page type to be used while upgrading the page to a higher level page. 
  3. Trainees: All users are by default Trainees. Trainees access the page through one or the other training curriculum. They may provide feedback at the level of a page through the comments on the corresponding linked knowledge map node.

Processes

Note: Upgradation and Modification of a page will be considered as a new version of the same page, with the same unique identifier. Older versions of the page may be available at the back end of the LMS and may be accessed on special demand.

  1. Creation:
    1. The content creator assigned to a knowledge map node will create the corresponding page and its content. He/She may interact with the Maintainer to identify learning objectives, source documents as required and prepare the training content before creating the page. On page creation the status of the page will be “Pending Review”
    2. Pages that are of the status “Pending Review” will be evaluated by the maintainer of the page/ corresponding knowledge map node. The maintainer may approve or reject pages based on whether it clears the following checklist
      1. Alignment of titles- The page title and the corresponding knowledge map node should have the exact same title.
      2. Specificity of content: The page content needs to be specific to the title and the learning objectives of the corresponding linked knowledge map node. It should not convey any message that is or may be represented in another page.
      3. Content independence: The content developed on the page should not be in the context of any other page and it should convey the learning objective completely.
      4. Simplicity: Generally any learned reader should be able to read and understand/ consume the content and its learning objective without additional reference/ reading.
      5. Duration: It should be possible to consume the content by an average reader within approximately three minutes. In exceptional cases it can be longer.
      6. Questions
    3. If the page does not pass the above checklist and is rejected by the maintainer then it will be converted to the stage “Pending Modification”. It will be passed back to the content creator for addressing the comments/ reason for rejection.
    4. The page will also need to be marked as “Pending Modification” once the corresponding KM Node (Title or learning objective) is updated.
  2. Modification: Pages that are with the status “Pending Modification” may be reviewed by the content creator and he/she may make changes as per the requirement/ comments.
  3. Upgradation: A page whose content has not been performing as well as expected and there is a scope to improve the delivery of the learning objectives by using another type of page, it may be tagged for upgradation. Once a page  has been tagged for upgradation it will be available to the content creator in an upgradation queue.
  4. Translation: Certain pages after being built into courses for specific cadres who are less likely to understand English, may be tagged for translation into another regional/ local language. Once it is tagged for translation it will be available to the content creator in the Translation queue.
  5. Deletion: Page deletion only occurs when the corresponding KM node is depreciated. Such deletions may also be available on the LMS backend, but are not available for viewing.
  6. Prioritization: Individual pages depending upon the need to make available the published version it will have a certain priority value. Priority value of 10 means highest priority for content development, while 0 means least or no priority. The content creator may pick up pages from a queue for modification/ translation based on the order of priority. The maintainer of the page has the rights to set the priority of the page. 
ManuMathew

1.3 Curriculum Development

1.3 Curriculum Development

Concepts

  1. Course: A course is an organized sequence of pages which will be used for the training of a  specific cadre. A course should comprehensively cover all training requirements of that cadre. Each course will have pages organized under the Page 🡪 Chapter ---> Module structure. Different courses will have different pages, but they may also use the same page as per the requirement of the course (which is linked with the same knowledge unit or node, and hence based on the same training need). This is depicted in the following schema:

    Fig: Course structure

    Each course will have a number of attributes as outlined below.

    Course ID

    This is the unique identifier assigned to the course at the time of creation.

    Title:

    The course will be named according to the cadre it is intended to train. Eg. Course for Treatment Supporters on NTEP

    Course Description

    This is a short description of the course, which will outline the objectives of the course and the topics covered under it.

    CourseStructure

    The course structure will contain the data regarding the linkage of the various pages organized under chapters/ Modules and the corresponding quizzes at various stages within the course/ Module/Chapter.

    Intended Cadre

    This will indicate the various cadres eligible to take the course.

    Status

    This will indicate the status of the course in terms of whether it is in draft stage/ unpublished or published status. It may also include statuses such as depreciated. 

    CourseMaintainer

    This is the person assigned to this course as the maintainer.

  2. Module: A module is created for a specific knowledge / functional area which is to be covered for a cadre based on the course objectives. A course may have different modules (knowledge areas) with different pages. For example, in the course for a Lab Technician, “ZN microscopy” may be a module. 

    NOTE: Modules may also have independent existence outside a course as well. These may be used for imparting a new knowledge area as a part of new expansion in the program or may be used for re/update training.

  3. Chapter: Chapters will be the topics that are to be covered under knowledge areas (modules). As above, there may be different topics (chapters) under each knowledge area (module). For example, in the module on Microscopy, “staining using ZN technique” may be one of the chapters. Chapters will hold the standardized learning material in the form of pages.
  4. Quiz: Courses will have quizzes at various stages (pre / post at the level of either course, module or chapter). The quizzes are created/ drawn from the questions attached to the pages that are contained within the course/ module/ chapter. The quiz, depending on how it is set up, will randomly draw questions from a set of questions that were associated with the pages. Based on configuration set by the course creator, the learners must pass/ clear the quiz to proceed and eventually complete the course and earn the certificate. The number of questions in an assessment and passing marks for each assessment will be set at the time of configuring the course/ module as per the need of the training. In the future a quiz may also be manually assessed/ scored.
  5. Certificate: Each course / module at the end or at achieving completion of the post-test successfully will have a certificate. The certificate is awarded from NTEP, and / or relevant institutions / stakeholders. A sample certificate has been provided in the Annex.   
  6. Webinar:  a webinar or an online training session would be scheduled inside the course whenever a remote facilitator would interact with the trainees for any particular purpose inside the course. This could be to deliver an instructor led session, conduct discussions or clarify queries. 

Principles

The broad principles to be followed while creating a curriculum/ course are as follows.

  1. One cadre One course- At a time in the training system of NTEP a specific cadre/ designation will only have one active standard course. A course should be comprehensive, such that it allows all necessary content required to successfully execute the TOR/JD of the corresponding cadre. The monitoring of the training status of a trainee will be considered as Trained/ Untrained under his/her cadre based on whether he/she has successfully completed the single course for that cadre. The individual may undergo modules that are independently available outside his/her course and will count as additional credit.
  2. Logical flow in sequencing of content: The training content will have to be placed in a sequence within the course. The pages will be sequenced within a chapter, followed by Chapters into Modules and finally modules into Courses. This sequence depending upon the intended audience/ cadre will have to be selected and ordered to ensure that both the appropriate high level concept is introduced and necessary in depth concepts are also discussed afterwards.
  3. Inbuilt pre/ post test : All courses should have an inbuilt assessment mechanism to objectively identify whether he/she has completed the requirements/ gained all necessary knowledge and skills expected from the course.
  4. Standard schedule: The course may be executed/ operationalized as per the convenience of the institution; however a standard scheduling pattern may be set. 

Roles

  1. Content creator - The content creator(described above) will also double up as the course creator/ curriculum designer. They will select and organize the pages prepared into chapters> modules> Courses in a sequence appropriate to the cadre. The content creator can create the course in unpublished form.
  2. Maintainer - The maintainer may review the draft/ unpublished courses and publish them. They may also unpublish existing courses and send them for revisions to the content creator or depreciate them altogether. 
  3. Operational Roles
    1. Course Coordinator - The course co-ordinator at various states/ STDCs will schedule the various courses according to the plan and training needs of the state and coordinate the conduct of the course
    2. Trainee - The trainee may access the course if he/she is one of the cadres for which the course is listed
    3. Facilitator - Facilitators may access the course when it is scheduled and he/she is added to that schedule as a facilitator.

 

Processes

  1. Create a new course: Once pages are available, a content creator may organize the pages into a course. After the Type A0 page is approved and published on the CTD e-learning platform, it may be included into a course. 
  2. Review and Approval of the course: Once the course is configured, approval from CTD and other stakeholders will be sought. A meeting of relevant stakeholders will be called to discuss feedback and will be documented. Relevant changes will be listed and made by course creator,
  3. Set up the course evaluation: As described in the previous section a course will have pre / post evaluation at the level of either course, module or chapter, randomly drawn from the questions attached to the pages that are contained within. The number of questions in an assessment and passing marks for each assessment will be set as per the need of the training in consultation with the relevant stakeholders.
  4. Configure the course certificate: A certificate for successful completion of the course will be awarded to the participants based on their performance in the course evaluation. The certificate will be designed with appropriate logos of the awarding organizations and will be decided based on consultation with the relevant stakeholders. A sample certificate is provided in the Annex for reference.
  5. Setup the feedback form: two types of feedback for a course will be sought from the facilitators and trainees: 
    1. Performance or retention of knowledge / skills from the course / module.
    2. Qualitative and Quantitative feedback from the end users on various aspects of the course/ module.
  6. Scheduling the course: Generally, once a course is configured, it needs to be scheduled for it to be accessible to trainees. Scheduling a course involves setting the start and end date for the course, adding webinars, contact sessions/ evaluations, adding facilitators, enrolling participants etc. The scheduling is done by the course coordinator based on the training plan.
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Style Guide

Style Guide

The style guide provide reference to what standard styles should be used while developing content. This would ensure uniformity of content appearance and will ensure that the trainee would identify the content as belonging to a whole. The style guide would specify standard content styles that can be applied to online content. This would include

  1. Color Palette
  2. Styles for text
    1. Headings with levels
    2. Bullets and numbering
    3. Quotes
    4. Captions for images, tables and figures
  3. Styles for Tables
  4. Styles for images
    1. Pictures and photographs
    2. Graphics
  5. Styles for videos
  6. Styles for animations
  7. Library of standard graphics
    1. People 
    2. Institutions
    3. Equipment

8. Language Guide

The details of each of the above will be provided subsequently.

ManuMathew

Language Guide

Language Guide

The TB language guide is primarily extracted from the 'Words Matter' document (Second Edition) published by StopTB Partnership in 2022 (https://conf2022.theunion.org/wp-content/uploads/2022/05/stbp_words-mat…). Its use has been envisioned to guide the accommodation of inclusive language for TB training & communication while developing & reviewing course content under the Modernised Training System. Categorized into 'Alternatives', 'To be Carefully Used' and 'Emerging Terms', the guide underlines terms that 'must be replaced or alternatives that are sensitive and inclusive, use of terms that must be re-considered and other emerging terms in TB. 

Alternatives

Use

Replace

Comments

They/them He/him, She/her More inclusive & gender sensitive
Contact Person TB Contact Does not have strong negative connotations but is not person-centered
Person Lost to Follow Up Defaulter Unnecessarily and unfairly places blame on the person receiving treatment
Noncitizen resident or Unauthorized resident/worker Illegal/Alien worker Offensive & isolates their access to TB treatment & care
Person with presumed TB TB Suspect Negative association
TB Prevention & Care or Ending TB TB Control Its continued use is no longer recommended by the World Health Organization (WHO) not people-centered, ignores contributions of communities & people affected by TB, -ve connotations of TB authorities as being in full control of all aspects of prevention, treatment & care
PLHIV/AIDS PLHWA/Person living with HIV AIDS Patient Necessary to reflect the fact that an HIV-positive person may continue to live well and productively for many years
Person Living with HIV/AIDS Innocent Victim The term wrongly implies that people infected in other ways (other than those infected medically or at birth through no fault of their own) are somehow guilty.
Person/s with physical disability physically challenged The term ‘physically challenged’ is deemed inappropriate as it places focus on the identity rather than the person & their barriers

To be carefully used

Use

Use carefully

Comments

Person with presumed TB Presumed Presumptive The term ‘Presumed Presumptive’ places emphasis on the disease and not the person with possible tuberculosis. While, it can be used to describe a stage in the process of diagnosing TB, when discussing an individual, it is best to say a person with presumed TB
Burden   It should be stressed that it is the disease, not the people affected by the disease, that burdens a country, a region or the world
Case Finding/Case Detection   Activity occurs by virtue of action taken by the person experiencing symptoms
People deprived of their liberty Prisoner/Inmate An alternative can be ‘People deprived of their liberty’ (in some contexts it can stigmatize people and can impact perceptions regarding the right to health for all
Compliance, Non-Compliance   Noncompliance unfairly assigns blame to the person receiving treatment when many external factors outside a person’s control may be the cause
Adherent/Nonadherent   Unfairly assigns singular responsibility for treatment completion to the person receiving treatment, when many external factors outside a person’s control
Mobile Worker   Refers to a large category of persons who may cross borders or move within their own country on a usually frequent and short-term basis for a variety of work-related reasons, without changing their primary residence or home base
Bacteriologically +ve/-ve Sputum/Smear Positive/Negative Smear microscopy is no longer recognized as a recommended diagnostic strategy. The preferred term is bacteriologically positive/ negative
Key and Vulnerable Population Risk Groups While the term is used in the epidemiology of TB to describe clinical risk groups when discussing an individual or group, it is best to say key and vulnerable populations .
Person Affected by TB/Person on Treatment/Client Patient/TB Patient Patient/TB Patient ‘clinicalizes’ them and focuses on the treatment process rather than the person
Emerging Terms

Terms

Definition

COVID-19 An infectious disease caused by the SARS-CoV-2 virus. COVID-19 was first reported to the WHO on 31 December 2019
Bi-Directional Testing The delivery of simultaneous diagnostic testing for more than one disease
COVID-19 Response Mechanism (C19RM) A special initiative of the Global Fund to Fight AIDS, TB and Malaria to provide countries with additional funding to respond to COVID-19 to mitigate its impact on HIV, TB and malaria programs and to initiate and strengthen improvements in health and community systems
awele.thurr@th…

Pillar 2: Training Operations

Pillar 2: Training Operations

The standardized training content and the curriculum developed in pillar 1 of the Modernized Training System are finally hosted on an online Learning Management System (LMS). This system serves as a platform for scheduling and execution of training. Various stakeholders such as training coordinators, facilitators and trainees interact with each other to manage and complete the above training process.

The training operation component of the modernized training system details out how the training should be conducted using the LMS and provides tools and methods for the end-to-end execution. This section is described further under these headings.

Training may either be conducted virtually or in-Person. The various training modalities could be:

  1. Instructor-led learning - The trainer, using the standardized content available, explains the concepts mentioned therein. They will emphasize the necessary aspects and may demonstrate the processes/ equipment. 

  2. Self-learning - Trainees using the standardized content may read/ consume it and learn the related concept. 

Blended training - In the modernized training, a mix of the above two training methods and a combination of virtual and in-person modalities will be used to complete the training of a trainee. This would leverage the best of virtual/ in-person and instructor-led and self-learning. This would also include demonstrations/ practical exercises. Sessions which require hands-on training will be conducted only in a physical setting. For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each chapter. An instructor-led session may be conducted for each module. This will help the trainees for better clarification of contents and to address the queries and doubts of the training participants.

The training operations have been elaborated further under the following heads:

  1. Role and Responsibilities of key Stakeholders

  2. Learning Management System 

  3. Training Planning (by STDC)
  4. Conducting the Training for each planned batch 
  5. The Planning tool
  6. Training Prerequisites
  7. Training Monitoring
  8. Annexures
Abhimanyu

2.1 Role and Responsibilities of key Stakeholders

2.1 Role and Responsibilities of key Stakeholders

Roles and responsibilities of Key Institutions are as following:

Sr

Institution

Activity

1

State TB Office (STO)

  • Administrative Leadership
  • Monitoring progress

2

State TB Training & Demonstration Center (STDC)

  • Update, review and monitor the training database in real time for the state.
  • Prepare the training plan and secure necessary resources for the execution of training
  • Coordinate with Central TB Division, National Institutes and relevant partners working in the area of training 
  • Scheduling and sending invitations to trainees
  • Logistics Management for trainings
  • Tracking and reporting on Training progress including the pre and post assessment 
  • Manage the trainings which are conducted at STDC (specified in the cadre-wise trainers guide)
  • Oversee the Quality of trainings conducted in the state at District and sub-district levels
  • Coordinate with the National Institutes for building the trainer resource pool and training of specific cadres at National Level (specified in the cadre-wise trainers guide).
  • Conduct quality assurance of the training and review user feedback.

3

District TB Office

  • Update, review and monitor the training database in real time for the district.

  • Coordinate with the STDC (Training coordinator) for Identifying trainees that require training or retraining.

  • Ensure that the trainees attend the trainings as per the schedule

  • Execute training for specific cadres (specified in the cadre-wise trainers guide) 

  • Provide local level facilitation when local groups or in-person training is being conducted in the district

Roles and responsibilities of Key Personnel are as following:

Sr

Personnel

Activity

1

Training Coordinator (STDC)

  • Planning the trainings across all Cadres in close coordination and guidance from the State TB Cell and STDC
  • Collecting and maintaining Training databases of all the staff of the state/ trainees, facilitators and training resources
  • Identifying and assigning the facilitators and resources for the execution of training (training location, etc)
  • Prepare Training Batches
  • Scheduling the course in LMS
  • Admitting the trainees into the Course
  • Scheduling Webinars/ Q&A Sessions for the trainees.
  • Training Monitoring 
  • Make changes in the schedule of ongoing training (if required) and keep all the relevant stakeholders informed (Trainers)

2

Master Trainer - For designated cadres

  • Identify the Trainers in coordination with STDC/ STC 
  • Provide training to the Trainers
  • Participate in select training conducted in the state
  • Quality assurance and Monitoring of Training Quality in the State 

3

Trainer - For designated cadres

  • Coordinate with the STDC to get Trained as a trainer and get update-training as and when necessary.
  • Coordinate with the STDC training coordinator to get assigned to various trainings conducted in the state
  • Conduct the training as scheduled and act as a faculty the virtual / in-person Trainings of the heath staff
  • Demonstration of the processes, equipment and lead the field visits as required for the trainings

4

Program Managers (STO, DTO,)

Competency assessment and assign staff for re-training

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2.2 Learning Management System

2.2 Learning Management System

Learning Management System (LMS) is an IT Application which can be accessed via a computer or mobile device. Swasth-eGurukul is a LMS created by ‘World Health Organisation’ (www.swasth-egurukul.in). LMS enables effective management of large-scale training programs involving a large number of trainers and trainees. LMS could aid in the following activities. The key User roles in LMS are:

Sr.

User Role

Description

1

Course Coordinator

  • Schedule a Course and its components
  • Assign the Trainer
  • Admit Trainees
  • Scheduling the Webinar
  • Monitoring the Trainings

2

Trainer

  • A Trainer would be assigned to specific courses, modules or webinars
  • The trainer would be able to access the content related to it. 
  • Administering/delivering the course
  • Trainer will be the Host of the Zoom meeting used for conducting the Webinar

3

Trainee

  • Trainee will register themselves on LMS
  • For scheduled courses the Trainees need to register. As the Course Coordinator admits, the trainee will get enrolled and access the course content
  • Trainees can access the training content, attempt assessments and obtain certificates.
  • Trainees can access their training records such as - courses enrolled, completed, assessment scores, certificates received etc.

Abhimanyu

2.3 Training Planning (by STDC)

2.3 Training Planning (by STDC)
  • Budgeting, PIP, Training calendar, infra
  • States will have to have a designated a Course Coordinator at the STDC

This section is being elaborated. Please check back later for details.

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2.4 Conducting the Training for each planned batch

2.4 Conducting the Training for each planned batch

Following is a set of activities which need to be taken up by the various stakeholders to plan and execute the training:

Sr.

Activity

Activity Type

To be done by

To be done when

Remarks

1

Collect information about trainees 

Once per batch

Course Coordinator

Planning stage

Use format provided in Planning Tool

To coordinate with DTOs

2

Identification of resources required for training 

Once per batch

Course Coordinator

Planning stage

Training location, stay, food etc. to be identified in close coordination with STDC/ STC/ Districts

3

Batch Creation 

Once per batch

Course Coordinator

Planning stage

Use format provided in planning tool to create batches and assign trainees

4

Scheduling the Course

Once per batch

Course Coordinator

Planning stage

Course coordinator needs to schedule the course as per the sanctioned/approved training plan/calendar. The necessary events in the training schedule(Webinar, virtual sessions, in-person sessions, demonstrations, training evaluations) should be decided at this stage.

5

Communication/ Invitation to Trainees

Once per batch

STDC/DTO

When the training is scheduled on the LMS

STDC/STC can direct the DTOs/incharge to relieve the trainees for the training 

6

Registration of Trainees on LMS 

Once for each trainee

Trainee

Before any training on LMS

The trainees should register on LMS and fill in the necessary details. The trainees who’ve already registered can use their existing login credentials for enrollment. 

7

Enrollment of Trainees for the Course

Once for each course

Trainee

Once a course is scheduled on LMS

The trainees need to enroll for the course that has been scheduled on LMS

8

Admitting Trainees to the Course

Once a day/ on Need basis

Course coordinator

Before training starts

The course coordinators may admit the trainees 

9

Pre-Test

Once per course

Trainee

Before Training starts

The trainees should complete the Pre-test before starting the training. 

10

Training Delivery

Once per course

Trainer

During Training

The trainer/ facilitator should deliver the training as described in Chapter wise trainer’s guide. 

11

Post- Test

Once per course 

Trainee

After Training

The trainees should complete the post-test at the end of training.Passing of the post-test is mandatory for the successful completion of the training

12

Certification

Once per course

Trainee

After Training

Based on the performance of the trainee in the interim quizzes and post-test, a certificate is generated for the course 

13

Analysis and Reporting

Once per batch

Course coordinator

Within 1 week of end of training

 
Abhimanyu

2.5 The Planning tool

2.5 The Planning tool

 

The excel based Planning tool (Ref: Annexure) will be used primarily for the following activities:

Sr.

Activity

Sheet Name

1

Collection of Trainee information (Name, Designation, District/TU/PHI, phone no, email ID, LMS details etc.

Trainee Database

2

Create Batches as per the resources available - specify no. of Trainees, training location, training dates, mode of training and Trainers’ details

Training Batch

3

Assign Trainees to the various Batches

Trainee Database

The Training Planning Tool can be downloaded from this link: 

 

Abhimanyu

2.6 Training Prerequisites

2.6 Training Prerequisites

For ensuring seamless and effective training, the trainers and trainees need to ensure that they adhere to the following prerequisites. This section lists down the prerequisites for the trainer and trainee for conducting the training.

  1. Trainer
    • Attend and complete the Training of Trainers (TOT) for the Course
    • Register as a trainer for the course in NTEP/ STDC (in Swasth-eGurukul).
    • Thorough with the latest version of the Trainers’ guide available online. 
    • Well-acquainted with the training processes to be followed for conducting training in Swasth - eGurukul. 
    • Have access to the Course on Swasth-eGurukul
    • Have access to the participant list and the schedule of training on Swasth-eGurukul
    • Ensure that the necessary arrangements for demonstration are in place (such as equipment, NTEP physical forms, Login credentials of Nikshay/ Nikshay Aushadhi, etc.)
    • Have access to a computer or Laptop and good internet connection
  2. Trainee 

    • Have access to a device (laptop, Tablet or Mobile) with good internet connection. 
    • Register on Swasth-eGurukul as a trainee. 
    • Enrol for the course (once the Course has been scheduled)
    • Attempted the Pre-Test before the training

Abhimanyu

2.7 Training Monitoring

2.7 Training Monitoring

To successfully conduct training at a large scale, close monitoring is critical and LMS enables the administrators to track the progress. As the trainees across the country register themselves in the portal, LMS would eventually have the database of the trainees trained in NTEP. Since training would be a continuous activity, this database would be updated as and when training is conducted. As the trainees would need to register for courses and go through the content and assessments using LMS, the system would know trainee wise - course wise - training status including the dates of the training and their performances in various assessments. This information would help the Program Managers in planning the refresher training. Analysis of the assessment scores would help the Program Managers understand the training needs of the staff. Based on the analysis, focussed training sessions on specific topics (which are less understood) could be conducted. 

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Annexures

Annexures

The list of the annexures is available here. The different items may be accessed by clicking on the individual items.    
 

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Trainers' Guide for Pharmacists (SDS & DDS)

Trainers' Guide for Pharmacists (SDS & DDS)
Introduction


The purpose of this document is to provide the course coordinators and trainers for the “Course for Pharmacists and storekeepers in NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

  • State Drug Stores Pharmacists cum storekeepers
  • District Drug Stores Pharmacists

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State Office may decide to choose the approach which is most suitable for their State. 


For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each chapter. An instructor-led session will also be conducted for each module. This will help the trainees for better clarification of contents and to address the queries and doubts of the training participants.


For the training areas which require handholding of trainees like demonstration of processes- like filling of forms, verification of supplies, stacking, etc. in-person training sessions need to be conducted.

Training curriculum / Agenda

Sr.

Module 

Chapters

Training Modality

Duration

(Hrs)

1

Basics of TB and NTEP

  1. TB & TB Epidemiology
  2. NTEP
  3. Diagnostic Technologies
  4. Approaches to TB Case Finding
  5. TB Case Finding in NTEP

Virtual

3 hrs

2

TB Treatment

  1. General concepts in TB Treatment
  2. DS-TB Treatment and care
  3. DR-TB Treatment and care
  4. Shorter Oral Bedaquiline containing MDR/RR-TB Regimen
  5. Longer Oral M/XDR-TB Regimen
  6. Isoniazid (H) Mono/Poly DR-TB Regimen
  7. TB Infection treatment and care
  8. Newer anti-TB Drugs in NTEP
  9. TB-Comorbidities and special situations
  10. General Concepts in Adherence Management

Virtual

3 hrs

3

General concepts and Principles of SCM in NTEP

  1. Key Concepts and Principles in SCM
  2. Drugs and consumables in NTEP
  3. Stores in NTEP
  4. Patient-wise Boxes
  5. Information Systems in NTEP SCM
  6. Roles and responsibilities in SCM

Virtual

3 hrs

(Includes 1 hr of Demonstration)

4

Inventory Management in NTEP

  1. Overview of Inventory management in NTEP
  2. Indenting and receipt
  3. Issue and consumption
  4. Reporting of Stocks
  5. Expiry Management
  6. Stocking NTEP drugs in Private sector

Physical

6 hrs

(Includes 3 hrs of Demonstration)

5

Procurement in NTEP

  1. Key concepts in Procurement
  2. Procurement Processes
  3. Government e-Marketplace [GeM]

Physical

2 hrs

(Includes 1 hr of Demonstration)

6

Logistics and Distribution of Drugs and consumables

  1. Flow of Supplies
  2. Packaging 
  3. Return and Reconstitution
  4. Transportation

Physical

4 hrs

(Includes 2 hr of Demonstration)

7

Supervision, Monitoring and Evaluation and QA

  1. Quality Assurance of Drugs
  2. Monitoring of sub-stores
  3. Store Visits
  4. Physical Verification
  5. Evaluation of Stores and Stocks

Physical

3 hrs

(Includes 2 hr of Demonstration)

Trainers 


For this course, following personnel may be appointed as the trainers

  • SDS Pharmacists
  • DDS Pharmacists (select)
  • DTO (select)
  • MO - STDC 
  • MO - STC
  • WHO-consultants


    Eligibility - 


    Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about Supply Chain Management and related processes in NTEP. The Trainers should have completed the ‘Course for Pharmacists’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System), Nikshay and Nikshay Aushadhi. The Trainers need to go through the Chapter- wise Training Guide for this Course.

    The training of pharmacists of District and TU level to be conducted at state level.


    It is recommended that the trainers are appointed from all regions of the State, so that subsequent refresher training can be conducted locally by these trainers.

Chapter wise detailed instructions for Trainers


The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

  • Module-wise and Chapter-wise, modality that may be adopted ( virtual/ Physical/ In-person)
  • The estimated time to complete the content
  • The key messages that a trainer should emphasise upon, while delivering the training
  • The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

 

Module 1: Basics of TB and NTEP                                                 Virtual Session (90 min)

 

Chapter 1.1

TB & TB Epidemiology

Virtual Session (26 min)

 

Emphasis Points

 

 

Post Session Activity

  • The participants may be asked to raise their doubts/questions. 
  • The participants may be asked to unmute themselves and may be asked to enumerate the various determinants of TB, difference between TB Infection and TB Disease etc.

 

Chapter 1.2

NTEP

Virtual Session (34 min)

 

Emphasis Points

  • Different institutions may be explained and discussed with respect to its coverage geographically, its organogram, the functions that particular institution is carrying out.

 

Post Session Activity

  • The institution from which participants have come may be explained in detail and its relationship with other institutions. (e.g. District level functionaries may be asked about their relation with the state level and TU level institutions)
  • The stages in TB patient’s care cycle may be elaborated as a story with special emphasis on long term post-treatment follow-up

 

Chapter 1.3

Diagnostic Technologies

Virtual Session (16 min)

 

Emphasis Points

  • Names of different tests, their significance in Diagnostic algorithm

 

Post Session Activity

  • The consumables required for different diagnostic technologies may also be mentioned here briefly to make it more relevant for the trainees

 

Chapter 1.4

Approaches to TB Case Finding

Virtual Session (6 min)

 

Emphasis Points

  • The three approaches may be discussed by giving suitable egs to fit into the three scenarios
  • The different case definition may be mentioned.

 

Post Session Activity

  • The participants may be given the scenarios like visit to HIV Clinic, ANC Clinic, Covid clinic, OPD visit to a tertiary hospital, etc

 

Module 2

 TB Treatment

Virtual Session (203 min)

 

Chapter 7.1

General concepts in TB Treatment

Virtual Session (45 min)

 

Emphasis Points

  • The other formats like Tb Treatment Card and NTEP ID card may also be shown and the different fields along with the significance may be discussed
  • The transfer of patients on Ni-kshay also demonstrated and the impact of this transfer on the patients on the trainees may be asked first and discussed in detail
  • The importance of monitoring the transfer of the patient should also be explained

 

Post Session Activity

  • The FDCs may be shown to the trainees over camera, (Various regimens and packaging should also be shown to them on their physical visits for training)
  • The wrongly filled treatment cards may also be shown and discussed.

 

Chapter 2.2

DS-TB Treatment and care

Virtual Session (10 min)

 

Emphasis Points

  • Explain the basis of categorization of regimen i.e. age and weigt
  • Explain the significance of weight measurement of patient on every follow-up visit
  • Explain the importance of weight change and changes in regimen required.
  • The weight bands may be explained and subsequent increase in dosage required.
  • The importance should be given on the fact that weight change of the patient requires change in drug dosages and hence the practice of one time dispensation of medicines for the complete course or the complete phase should be discouraged
  • The ADRs due to DS-TB treatment may be explained and when should one seek medical attention. It should be explained to the participants that not each patient will develop ADRs and tolerance develops for the drugs with due course of treatment and when should patient seek medical care.

 

Post Session Activity

  • The participants may be asked to enumerate the ADRs and when to seek medical care
  • Some participants may also be asked – how to counsel the patient about the ADRs 

 

Chapter 2.3

DR-TB Treatment and care

Virtual Session (20 min)

 

Emphasis Points

  • The meaning of DR-TB should be explained emphasizing on the fact that that once a patient develops DR-TB, he’ll be transmitting the DR-TB to the community. 
  • The different factors that lead to development of drug resistance should be explained. The role of incomplete and inadequate treatment should be emphasized connecting it to the importance of monthly follow-up and weight monitoring. It should again be emphasized that the practice of one-time dispensation of DS-TB drug to be discouraged.
  • The different types of drug resistance may be explained with the different regimens available.
  • The need for creation of different PWBs should be explained here.
  • The MERM and its importance should be explained.

 

Post Session Activity

 

 

Chapter 2.4

Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen

Virtual Session (14 min)

 

Emphasis Points

  • The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained.
  • The action to be followed after ADRs identification, whom to contact need to be explained.

 

Post Session Activity

  • The regimen may be shown to the participants- over the camera
  • The composition of regimen and duration may be asked

 

Chapter 2.5

Longer Oral M/XDR-TB Regimen

Virtual Session (10 min)

 

Emphasis Points

  • The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained.
  • The action to be followed after ADRs identification, whom to contact need to be explained.

 

Post Session Activity

  • The regimen may be shown to the participants- over the camera
  • The composition of regimen and duration may be asked

 

Chapter 2.6

Isoniazid (H) Mono/Poly DR-TB Regimen

Virtual Session (5 min)

 

Emphasis Points

  • The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained.
  • The action to be followed after ADRs identification, whom to contact need to be explained.

 

Post Session Activity

  • The regimen may be shown to the participants- over the camera
  • The composition of regimen and duration may be asked

 

Chapter 2.7

TB Infection treatment and care

Virtual Session (14 min)

 

Emphasis Points

  • The TB infection may be explained here. The different tests available for TB infection testing may be mentioned here. 
  • The two regimens should be explained.

 

Post Session Activity

  • The regimen may be shown to the participants- over the camera.
  • The composition of regimen and duration may be asked.

 

Chapter 2.8

TB-Comorbidities and special situations

Virtual Session (26 min)

 

Emphasis Points

  • Various Comorbidities and special situations like Pregnancy and lactation may be enlisted. The significance and impact of having these comorbidities to a TB patient should be explained.
  • Bidirectional screening and its importance for HIV, Diabetes, COVID should be explained.

 

Post Session Activity

  • The details of the facilities for alcohol cessation and tobacco cessation may be shared with the participants.

 

Chapter 2.9

General Concepts in Adherence Management

Virtual Session (48 min)

 

Emphasis Points

  • What is adherence, importance of adherence, their role in adherence management, different ways of recording adherence- 3 ways(on Treatment Card by TS/STS, Self-reporting (99DOTS, MERM, TB Arogya Sathi), in Ni-kshay by TS, STS), 
  • How to assign TS and role of TS

 

Post Session Activity

  • Demonstration of the following at the end of the session:
  1. TB Arogya Sathi app and adherence recording
  2. Ni-kshay and adherence recording

 

Module 3: General concepts and Principles of SCM in NTEP             Virtual Session (114 min)

Chapter 3.1

Key Concepts and Principles in SCM

Virtual Session (33 min)

 

Emphasis Points

  • Explain the flow of supplies through different tiers in SCM
  • various types of drugs with emphasis on Minimum & Maximum stock, Buffer stock and its significance. May be explained by giving suitable examples from the local context and stories.
  • Situational examples and past experiences to be shared, explain the various stocks like lost in transit, quarantine, substandard etc.
  • The drug distribution flow and Stock types may be explained through a storyline (i.e. Some quantity of stock was transferred to State- in the transit some got damaged, some was quarantined for testing, and so on
  • Identification of short expiry drugs and broad principles of management of Short expiry drugs. Outline the principle of FEFO and its scenario-based usage
  • Indicating the various stocking points along with the purpose of respective stores.

 

Post Session Activity

  • The participants may be asked about the significance of SCM in their own words to check their understanding and their role clearly in the SCM
  • To ask what will happen if SCM is not maintained efficiently
  • Situational based examples for different types of stocks may be asked 

 

Chapter 3.2

Drugs and consumables in NTEP

Virtual Session (14 min)

 

Emphasis Points

  • The different drugs and consumables handled by different stores may be shown over the camera or the images of the commodities may be flashed
  • These supplies should be arranged beforehand by the trainer and should be present on the demonstration table
  • The lab consumables handled by the respective store (by the trainees) and the importance of maintaining the efficient supplies of lab consumables
  • The consequences of poor SCM of lab consumables should also be explained

 

Post Session Activity

  • Different Drugs and consumables may be shown over camera/physically
  • The participants may be asked to identify the different supplies by asking them to unmute themselves
  • Various registers and forms may also be displayed and brief intro about it may also be mentioned.

 

Chapter 3.3

Stores in NTEP

Virtual Session (14 min)

 

Emphasis Points

  • Different stores at State, district, TB, PHI may be explained ( Covering its geographical coverage, the infrastructure requirements, HRs posted there and the functions carried out by the respective stores.

 

Post Session Activity

  • The trainees may be asked about the existing gaps in stores with respect to stores infra, and the gaps in functioning of stores which are under their jurisdiction

 

Chapter 3.4

Patient-wise Boxes

Virtual Session (29 min)

 

Emphasis Points

 

 

Post Session Activity

 

 

Chapter 3.5

Information Systems in NTEP SCM

Virtual Session (10 min)

 

Emphasis Points

  • Ni-kshay Aushadhi and its significance,
  • Detailed discussion on the Dashboard and various reports available in the Ni-kshay Aushadhi

 

Post Session Activity

  • Demonstration of the demo version of the portal and the navigation through it to discuss the different dashboard and its significance, generation of different reports
  • Data to be fetched from Dashboard / various reports of Ni-kshay  to be shown and participants may be asked to give their observation

 

Chapter 3.6

Roles and responsibilities in SCM

Virtual Session (14 min)

 

Emphasis Points

  • Explain the roles and responsibilities of different HR involved associating it with the functions of the stores
  • Explain the importance and role of Pharmacists in NTEP emphasis on SCM, stock-keeping, and expiry management and use of Ni-kshay Aushadhi

 

Post Session Activity

  • Some of the participants may be asked to enumerate the roles of the position they are holding

 

Module 4: Inventory Management in NTEP                      Physical Session (125 min)

Chapter 4.1

Overview of Inventory management in NTEP

Physical Session (8 min)

 

Emphasis Points

  • Explain about the concept and the significance of it. discuss the process involved therein and significance of each step and also associate it with their role (trainees role in inventory management)
    discuss the different stocking norms at different levels and importance of it (norms at a particular level and why)

 

Post Session Activity

  • Different scenarios from daily life may asked to shared
  • Essentials for Robust Supply Chain
  • Situational questions may be asked to participants

 

Chapter 4.2

Indenting and receipt

Physical Session (24 min)

 

Emphasis Points

  • Types of method to be explained (Quarterly/ ADR along with its significance
  • The different process involved in Indenting of supplies should be explained in detail giving example of drugs or any other supplies.
  • Various sources of receipt to be indicated along with the purpose of them
  • Steps to be followed physically to be explained 
  • The storytelling methodology may be adopted - where to request supply, supplies come from where, what to do in receipt of supplies and how to record the process in Nikshay Aushadhi
  • Step wise procedure in Ni-kshay Aushadhi for receipt to be shown

 

Post Session Activity

  • Demonstration of the indenting in Ni-kshay Aushadhi, The processes of requesting supplies in Ni-kshay Aushadhi.
    The recording of receipt of supplies from different stores should be demonstrated in Ni-kshay Aushadhi.
  • After the Module all the process should be demonstrated to the participants on live supplies- like checking for documents, inspection, check for damaged stocks, acknowledgement , followed by documenting in Ni-kshay Aushadhi (recording and reporting) for the said supplies.

 

Chapter 4.3

Issue and consumption

Physical Session (48 min)

 

Emphasis Points

  • Various sources to explained 
  • Essential steps  required to be taken up by the Pharmacist upon the issue of
  • Various methods for issue of drugs to be explained, with emphasis on the scenarios where these methods to be used

 

Post Session Activity

  • Demonstration of the issuing of supplies in Ni-kshay Aushadhi, The processes of issuing supplies in Ni-kshay Aushadhi.
  • The recording of issue of supplies to different stores should be demonstrated in Ni-kshay Aushadhi.
  • After the Module all the process should be demonstrated to the participants on live supplies- like checking for documents, inspection, check for damaged stocks, acknowledgement, followed by documenting in Ni-kshay Aushadhi (recording and reporting) for the said supplies. The same demonstrations to be made for issue of supplies as well.
  • The drug dispensation module may be demonstrated to the participants (in real-time while dispensing the medicines to the patient at the PHI)

 

Chapter 4.4

Reporting of Stocks

Physical Session (13 min)

 

Emphasis Points

  • Importance of forecasting and follow-up actions following forecasting.
  • Data for forecasting to be discussed with focus on the which data and from which date to be considered 
  • the need of forecasting may also be emphasized by giving the national perspective like that will happen if forecasting goes wrong and how to different levels forecast the supplies of different commodities and the factors affecting it.

 

Post Session Activity

  • Explain the participant about the consequences of not forecasting and doing it incorrectly. The participants should have clarity about the process and their role in making the process efficient
  • Hypothetically situation (excess stock, shortage and short expiry) to be created and data of stock, expiry, consumption to be given and participant may be asked to forecast the requirement for 12moths. 

 

Chapter 4.5

Expiry Management

Physical Session (19 min)

 

Emphasis Points

  • The end to end process- like what's expiry, how to identify expiry supplies, shelf-life of different supplies, forecasting of expiry drugs, reporting it and the follow-up actions to forecasting of expiry drugs including the scientific disposal of expiry drugs may be explained.

 

Post Session Activity

  • the participants may be asked to enumerate the different steps and the consequences if any of the step is not done efficiently.
  • Demonstration of whole process in Nikshay Aushadhi

 

Chapter 4.6

Stocking NTEP drugs in Private sector

Physical Session (13 min)

 

Emphasis Points

  • Importance of stocking drugs in private sector to be explained

 

Post Session Activity

  • Participants may be sked to share their methods currently being sued for stocking and recording of drugs in private sector

 

Module 5: Procurement in NTEP                                                     Physical Session (39 min)

Chapter 5.1

Key concepts in Procurement

Physical Session (13 min)

 

Emphasis Points

  • Procurement – Goods, Works and Services
  • Types of Procurement

 

Post Session Activity

  • Participants to be asked to explain procurement of goods, works and services with examples 
  • clearly set out the differences between them 

 

Chapter 5.2

Procurement Processes

Physical Session (8 min)

 

Emphasis Points

  • Type and Process of procurement to be explained 

 

Post Session Activity

  • Following the types of procurements (direct, tender, single source / sole etc, situation to be provided and participants may be asked which process to be followed and also asked to indicate the process from end to end.

 

Chapter 5.3

Government e-Marketplace [GeM]

Physical Session (18 min)

 

Emphasis Points

  • the GeM, its significance and the processes involved

 

Post Session Activity

  • Demonstration of GeM and the different processes involved for the supplies at the participants level if any.
  • Participants may be asked to explain upon the methods of evaluation, custom bids, various different options available under the GEM

 

Module 6: Logistics and Distribution of Drugs and consumables 

Physical Session (89 min)

 

Chapter 6.1

Flow of Supplies

Physical Session (23 min)

 

Emphasis Points

  • Explain the difference in flow of DS-TB drugs and flow of DR-TB Drugs, flow of Bdq and Dlm need to be explained separately. Flow of supplies of CBNAAT cartridges and Truenat chips may be explained in state-specific context.

 

Post Session Activity

  • The participants may be asked to discuss the issues they are facing in the supplies and solutions may be suggested.

 

Chapter 6.2

Packaging

Physical Session (35 min)

 

Emphasis Points

  • The importance of packaging, specifications, labelling requirement, packaging instructions, preparation of PWB for different regimens and its recording in Nikshay Aushadhi should come out clearly. 

 

Post Session Activity

  • The different PWBs (physically) may be shown to the participants along with the constituents (with attention on the details of specification of boxes, labelling of boxes).
  • The recording of the whole process in Nikshay Aushadhi (PWB prep in real-time may also be demonstrated)

 

Chapter 6.3

Return and Reconstitution

Physical Session (18 min)

 

Emphasis Points

  • The overview of the process and importance of it.

 

Post Session Activity

  • Participants may be asked about the circumstances when return and reconstitution is carried out
  • Demonstrate the entire process in Nikshay Aushadhi
  • Situational Questions may be asked about Bdq and Dlm return and reconstitution.( Eg 10 Bdq tablets need to be returned- the process of return and reconstitution may be discussed)
  • Some participants may share their experiences with respect to this process, the challenges they have faced and solutions may be suggested.

 

Chapter 6.4

Transportation

Physical Session (13 min)

 

Emphasis Points

 

 

Post Session Activity

  • The transportation facility available at the store may be demonstrated and the best practices may be discussed with the participants

 

Module 7

Supervision, Monitoring and Evaluation and QA

Physical Session (76 min)

 

Chapter 7.1

Quality Assurance of Drugs

Physical Session (33 min)

 

Emphasis Points

  •  Type of Quality Assurance (Pre Dispatch / Post dispatch)
  • Step to be followed for collection of sample for testing and in case of repeat testing
  • Explain the process of recording the sample collection in Ni-kshay Aushadhi

 

Post Session Activity

  • The drug collection process for testing may be demonstrated to the participants. ( One batch of any drug and take out 10 strips for testing and packing. The remaining drugs need to be put in quarantine. 
  • Demo on Ni-kshay Aushadhi  to record the transaction

 

Chapter 7.2

Monitoring of sub-stores

Physical Session (10 min)

 

Emphasis Points

  • Explain the significance of Monitoring and why it is reuired
  • Different types of Monitoring methods to be explained with examples 

 

Post Session Activity

  • Different groups may be formed, and the groups may be asked to do analysis of the reports, performance of sub-stores through Nikshay Aushadhi. 
  • The sample reports will be provided by the facilitator. The reports prepared may be reviewed jointly and follow-up actions may be discussed.

 

Chapter 7.3

Store Visits and Physical Verification

Physical Session (15 min)

 

Emphasis Points

  • Key points to be considered while visiting a store
  • Post Visit, what steps to be taken
  • What steps to be followed for conducting Physical verification and at what Intervals
  • Importance of recording of physical verification

 

Post Session Activity

  • For store visit and Physical verification, the two demonstrations may be clubbed as a single exercise. The batch may be divided into subgroups (not more than 5) and may visit different stores (SDS, DDS, TU, PHI). The participants may be asked to fill the checklist. After the visit, the checklists filled by different trainees may be evaluated and discussed. Team to propose recommendation 
  • An Audit Trail may also be undertaken by the team, one batch to be selected from SDS (preferably issued to district almost 5-6 months back). Team to visit said district and to check upon the date of receipt, documentation and to check in which district it was issued. Then team to visit said TU and again take out the trail of same batch and figure out the PHI. Similarly visit said PHI and check. Afteward, team to enlist the observations and propose recommendation if required

 

Chapter 7.4

Physical Verification[SS1] 

Physical   Session (13 min)

 

Emphasis Points

  •   What steps to be followed for conducting Physical verification and at what Intervals
  • Importance of recording of physical verification

 

Post Session Activity

  • The site may be visited and the different processes may be explained.

 

Chapter 7.5

Evaluation of Stores and Stocks[SS2] 

Physical Session (5 min)

 

Emphasis Points

 

 

Post Session Activity

 

 


 


 


 

Abhimanyu

Trainers' Guide for Health Volunteers Course

Trainers' Guide for Health Volunteers Course
Trainees

The targeted trainees for this course are generally those persons at the community level who would be interacting with the population for the purpose of on ground TB activities related to awareness, screening and Treatment Support. These may include:

  1. ASHA Workers
  2. Volunteers from NGOs, Community Representatives/ Youth Volunteers
  3. TB Champions / Survivors/ Family Members
  4. Workplace Representatives who volunteer for becoming focus for TB Services
  5. Educators/ Teachers from Schools and Colleges

 

Trainers

The following cadres are supposed to be trained to become trainers on this course.

  1. STS
  2. TB HV
  3. MO-PHI
  4. MPHW/ Block Coordinators (NHM trainers)
  5. DPC/ PPM Co-ordinators
  6. NGO coordinators/ Supervisors
  7. Representatives from Private/ Corporate sector

The capacity of these trainers to conduct the training for health volunteers will be in-built into their training and is considered as one of their essential competencies.

Training Methods

Teaching and discussing the course content using the standardised training content available on the NTEP approved LMS (such as Swasth-eGurukul). This training may use blended training delivery methods that are appropriate to the local context. This would include a mix of the following options

  1. Traning Premises
    1. In-person
    2. virtual 
  2. Mode of delivery
    1. Facilitator led
    2. Self learning
    3. Demonstrations
    4. practical exercises. 

In the blended mode, an instructor-led session should be conducted for each chapter. Simultaneously the trainees would go through the content available online themselves according to the schedule. Trainees need to attempt the quizzes after each chapter/module. 

At the end of each chapter/session the trainer/ facilitator should summarise the key messages of the chapter by engaging trainees through questions and discussions. The discussion should focus on aspects related to the competencies listed below. These sessions should also help the trainees to clarify doubts and queries. 

For the training areas which require hand-holding of trainees like to perform actual processes such as filling of forms, counselling/ addressing stigma, screening, sample collection, adherence monitoring, a demonstration/ role play mode may be adopted.

The duration of training content including discussions/ demonstrations/ role play, pre/post training assessments, is expected to be completed 6 hours. The course coordinator may schedule the course in multiple sessions totaling to this duration as appropriate.

Competencies of the Health Volunteer

The following nine competencies are important to a health volunteer. 

Competency Assessment Protocol

1. Talk about TB, including

  • Being an infectious respiratory disease
  • It is curable
  • Diagnosis of TB and Diagnostic services available in the Govt
  • How to prevent TB (Ventilation, Sunlight, Cough etiquette)
Check ability to discuss with general public about TB and awareness of patient family members regarding TB during home visits.
2. Screen for TB using the 4 symptom complex Check ability to screen a patient during house visits.
3. Refer for diagnosis to the nearest TB Testing Centre Check ability to counsel patients, refer them to the nearest TB Diagnostic centre for TB Diagnosis, and record the referral during house visits.
4. Quality Sample collection and transportation 

Check ability to, provide sputum cups to patients, spot and early morning sputum, counsel TB patients on good quality sputum collection, and transport the sample to the nearest health facility during house visits.

May review with TB Diagnostic centre regarding quality of samples provided by the particular volunteer.

5. Record and Monitor Treatment adherence for TB Treatment, TPT *

Check ability to record doses taken, missed doses, and initiate patient retrieval incases of missed doses during house visits.

May also review Nikshay Adherence scores of past or presently linked patients

6. Counsel patients *, and their family for 

  1. treatment adherence, 
  2. nutrition, 
  3. ADR
  4. addressing stigma
Check ability to counsel a patient on the 4 aspects during patient visit.
7. Refer for ADR management* Check ability to actively check for ADR during patient visit and any linked patient remarks regarding how ADR was managed for them.
8. Post Treatment Follow-up* Check whether up to two previously linked (Treatment completed) patients have all their post treatment follow up due completed.
9. Use Nikshay for performing the actions related to the above Check ability to login, enrol and refer patients to health facilities, sample collection and transportation and also mark treatment adherence in Nikshay during patient visit.

The five (first four and last one) are core competencies of all volunteers while the remaining 5 (marked with *) are core competencies only if the volunteer acts/ intends to act as a treatment supporter.

The knowledge and training related to these competencies will be provided through the Course for Health Volunteers on NTEP and assessed through the pre and post-test assessments/ quizzes.

Competency assessment needs to be done periodically (once in two years) or at the time of registration or initiation of the treatment regimen.

Pre-training Preparation

Before starting a batch of training, the following preparations need to be completed.

  1. Creation/ confirmation/ Issue of Nikshay Usernames to the Health Volunteers
  2. Preparation of Props (Drug Blister packs, PWB, Specimen collection container, falcon tube, Specimen carry bags, IEC Materials)
Chapter wise Trainers notes

The course is divided into three modules, with a total of 12 chapters, each with specific learning and training objectives in alignment with the competencies of the person.   
The different scenarios and probes for the conversation and discussion have been covered in details at relevant sections. Three standard role plays have also been incorporated at the end of each module in the training course.

Session Activity Duration
Session-1 (Introduction)

Introduction and Overview of course   
(The course structure should be explained that there are 3 modules and modules are further divided into chapters)

NOTE: This session may be used as an ice-breaking session and to establish a rapport with the participants. It may also be emphasized here the importance of pre-test, quizzes and post-test assessment to successfully finish the course and obtain the certificate.

5 mins
Pre-test assessment Note: This is Mandatory before proceeding with course content 10 mins
Module 1. Basics of TB and NTEP (120 mins)
Chapter 1: Tuberculosis

Emphasis points during the session

  • burden of TB Disease in terms of new cases, deaths and suffering
  • the causative bacteria  
  • mode of transmission, progression to TB disease and the difference between TB infection and active TB disease.
  • 4 major symptoms of Pulmonary TB and how to enquire about these symptoms.
  •  Types of TB disease on the basis of sites of TB disease. The various sites of EPTB may be mentioned and explained in local language/context.   

    Post Session activity:  
  • Facilitator may ask the audience one after the other "50-Year-old ASHA died due to TB. Why did she die?". Write responses on board and classify them into biological, behavioural, socio-economic and occupational determinants.
  • Trainees may be asked about difference between TB infection and active TB disease.
  • Ask any one trainee to enumerate the 4 symptoms and may ask other trainees to explain the meaning of each symptom.
30 mins
Chapter 2: NTEP

Emphasis points during the session

  • The goals of NTEP.
  • The TB Unit and its significance and the HR posted there.
  • The TB case classification in NTEP
  • The TB patient care cascade and their interaction with the health system.
  • The role of the health volunteer and Treatment Supporter in NTEP

    Post Session Activity:  

  • Ask the participants to enumerate and various stages of TB patient care ecosystem and what all activities are carried out in each of the stage.
15 mins
Chapter 3-TB diagnosis and Case Finding

Emphasis points during the session

  • Identifying Presumptive Pulmonary TB using the 4 Symptom complex of TB 
  • Process of referral for testing and specimen collection and transport.
  • Discuss the video on the sputum collection.

    Post Session Activity:  

  • Ask the participants to enumerate the 4 chief symptoms of PTB and explain each of the symptom.
  • May ask one of the participants to demonstrate how they would refer a case and sample for testing.
  • Ask the participants about the dos and don'ts regarding sputum collection.
15 mins
Chapter 4: Nikshay & Treatment Supporter 

 

Emphasis points during the session

  • Nikshay portal and various features available in it which are relevant to treatment-supporters.
  • Explain the trainees the pre-requisites and process to get themselves registered on Nikshay platform
  • How they will enroll cases, request for test, and add sample details on Ni-kshay. 
     

Post Session Activity: 
1.    The Nikshay Mobile app may be demonstrated.

20 mins
Role play #1:

A short role play with the trainees to explain the process of screening and case finding, identifying the presumptive cases, and referring them to the nearest DMC for TB diagnosis. The trainer may act as the case/patient and one participant may act as an ASHA.

Scenario Brief

  • On a routine community visit, ASHA came to know about Ashish who works in a brick kiln on daily-wages. Ashish has been coughing and unexplained weight-loss for more than a month. He’s also reluctant to get tested and is relying on a nearby Pharmacist to get a cure for his long-standing cough issues.

Probes:

  • Identification of vulnerable population
  • Enquiring about the chief symptoms of Pulmonary TB and signs and symptoms of EPTB (with constitutional symptoms life fever, night sweats and weight loss)
  • Information about nearest testing facilities and process of sputum collection
  • Provision for free diagnostic and treatment services and patient support for TB patients.
  • Educating the patients and family about the signs and symptoms of TB disease and addressing their doubts and concerns.
  • How the enrolment, referral for testing and sample is collected and transported through Ni-kshay
10 mins
Quiz #1 The participants need to attempt the quiz based on training content covered in Module 1. 
Participants should complete the quiz before moving on to Module 2. This is a pre-requisite for final certificate
10 mins
Module 2: Treatment Support and Monitoring of TB Patient (90 mins)
Chapter 5- TB Treatment and Care

Emphasis points during the session

  • Explain Drug Sensitive Tuberculosis and the treatment phases.
  • Describe the treatment regimen for Drug-Sensitive TB (DS-TB) – Adult FDC & Paediatric formulations.
  • Explain the patient flow for DSTB Treatment
  • Explain the various Adverse drug reactions and their management.
  • Explain the DR-TB and the factors that lead to development of DR-TB.
  • Explain the Adverse Drug Reactions to drugs used in DR-TB Treatment and its identification, management and timely referral to health facility. (It may also be emphasized here that the DR-TB treatment is more complex and involves more toxic drugs, hence ADRs are more frequent and there is need to identify the ADRs early and manage these at nearest health facilities/referral centre to N/DDR-TB centre.)
  • Explain the TB Infection and two therapies for TB Prevention 
     

    Post session activity:

  • Have a practical demo of the drug formulations (blister packs/ pouches/ FDCs) of an Adult and paediatric DSTB Treatment regimen.
  • The participants may be asked to enumerate common ADRs to first/ second-line anti-TB treatment and subsequent action by Health Volunteer.
  • May ask about the options for TPT regimen
40 mins
Chapter 6- Treatment Adherence

Emphasis points during the session

  • The meaning and importance of Treatment Adherence.
  • The various options available to record patient adherence.
  • Monitoring of adherence in Nikshay
  • The recording of adherence and missed dose in Nikshay portal.
  • The role of Health Volunteers in TB Treatment and care.

Post session activity:

  • One-two participants may be asked about how they enquire about adherence to TB patients. 
  • Adherence recording and monitoring can be demonstrated through Nikshay app or through videos)
30 mins
Role play #2:

Scenario 1: Mr Ashish who is diagnosed with TB has been initiated on first-line ATT. He was hesitant to start treatment after learning about his TB disease. He lives in an over-crowded chawl with poor hygiene. 
ASHA visits him on Day-5 after his treatment initiation. She speaks to him and convinces him to continue the treatment. She further discovers that Ghanshyam (father of Ashish) who has diabetes is also living in the same household.

Probes:
1. Whether DBT has been initiated or not
2. Identification of ADR. (The different ADRs may be explained and enquired about)
3. Importance of adherence
4. Contact tracing also needs to be carried out
5. TPT and its eligibility.
6. Counselling about TB to Ashish and his family.
7. The need to control blood sugar of Ghanshyam

Scenario: 2: ASHA visits Ashish’s house after 7 weeks after his treatment initiation. He is now feeling healthy. His TB symptoms have subsided and he has gained weight. He is now thinking about taking up some construction work in some far off place in Mumbai.

Probes 
• Identification of ADRs if any
• Change in weight and accordingly change in dosages.
• Importance of follow-up at DMC for end of IP lab investigation.
• The option of transferring the treatment centre for TB care and management. 
• Importance of adhering to the ongoing treatment and recording it electronically.

Key message at the end of role play :
In the form of summary and important areas to be covered while visiting a patient after his treatment initiation. Need to take healthy food and even if they feel healthy, they shouldn’t stop the treatment

10 mins
Quiz #2 The participants need to attempt the quiz based on training content covered in Module 2.  
Participants should complete the quiz before moving on to Module 3. This is a pre-requisite for final certificate
10mins
Module 3: Patient Support (120 mins)
Chapter 7 - Public Health Action

Emphasis points during the session

  • The concept of Public Health action
  • Various components of PHA carried out under NTEP for a diagnosed TB patient
  • The contact tracing and investigation carried out for TB patient under NTEP
  • Tasks are carried out by Health Volunteers on home visit to a TB patient
  • The meaning of Treatment Supporter and who qualifies to be TS to a TB patient

Post Session activity

  • Ask the participants to enumerate the 6 public health actions that are carried out after the TB Notification
  • Ask other participants to explain each of the PHAs
25 mins
Chapter 8: TB Arogya Sathi Application

Emphasis points during the session

  • Explain the trainees about the TB Arogya Sathi Application, its multilingual interface, various information available in it and how TB patients can use it to mark their adherence in it and see their DBT status in the application.

    Post Session Activity:

  1. The TB Arogya Sathi App may be demonstrated to participants or videos can be displayed at the end of session.
  2. The use of TB Screening tool in TB Arogya Sathi app may be demonstrated and the utility of this tool in enrolment of presumptive TB. 
  3. Participants may be asked to demonstrate the use of application and clear their doubts.
20 mins
Chapter 9- Counselling
  • Explain the importance of TB awareness generation in community and how it is carried out in community
  • Describe counselling for TB patients, at what stages it is carried out and what components are explained during different stages of TB treatment and care
  • Explain Do's and Don'ts for Patient Communication
  • Explain Nutritional Counselling and its importance related to TB patients

Post Session activity

  1. Give the participants different scenarios(Like pre-treatment/During treatment/post-treatment) and Ask the different participants about the components of counselling at different scenarios
20 mins
Chapter 10- Social inclusion and wellness activity
  • Explain about the Stigma and discrimination faced by TB patients and its adverse effects at individual level and community level.
  • Explain the gender aspects of TB and hoe to address gender inequalities.
  • Explain about various wellness activities meant for TB patients
20 mins
Chapter 11: Community Engagement
  • Explain the meaning of community engagement and its importance in TB care.
  • Explain about the various strategies of Community engagement in NTEP
  • Explain about the TB champions.
  • Explain the role of HVs in Community engagement.

Post Session activity

  • Ask the participants, in what ways the TB Champions help the TB patients
20 mins
Chapter 12: Linkages to Social Support Scheme
  • Explain the meaning of DBT
  • Explain the DBT schemes in NTEP including NPY, Tribal SS, TS honarium and incentives for notifications and outcomes
  • Explain the various criteria for availing DBT Scheme benefits under NPY
10 mins
Role play #3:

Scenario: 

A newly diagnosed TB patient initiated on treatment comes to his hometown for home based care and treatment. ASHA worker visits his home to verify his address and upon enquiring with neighbours she learnt that Ashish is being stigmatised for contracting TB and his family is being discriminated against. Now ASHA has to give correct information regarding TB to the neighbourhood.

Probes: 
Correct information about TB 
Appreciation for Ashish to initiate the treatment early. 
Motivating the community to support Ashish and his family. 
Counselling to Ashish and his family to prevent TB infection. 
Complete PHA 
Precautions to be taken while visiting a TB patient’s home

15 mins
Quiz #3: Post - Test

All module content will be covered in this quiz. 

Completion of this final quiz successfully, along with the two quizzes in-between the course is mandatory for certificate generation   

10 mins
 

 

Roles and responsibilities of Key Stakeholders  

Please refer to the general roles of various stakeholders for training of Health Volunteers (click here). 

Apart from these general roles, the state NHM has an important role to play in the training of Health Volunteers, especially those who are ASHAs in the state. The state NHM needs to ensure that all the ASHAs are being trained on TB and NTEP as per the standard training content. The state ASHA cell at the NHM, should ensure that the following steps are being taken:

  • Support STDC/ STC in planning the training and inclusion in PIP 
  • Prepare and share the list of ASHA’s in the prescribed format with the respective STDC Team
  • Guide and provide directives to the respective District/ Blocks to deploy ASHA’s along with concerned supervisors to ensure active participation.
nitin.solanki

Trainers' Guide for STS Course

Trainers' Guide for STS Course

Introduction

The purpose of this document is to provide the course coordinators and trainers for the ‘Course for STS in NTEP’ guidance for planning and executing the training. The targeted trainees for this course would be:

  • Senior Treatment Supervisor (STS)
  • Tuberculosis Health visitor (TB-HV)

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstration and role plays. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernized Training System, each State Office may decide to choose the approach which is most suitable for their State. 

The training of STS to be conducted at state/Regional level preferably at the STDC. 

The batch size for Physical Session/Virtual Sessions should not be more than 25.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each module. An instructor-led session will also be conducted for each module. This will help the trainees for better clarification of contents and to address the queries and doubts.

For the training areas which require hand-holding of trainees like demonstration of processes- like patient management in Ni-kshay, filling of various forms, Adherence Management tools, recording information on Public Health action, use of NI-kshay Aushadhi, etc in-person training sessions need to be conducted.

The training course content has 11 modules and 43 chapters. Based on different modalities used for the training, the training delivery should take at least 40 hours.

For the purpose of assessment of trainees, a pretest before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto-generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes.  

Training curriculum / Agenda

Sr.

Module 

Chapters

Training Modality

Duration

(Hrs)

1

Basics of TB and NTEP

  1. TB & TB Epidemiology
  2. NTEP
  3. Integration of NTEP with Health System

Virtual


 

4

2



 

TB Diagnosis and Case finding

  1. TB Case Finding in NTEP
  2. Diagnostic Technologies
  3. Diagnostic Network and Hierarchy
  4. Approaches to TB Case Finding
  5. Active Case Finding Campaign

Virtual

4


 

3

TB Treatment and care

  1. General concepts in TB Treatment
  2. DS-TB Treatment and care
  3. DR-TB Treatment and care
  4. TB Infection treatment and care
  5. TB-Comorbidities and special situations

Virtual

4



 

4

Adherence Management

  1. Patient Management
  2. General Concepts in Adherence Management
  3. Adherence Support
  4. Adherence recording
  5. 99 DOTS
  6. Medication Event Reminder Monitor(MERM)
  7. Adherence Monitoring and follow-up Action

Physical

4

5

Public Health Action

  1. Patient Support
  2. TB Arogya Sathi Application
  3. Contact Investigation
  4. Counseling and education
  5. AIC

Physical

4


 

6

DBT

  1. General Concepts
  2. Processes in DBT

Physical

4

7

Supervision, Monitoring and Evaluation

  1. Supervision
  2. Program Monitoring Indicators
  3. Monitoring

Physical

4

 

Supply Chain Management in NTEP

  1. General concepts in SCM
  2. Stocking Norms
  3. General Processes involved in SCM

Physical

4


 

9

Private sector Engagement

  1. Overview of Private Sector Engagement
  2. Models for Private Sector engagement
  3. Partnership Options
  4. Regulations
  5. TB Mukt Panchayat Initiative

Virtual

2


 

10

ACSM and Community Engagement

  1. General Concepts in ACSM
  2.  Guidelines and Protocols for ACSM activities
  3. Community Engagement
  4. TB Champion
  5. Social Inclusion and wellness activities
  6. Engaging Family care givers
  7. Pradhan Mantri TB Mukt Bharat Abhiyan
 

3

11

Training the Health Volunteers and Treatment Supporters

   

3



 

Trainers 

For this course, following personnel may be appointed as the trainers:  

  • MO - STDC 
  • MO - STC
  • WHO-consultants
  • DTO (select)
  • SDS/DDS Pharmacists (Select)- for Supply chain and drug distribution module.

     

Eligibility

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. The Trainers should have completed the ‘Course for STS’ and they must possess strong knowledge about the NTEP and the various processes related to patient workflow, Niskahy and Niskahy Aushadhi.  The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure.

The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System), Ni-kshay and Ni-kshay Aushadhi.

  1. Chapter wise detailed instructions for Trainers 

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

  • Module-wise and Chapter-wise, modality that may be adopted (virtual/ Physical/ In-person)
  • The estimated time to complete the content.
  • The key messages that a trainer should emphasize upon, while delivering the training
  • The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation. 

Module 1: Basics of TB and NTEP                                              Virtual Session (4 hours)

Chapter 1.1

TB & TB Epidemiology

Virtual Session (60 min)

Emphasis Points

  • Differences between TB Infection and active TB Disease
  • TB has many determinants- behavioral, socio economic, biological
  • Vulnerable population for TB
  • Concepts of TB Notification Rate and TB Incidence Rate

Post Session Activity

  • The participants may be asked to (i) enumerate the various determinants of TB and (ii) difference between TB Infection and TB Disease 
  • Give an exercise to calculate the Notification rate of a TU. In a TU with a population of 2 lakhs, 100 TB cases were diagnosed and reported during the year 2022.. A total of 90 people with TB were initiated on treatment, 5 died and  2 migrated  before initiation of treatment.and 3 could not be contacted at all. What is the annual TB notification rate for that TU in 2022? [ Answer: 50 per lakh]
  • Discuss - Can we call the above obtained Notification figure as the incidence of TB in that TU? If not Why? [Discussion Points: Notification and Incidence are not the same. Notification includes all diagnosed TB cases and reported to the system. It includes both new and previously treated cases. There may be cases diagnosed, but not reported. It is possible that there will be cases in the community not diagnosed at all.]    

Chapter 1.2

NTEP

Virtual Session (45 min)

Emphasis Points

  • Explain what India is committed to achieve in 2025 in relation to SDG related to ending TB. Clarify that the country has preponed the 2030 SDG targets related to ending TB to 2025.
  • Organizational structure of NTEP with broad functions of each institutions (state level and below)
  • Different stages in the patient’s life cycle need to be explained in detail and emphasis on the concept of continuum of care from ‘presumptive TB to post treatment follow up’
  • Concepts of ‘’Standards of TB Care’’ as a minimum set of care that every citizen in India should receive irrespective of where he/she seeks care from

Post Session Activity

  • Discuss- ‘What India is committed to achieve in 2025 in relation to ending TB?’’ [Clarify that the country is only trying to achieve the SDG goals related to Ending TB]
  • Discuss- ‘Can Medical College be a PHI?’

Chapter 1.3

Integration of NTEP with Health System  

Virtual Session(30 mins)

Emphasis Points

  • Need for integration of NTEP with the general health system & NHM and how that integration is envisioned . 

Post Session Activity

  • Discuss - "What are the opportunities available to NTEP through Health & Wellness Centers? How could that be materialized”’

Module 2

TB Diagnosis and Case Finding

Virtual Session (4 hours)

Chapter 2.1

Diagnostic Technologies

Virtual Session (30 min)

Emphasis Points

  • Names of different tests,their uses, advantages and disadvantages

Post Session Activity

  • Ask what are the advantages and disadvantages of FL- LPA over NAAT?

Chapter 2.2

Diagnostic Network & Hierarchy

Virtual Session (30 min)

Emphasis Points

  • Network and hierarchy of laboratories and their basic role

Post Session Activity

  • Ask “ how many sputum collection and transportation facilities are there in their concerned TU? Make one participant explain how it functions and what are the benefits out of it”?- Bring out the following benefits (1) prevents leaks in cascade of care (reduce loss from presumptive TB identification to TB Testing)  (2) minimizes patient inconveniences (3) minimize patient Turnaround Time (4) reduce out of pocket expenditure (5) helps in infection control as people with symptoms need not travel

Chapter 2.3

Approaches to TB Case Finding

Virtual Session (30 min)

Emphasis Points

  • Differentiate between screening and testing. 
  • The three approaches may be discussed by giving suitable examples to fit into the three scenarios

Post Session Activity

  • Discuss  the following scenarios and ask the participants which case finding those are

(i) Screening for active TB in a Diabetic Clinic & testing those who screened positive

(ii) Screening for active TB in an elderly home & testing those who screened positive

(iii) Screening for active TB in cancer wards & testing those who screened positive

Chapter 2.4

TB Case Finding in NTEP

Virtual Session (30 min)

Emphasis Points

Diagnostic algorithm for Pulmonary TB- Role of Chest X ray as a screening tool and the need to complete the diagnostic algorithm.

Classification of TB on the basis of site,diagnosis,  drug resistance

 

Post Session Activity

 Discuss: “What proportion of presumptive TB patients in your TU completes the diagnostic algorithm? What are the implications if the people are not completing the diagnostic algorithm?”

 

Chapter 2.5

Active Case Finding Campaign

Virtual Session(45 mins)

Emphasis Points

Step by step process in planning and execution of an ACF campaign with special emphasis on identification of target population, need for micro planning and  need to prevent the leaks in the cascade of care.

Post Session Activity

Discuss how they monitor the ACF in their TU against ‘Cascade of Care? What are the measures they undertake to prevent the leaks in ‘’Cascade of care’’? 

Module 3: TB Treatment and care                                                   Virtual Session (4 hours)

Chapter 3.1

  • General Concepts in TB Treatment

Virtual Session (60 mins)

Emphasis Points

  • It's an overview chapter explaining the concepts- Fixed Dose Combination, Intensive & Continuation Phase.  
  • Process of Treatment Initiation and Transfer of patients 

Post Session Activity

  • Request two participants to demonstrate  in Demo Ni-kshay the ‘Transfer’ of patients using (i) Push and (ii) Pull methods. 

Chapter 3.2

DS-TB Treatment and Care

Virtual Session ( 30 mins)

Emphasis Points

  • Regimen and dose of drugs for managing DS-TB for adults and pediatric group and weight bands available 
  • Display all FDCs in NTEP and ensure the participants could identify all information related to it
  • Common adverse events of anti-TB drugs

Post Session Activity

  • Call one participant and ask to explain the step by step process for initiating treatment to a 50 Kg old adult diagnosed with pulmonary TB (Rif Sensitive). Write down all the steps in a flip chart/chatbox/Virtual whiteboard. Ask other members to comment on the missed steps and the order of steps. 
  • Call a second participant and ask to explain the follow up for the same patient.

Chapter 3.3

DR-TB Treatment and care

Virtual Session (30 mins)

Emphasis Points

  • What is UDST?
  • Classification of DR-TB?
  • Regimens available for DR-TB?
  • Levels of facilities where treatment needs to be initiated.

Post Session Activity

  • Ask participants for doubts and help them clear those doubts. 
   

Chapter 3.4 

Different DR-TB Regimens

Virtual Session (15 mins)

Emphasis points

  • Different regimens, constituents and duration
  • ADRs due to different regimens

Chapter 3.4

TB Infection treatment and care

Virtual Session (30 min)

Emphasis Points

  •  Eligible people for TPT
  • Testing for TPT 
  • Steps for Ruling out active TB before initiating TPT
  • Adherence monitoring and treatment support for those on TPT

Post Session Activity

Role Play- Counseling for TPT 

Chapter 3.5

TB Co-morbidity and special situations

Virtual Session (30 min)

Emphasis Points

  • Bidirectional screening for TB-HIV, TB-Diabetes
  • Need for screening for tobacco and alcohol use among people with TB
  • Nutritional assessment for people with TB.
  • Need for and mechanism of Linkages of people with comorbidity (HIV, Diabetes, Malnutrition, Tobacco and alcoholism)

Post Session Activity

  • Ask the participants to describe the existing mechanism at their TU to screen TB among the people visiting ICTC centers - how is the screening being done? How is it ensured that all those referred for testing have undergone testing? Discuss if there is any scope for improvement.
  • Ask the participant to describe how diabetes testing is done among people with TB in their TU? What are the steps if a person with TB is found to have diabetes? Who and how is diabetic control ensured for that person? Discuss if there are any ways to improve. 

Module 4:                     Adherence Management                          Physical Session (4 hours)

Chapter 4.1

Patient Management

Virtual Session (60 mins)

Emphasis Points

How the information of patients is managed through Ni-kshay (Enrollment, Request for Test). 

Post Activity Session

Call two participants to demonstrate how they (1) enroll a subject and (2) request for Test in Ni-kshay

Make all participants to view their task list in Ni-kshay and discuss how they are going to use the feature

Chapter 4.2

General concepts in Adherence management

Physical Session (60 mins)

Emphasis Points

  • This is an overview chapter where participants need to understand the (i) General Concepts in Adherence Management such as why adherence monitoring and treatment support is important, (ii) what are the various supports required by a person with TB during TB treatment and (iii) various ways of providing those supports and (iv) various ways to monitor treatment adherence?

Post Session Activity

  • Ask one participant to demonstrate how they register treatment supporter in Ni-kshay

Chapter 4.3

  • Adherence Support

Physical Session (60  mins)

Emphasis Points

  • Imparting skills to Record adherence in Ni-kshay- Demonstrate the recording of adherence in Ni-kshay. 
  • Recording adherence using TB Arogya Sathi Application

Post Session Activity

  • Call one participant and ask to demonstrate recording adherence using TB Arogya Sathi Application

Chapter 4.4

Chapter: 99 DOTS

Physical Session (30 mins)

Emphasis Points

  • Need to have 99 DOTS Envelops for this sessions. 
  • Explain step by step process of adherence monitoring using 99 DOTS (Choosing the envelope, educating the person with TB on 99DOTS, linking it with Ni-kshay, administering the first dose, troubleshooting)

Post Session Activity

  • Give the following scenarios and ask them to troubleshoot\

Scenario 1: One of their patients complained that she used to dial the toll-free number every day and used to hear “Thank You” also. But when you check, the Nikshay dashboard is still showing red.


 

Scenario 2: One of your clients with TB called you and told you that his call is not going to the ‘toll free’ number because of ‘insufficient’ balance. 

Chapter 4.5

Chapter: MERM

Physical Session (30 mins)

 
  • Need to have a MERM device for demonstration.
  • Battery assembly may be explained and the different scenarios to troubleshoot should be explained.
  • The process flow in Ni-kshay(registering the device, setting the alarm and refill time) should be explained to the participants. 
 
  • One/more participants may be asked to demonstrate this in Ni-kshay(Demo)

Chapter 4.6

Chapter: Monitoring of adherence

Physical Session (60 mins)

Emphasis Points

 Participants need to be empowered to use adherence summary dashboards and interpret the indicators.   

Post Session Activity

  • Request everybody to open their adherence dashboards and comment on their % of 'Average Adherence' of all patients on treatment.
  • Request all participants to open their adherence task list and ask their plans based on the task list

Module 5: Public Health Action                                       Physical Session (4 hours)

Chapter 5.1

Patient Support

Physical Session (60 min)

Emphasis Points

  • Various kinds of support the TB patient needs (nutritional support, psycho social support, support for deaddiction, travel support) and how STS could help in offering the same 

Post Session Activity

  • Give a scenario: A 62 year old woman from a Tribal community affected with TB. Ask all participants to list out all the Government schemes/initiatives which can support her during the treatment period? Write down all schemes in a flip chart/Chatbox/Virtual board  

Chapter 5.3

Contact Investigation

Physical Session (60 mins)

Emphasis Points

  • Step by step process for contact investigations
  • Discuss the steps to record the contact tracing in Ni-kshay

Post Session Activity

  • Ask one of the participants how contact investigations are happening in his/her TU (Coverage, Quality, Periodicity, Challenges).  
  • Ask one/more participants to demonstrate the process in Ni-kshay(Demo) 

Chapter 5.4

Counselling and Education

Physical Session (60 mins)

Emphasis Points

  • Basic principles of counselling (DOs and DONTs)
  • Points to be included while counselling of a person with TB

Post Session Activity

  • Ask participants to comment on the following statements made by STS while counselling a person with TB
  1. “I have already informed all people who came to your shop that you are having TB”. (Clue: It's a breach of confidentiality. It should have been discussed with the person with TB first. The person with TB should have been empowered to disclose it to others if required)
  2. “If you are not taking the medicines properly, you will definitely die”. (Clue: It's a coercive/threatening language and should be avoided)
  3. “Because you were a smoker and alcoholic, you got TB” (Clue: It's a blame on the person and should be avoided)

Module 6                 

DBT

Physical Session (4 hours)

Chapter 6.1

General Concepts in DBT

60 mins

Emphasis Points

This is an overview chapter. 

  • Various DBT schemes for people affected with TB
  • Various stakeholders while processing DBT (Beneficiary, Maker, Checker)
  • PFMS

Post Session Activity

  • Re-emphasise the concepts - Maker & Checker; Ni-kshay & PFMS.

Chapter 6.2

Processes in DBT

150 mins

Emphasis Points

  • Explain beneficiary registration, benefit process & benefit approval.
  • Processing incentives for NP, private provider, treatment supporter, tribal TB
  • Calculation of benefits
  • DBT reports & registers in Ni-kshay

Post Session Activity

  • Make every participant open their DBT benefit register and beneficiary register and comment on performance. 

Module 7      

Supervision, Monitoring & Evaluation

Physical (4 hours)

Chapter 7.1             

Supervision 

60 minutes

Emphasis Points

  • General Concepts of Supervision and basis tenants of a good supervisory process
  • Supervisory Protocols for STS
  • Supervisory roles of MO-TC & DTO at TU

Post Session Activity

  • Reemphasise the concept of supportive supervision. Get feedback on how some of them plan to change their supervision plan.

Chapter 7.2

Program Monitoring Indicators 

120 minutes

Emphasis Points

  • Nine program monitoring indicators - definitions, how to calculate the indicators, how to interpret the indicators.
  • How to perform a root cause analysis- (1) drill down to the problem using data, (2) perform a person, place, time analysis, (3) explore for potential reasons of low performance through interviews. 

Post Session Activity

Assignment: Each participant needs to calculate any 3 indicators in their TU based on real time data and interpret those indicators.

  • For one of the low performing indicators, they need to do a root cause analysis and come up with potential solutions.
  • Every participant needs to submit an assignment based on this.

Module 8 

Supply Chain Management

Physical (4 hours)

Chapter 8.1

General Concepts

60 mins

Emphasis Points

General Concepts of SCM

  • Principles of SCM
  • Drug distribution flow
  • Nikshay Aushadhi

Post Session Activity

Ask for any doubts from the participants and clarify the same.

Chapter 8.2

Stocking Norms

30 mins

Emphasis Points

Buffer stocks and storage norms

Post Session Activity

Reinforce the concepts of buffer stock and storage norms. 

Chapter 8.3

Supply chain process

150 mins

Emphasis Points

  • Indenting, Receipt
  • Storage of drugs

Post Session Activity

  • Request one participant to demonstrate drug indenting through Ni-kshay aushadhi

Chapter 8.4

Drug dispensation Module

30 mins

Emphasis Points

  • Dispensation of drug using Ni-kshay, adding filling and returning dispensation

Post Session Activity

  • Request one participant to demonstrate the Ni-kshay dispensation module.

Module 9         

Multisectoral Sector Engagement

Virtual (2 hours)

Chapter 9.1                   

General Concepts

30 mins

Emphasis Points

Why private sector engagement is important and what is the Vision of NTEP on private sector engagement.

Post Session Activity

  • Recollect Standards of TB Care in India and emphasize that the vision of NTEP with regard to private sector engagement is to ensure STCI to all patients. The choice of where to take treatment remains with the patient. Emphasize that more than the private sector, it is the NTEP who wants to engage with the private sector to ensure that all patients reaching them receive STCI.  Tell that TU is a population and ensuring STCI to all cases emerging from that population is the responsibility of STS. STS can engage the private sector to minimize his/her workload.

Chapter 9.2

Models of Private Sector Engagement

60 mins

Emphasis Points

Explain PPSAs, Direct Option for engagement.

Explain STEPS

Post Session Activity

Ask each of the participants to think what model suits for private sector engagement in their TU and why.

Chapter 9.3

Partnership Guidelines

30 mins

Emphasis Points

Emphasis on various options under partnership options

Post Session Activity

Discuss what all partnership options are currently existing in their TUs and what would they want to have.

Chapter 9.4

Regulations 

30 mins

Emphasis Points

Regulations of Mandatory TB Notification and Schedule H1

Post Session Activity

Discuss how information from schedule H1 could be used? (Clue: Most crucial field in the schedule H1 register is the name of the provider who prescribed it. Information from Schedule H1 register could be used to Identify the provider prescribing the anti TB drugs and prioritize for engagement, Identify missing TB cases)

Module 10

ACSM and Community Engagement

Physical (3 hours)

Chapter 10.1

General Concepts in ACSM

60 mins

Emphasis Points

  • Differentiate clearly among Advocacy, Communication and Social Mobilization
  • Common approaches for ACSM for TB Elimination

Post Session Activity

 

Chapter 10.3

Protocols for ACSM activities

60 mins

Emphasis Points

Organising Community Meetings, Peer group interventions, ACSM activities in schools

Post Session Activity

Discuss experiences form 1-2 participants regarding organizing community meetings

Chapter 10.4

Community Engagement

60 mins

Emphasis Points

LSGs and their role in TB Elimination

TB Forums and what they can do

What role can TB Champions play?

Post Session Activity

Discuss what needs to be done to reduce stigma regarding TB in the community. Encourage everybody to discuss.

Abhimanyu

Trainers' Guide for STLS Course

Trainers' Guide for STLS Course

1. Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for STLS in NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

    Senior TB Laboratory Supervisors

 

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State may decide to choose the approach which is most suitable for their State.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each module. An instructor-led session will also be conducted at the end of each module. This will help the trainees for better clarification of contents and to address the queries and doubts. 

For the training areas which require handholding of trainees like demonstration of processes- Specimen collection and transportation, smear microscopy, using different NAAT, patient workflow in Ni-kshay, maintaining Lab Supplies, etc in-person training sessions need to be conducted.

The training course content has 15 modules and 56 chapters. Based on different modalities used for the training, the training delivery should take 60 hours (including demonstrations)

For the purpose of assessment of trainees, a pre-test before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes.

The training of STLS needs to be conducted at STDC/IRL where all the lab facilities are available.

The batch size for Physical Session should not be more than 7 participants and not more than 25 participants for virtual sessions.

2. Training curriculum / Agenda

 Sr. 

Module  

Chapters 

Training Modality 

  1. Duration 

(Hrs) 

Basics of TB and NTEP 

  1. TB & TB Epidemiology
  2. NTEP
  3. Integration of NTEP with Health System

Virtual

4

 

 

TB Diagnosis and case finding in NTEP 

  1. TB Case Finding in NTEP
  2. Diagnostic Technologies
  3. Diagnostic Network and Hierarchy
  4. Approaches to TB Case Finding
  5. Active Case Finding Campaign

 Virtual

4

3

Specimen collection and Transportation

  1. General concepts in specimen collection & transportation
  2. Packaging & dispatching sample to a C&DST lab
Physical

2


 

4

Smear Microscopy

  1. Collection & Storage of Good Quality Specimen
  2. Sputum Smear Preparation
  3. Preparation of Staining solutions
  4. Staining Sputum Smear
  5. Reading Smear and Reporting Microscopy results

 Physical

8

5

CBNAAT

  1. CBNAAT as a Rapid Molecular Diagnostic tool
  2. Sample processing for CBNAAT
  3. CBNAAT Result Interpretation and recording
  4. Troubleshooting in CBNAAT
  5. Maintenance of CBNAAT

 Physical

8

Truenat

  1. Truenat as a Rapid Molecular Diagnostic Test
  2. Specimen processing for Truenat
  3. Truenat result Interpretation and recording
  4. Troubleshooting in Truenat
  5. Truenat Instrument maintenance and record keeping

 Physical

8

7

Ensuring Smooth functioning of Lab Services

  1. Biomedical waste management in a microscopy lab
  2. Biomedical waste management in CBNAAT Lab
  3. Biomedical waste management in Truenat lab
  4. Record maintenance
Physical

3

8

Ensuring Quality TB lab services at TDCs

  1. General concepts in quality assurance
  2. External quality assurance 

 Physical

3

9

Infection Prevention and Control [IPC]

  1. General concepts in IPC
  2. Airborne Infection Control
Virtual

2

10

TB Treatment and care

  1. Concepts in TB Treatment
  2. Patient Management
  3. Adverse Drug Reactions with anti-TB Drugs
  4. Documentation of Treatment
  5. Extra Pulmonary TB (EPTB)
  6. Drug Sensitive TB (DS-TB)
  7. Drug Resistant TB (DR-TB)
  8. Follow up of TB patients.
  9. Adherence monitoring
  10. Treatment Support
  11. TB & Comorbidities and special situations
  12. TB Preventive Treatment

 Virtual

6

9

Public Health Action

  1. Public health actions for TB

 virtual

1

11

Supply Chain Management

  1. Supply Chain Management in NTEP
  2. Maintaining Supplies of Lab consumables at TDC 

 Virtual

2

12

Supervision, Monitoring & Evaluation

  1. Supportive supervision
  2. Evaluation 
Virtual

2

13

Private sector Engagement

  1. Private sector engagement in NTEP
Virtual

2

14

ACSM

  1. Advocacy, Communication & Social Mobilization in NTEP
  2. Community engagement in NTEP
Virtual

2

15

Training

Training the Lab Technicians

 

2

 

3. Trainers

         For this course, following personnel may be appointed as the trainers

  • STDC- Medical Officers
  • IRL Microbiologist
  • EQA Microbiologist
  • NRL Microbiologist
  • WHO consultants

 Eligibility -

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about TB laboratories and related processes in NTEP. The Trainers should have completed the ‘Course for STLS on NTEP’’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System) and Nik-shay. The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure

Chapter wise detailed instructions for Trainers 

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

  • Module-wise and Chapter-wise, modality that may be adopted (virtual/ Physical/ In-person)
  • The estimated time to complete the content.
  • The key messages that a trainer should emphasize upon, while delivering the training
  • The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

 

Module 1: Basics of TB and NTEP                                              Virtual Session (4 hours)

Chapter 1.1

TB & TB Epidemiology

Virtual Session (60 min)

Emphasis Points

  • Differences between TB Infection and active TB Disease
  • TB has many determinants- behavioral, socio economic, biological
  • Vulnerable population for TB
  • Concepts of TB Notification Rate and TB Incidence Rate

Post Session Activity

  • The participants may be asked to (i) enumerate the various determinants of TB and (ii) difference between TB Infection and TB Disease 
  • Give an exercise to calculate the Notification rate of a TU. In a TU with a population of 2 lakhs, 100 TB cases were diagnosed and reported during the year 2022.. A total of 90 people with TB were initiated on treatment, 5 died and  2 migrated  before initiation of treatment.and 3 could not be contacted at all. What is the annual TB notification rate for that TU in 2021? [ Answer: 50 per lakh]
  • Discuss - Can we call the above obtained Notification figure as the incidence of TB in that TU? If not Why? [Discussion Points: Notification and Incidence are not the same. Notification includes all diagnosed TB cases and reported to the system. It includes both new and previously treated cases. There may be cases diagnosed, but not reported. It is possible that there will be cases in the community not diagnosed at all.]    

Chapter 1.2

NTEP

Virtual Session (45 min)

Emphasis Points

  • Explain what India is committed to achieve in 2025 in relation to SDG related to ending TB. Clarify that the country has preponed the 2030 SDG targets related to ending TB to 2025.
  • Organizational structure of NTEP with broad functions of each institution (state level and below)
  • Different stages in the patient’s life cycle need to be explained in detail and emphasis on the concept of continuum of care from ‘presumptive TB to post treatment follow up’.
  • Concepts of ‘’Standards of TB Care’’ as a minimum set of care that every citizen in India should receive irrespective of where he/she seeks care from

Post Session Activity

  • Discuss- ‘What India is committed to achieve in 2025 in relation to ending TB?’’ [Clarify that the country is only trying to achieve the SDG goals related to Ending TB]
  • Discuss- ‘Can Medical College be a PHI?’

Chapter 1.3

Integration of NTEP with Health System  

Virtual Session (30 mins)

Emphasis Points

  • Need for integration of NTEP with the general health system & NHM and how that integration is envisioned. 

Post Session Activity

  • Discuss - "What are the opportunities available to NTEP through Health & Wellness Centers? How could that be materialized’?

Chapter 1.4

Patient Management

Virtual Session (60 mins)

Emphasis Points

How the information of patients are managed through Ni-kshay (Enrollment, Request for Test). 

Post Activity Session

Call two participants to demonstrate how they (1) enroll a subject and (2) request for Test in Ni-kshay

Make all participants to view their task list in Ni-kshay and discuss how they are going to use the feature

Module 2

TB Diagnosis and Case Finding

Virtual Session (4 hours)

Chapter 2.1

Diagnostic Technologies

Virtual Session (30 min)

Emphasis Points

  • Names of different tests, their uses, advantages and disadvantages

Post Session Activity

  • Ask what are the advantages and disadvantages of FL- LPA over NAAT?

Chapter 2.2

Diagnostic Network & Hierarchy

Virtual Session (30 min)

Emphasis Points

  • Network and hierarchy of laboratories and their basic role

Post Session Activity

  • Ask “ how many sputum collection and transportation facilities are there in their concerned TU? Make one participant explain how it functions and what are the benefits out of it”?- Bring out the following benefits (1) prevents leaks in cascade of care (reduce loss from presumptive TB identification to TB Testing)  (2) minimizes patient inconveniences (3) minimize patient Turnaround Time (4) reduce out of pocket expenditure (5) helps in infection control as people with symptoms need not travel

Chapter 2.3

Approaches to TB Case Finding

Virtual Session (30 min)

Emphasis Points

  • Differentiate between screening and testing. 
  • The three approaches may be discussed by giving suitable examples to fit into the three scenarios

Post Session Activity

  • Discuss the following scenarios and ask the participants which case finding those are

(i) Screening for active TB in a Diabetic Clinic & testing those who screened positive

(ii) Screening for active TB in an elderly home & testing those who screened positive

(iii) Screening for active TB in cancer wards & testing those who screened positive

Chapter 2.4

TB Case Finding in NTEP

Virtual Session (30 min)

Emphasis Points

Diagnostic algorithm for Pulmonary TB- Role of Chest X ray as a screening tool and the need to complete the diagnostic algorithm.

Classification of TB on the basis of site,diagnosis, drug resistance

 

Post Session Activity

 Discuss: “What proportion of presumptive TB patients in your TU completes the diagnostic algorithm? What are the implications if the people are not completing the diagnostic algorithm?”

 

Chapter 2.5

Active Case Finding Campaign

Virtual Session (45 mins)

Emphasis Points

Step by step process in planning and execution of an ACF campaign with special emphasis on identification of target population, need for micro planning and need to prevent the leaks in the cascade of care.

Post Session Activity

Discuss how they monitor the ACF in their TU against ‘Cascade of Care? What are the measures they undertake to prevent the leaks in ‘’Cascade of care’’? 

Module 3: Specimen collection and transportation Virtual Session 

(Physical Session: 2 hour)

Chapter 3.1 

General concepts in SCT

Physical (45 mins)

Emphasis Points 

  • Need for transportation of specimen.
  • Modes of transportation employed.
  • The Process of Sputum collection
  • Requirement for Cold chain
  • The different items may be shown. 

Post Session Activity 

  • The participants may be asked to identify different items and the specification- Eg Thermocol box size, falcon tube size, etc. 

Chapter 3.2

Packaging and dispatching a sample to a C&DST lab 

Virtual (45 mins)

Emphasis Points 

  • Triple layer packaging, cold/cool chain; specimen transport carriers-technical specifications and labeling; dispatch of samples-Ni-kshay 

Post Session Activity 

  • One participant may be asked to add test request(dispatching the sample to CDST lab) in Ni-kshay
  • Few participants may be asked to demonstrate the triple layer packaging on negative sample/distilled water.

Module 4: Smear microscopy: 

Physical Session (8 hours )  

Chapter 4.1 

Collecting and storage of good quality specimen 

Physical (60 mins)

Emphasis Points 

  • Necessary steps in accepting request for TB test; Explain spot and morning samples, necessary steps during specimen receipt at laboratory, storage

Post Session Activity 

  • Role play for collection of sputum sample 

    (Probes- Collect two specimens, patient education, dispensing sputum cup, labelling etc.)

Chapter 4.2 

Sputum smear preparation 

Physical (60 mins)

Emphasis Points 

  •  Steps involved and their details; Do’s and Don’t to be highlighted at each step
  • Emphasis to be given to prepare smear within 6 inches of burning spirit lamp and using other AIC measures (Direction of airflow, position of exhaust fan with respect to working station.

Post Session Activity 

  • May ask the different trainees to enumerate the different steps involved in Smear Microscopy.
  •  May ask the details of individual steps from different participants.
  •  Demonstrate good smears, smear thickness to visualize print through it
  •  

Chapter 4.3 

Staining sputum smear  

Physical (60 mins)

Emphasis Points 

  • Describe staining process-ZN, FM; properties of well stained slide-ZN/FM, importance of quality stains and staining process.

Post Session Activity 

  •  Demonstrate the well stained slides-ZN/FM (dark room)

Chapter 4.4 

Reading smear and reporting microscopy results  

 Physical (60 mins)

Emphasis Points 

  • Steps involved, focusing slides, 
  • Use of Different objective lens, 
  • Paper based reporting in Lab register.
  • Digital reporting in Ni-kshay Diagnostic Module

Post Session Activity 

  • Worksheets to demonstrate and fill paper-based records.
  •  Demonstration on Ni-shay Diagnostic Module (Demo) 
  • May ask one of the participants to generate the DMC register.

Chapter 4.5 

Maintenance of microscope 

Physical (30 mins)

Emphasis Points 

  • Elaborate why storage is essential, steps in cleaning, storage and maintenance of microscope, AMC, troubleshooting. 

Post Session Activity 

  • Demonstrate cleaning of the microscope
  • May also ask some of the participants to demonstrate the handling and storage of microscope. 
  • May also ask the participants about the different problems encountered while handling the microscope and other participants about the causes and the other set of participants about the solutions/ways to fix.

Practical Exercise

The practical exercise should include the demonstration by the trainer first and then practical demonstration by the trainees should follow.

 

Formation of batches: Depending on the availability of infrastructure (Like Size of the room/lab, availability of microscopes, availability of Truenat/CBNAAT machines and the modules therein). 

Planning of exercise- The exercise should suitably be planned well in advance involving the lab technicians and other trainers.

Setting of training hall/Lab- 

  • The Laboratory should be suitably equipped to demonstrate the various equipment, consumables. Requirement of equipment, supplies, reagents, samples, etc should be communicated to the lab incharge beforehand and same should be arranged before the start of the training.

  • The unnecessary items should be removed from the workstation before the training session.

  • The biosafety precautions should be followed meticulously during the demonstration. The spill management kit, etc should be in place to deal with any contingencies.

 

Workflow:

Smear Microscopy: 

The batch of trainees after theoretical discussion and demonstration of various items, equipment and reagents should be taken to lab with strict instructions to maintain all biosafety and IPC measures (including PPEs)

They may be allotted individual workspaces (with samples, broom sticks, spirit lamps, etc) and may start the practical exercises under the supervision of trainers.  

Not more than 3 trainees should be supervised by one trainer at a time. 

 

 

CBNAAT:

 

Truenat:

 

 

 

Module 5: CBNAAT 

(Physical Session: 08 hours)

Chapter 5.1 

CBNAAT as a rapid molecular diagnostic tool 

Physical (60 mins)

Emphasis Points 

  • Key components of CBNAAT, 
  • process overview of CBNAAT
  • consumables required; 
  • in-built controls, 
  • other CBNAAT tests

Post Session Activity 

  • The CBNAAT machine may be demonstrated.
  • The participants may be asked to name and identify the different parts of the CBNAAT machine. 
  • The participants may be asked to identify the different consumables and ways to handle it.
  • May ask the different tests that can be conducted using the CBNAAT equipment.

Chapter 5.2 

Sample processing for CBNAA

Physical (60 mins)

Emphasis Points 

  • Importance of complete sample liquefaction; 
  • processing for EP samples

Post Session Activity 

  • Demonstration of sample processing

  • CBNAAT cartridge loading may be demonstrated to the participants (with emphasis on DOs and Donts)

Chapter 5.3 

 

CBNAAT result interpretation and recording. 

Physical (60 mins)

Emphasis Points 

  • Visualization of results;
  •  Interpretation of results
  • Non-conclusive results-retesting procedure. 
  • Recording of results in Ni-kshay
  • Recording of results in paper-based register

Post Session Activity 

  • Discussion on need for new sample/use of left over sample for retesting.
  • may ask one of the participants to demonstrate Recording of results in Ni-kshay

Chapter 5.4 

Troubleshooting in CBNAAT 

 

Physical (30 mins)

Emphasis Points 

  •  Interfering substances, 
  • Troubleshooting-errors, invalids, hardware problems, test failure without error codes; data backup should be discussed

Post Session Activity 

  • Discuss what troubleshooting is possible in the lab and when technical support is required from the vendor

Chapter 5.5 

Maintenance of CBNAAT 

 

Physical (60 mins)

Emphasis Points 

  • Need for maintenance, frequency, materials required.

Post Session Activity 

  • Prepare and fill log for daily, monthly maintenance.
  Practical Exercise on CBNAAT Physical (180 mins)

Module 6: Truenat 

(Physical Session: 08 hours)

Chapter 6.1 

Truenat as a rapid molecular diagnostic test 

 Physical (45 mins)

Emphasis Points 

  • Context setting and the relevance of the technology.
  • Emphasis that it is an indigenous technology and focus of programme to adopt this technology  
  • Components of Truenat workstation, consumables required, process overview, inbuilt controls
  • Storage conditions of the consumables also need to be discussed

Post Session Activity 

  • The different components may be shown and the importance of each part/component may be discussed
  •  Exercise on forecasting laboratory consumables 
  • The participants may also be asked to explain the Truenat cartridge and importance of different chambers

Chapter 6.2 

Specimen processing for Truenat

 Physical (60 mins)

Emphasis Points 

  •  Importance of cleaning the workstation daily before and after starting the work
  • Importance of sample pre-treatment, liquefaction, processing EP TB samples; DNA extraction; Amplification and Detection
  • importance of complete liquefaction
  • emphasis on critical steps in DNA extraction

Post Session Activity 

  • One participant may be asked to demonstrate the cleaning the workstation(Unidirectional cleaning)
  • Demonstrate the different steps involved in the specimen processing;
  • Discussion with the participants about the Dos and Donts during the specimen processing

Chapter 6.3

Testing using the Truenat

Physical (60 mins)

Emphasis points

  • The different processes should be explained after unloading the cartridge, using autoanalyzer for MTB testing, handling elute, testing for Rif resistance.
  • Emphasis should be on the best practices.

Post session Activity

  • The test can be demonstrated using the negative sample and participants should be given the opportunity to handle the equipment under the guidance and supervision of the trainer.

Chapter 6.4 

Truenat result interpretation and recording. 

 Physical (60 mins)

Emphasis Points 

  • Result visualization and interpretation; Recording-paper based & Ni-kshay

Post Session Activity 

  • How to retrieve test results should be demonstrated. 
  • Discussion on need for new sample/use of leftover sample for retesting

Chapter 6.5 

Troubleshooting in Truenat 

 Physical (30 mins)

Emphasis Points 

  •  Interfering substances, Troubleshooting-errors with Trueprep and Truelab; error classification, test failure without error codes

Post Session Activity 

  • Discuss what troubleshooting is possible in the lab and when technical support is required from the vendor

Chapter 6.6 

Truenat instrument maintenance and record keeping. 

 Physical (30 mins)

Emphasis Points 

Need for maintenance, frequency, materials required; data backup.

Post Session Activity 

Prepare and fill log for daily, weekly, monthly maintenance.

  Practical Exercises on Truenat Duration: 3 hours

Module 7

ENSURING SMOOTH FUNCTIONING OF LAB SERVICES

Physical Session (3 hours)

Chapter 7.1 

Maintaining Supplies of Lab Consumables at DMC; Consumables required at DMC. 

Physical (60 mins)

Emphasis Points

  • Elaborate on consumables requires for sputum collection, slide preparation, staining and examination; stock registers; Technical specifications; Indenting supplies; Preparation of stains-ZN and FM.

 
Post Session activity

  •  Exercise on inventory management for laboratory consumables
  • Some participants may be asked to prepare the reagents following the instruction of the trainer. 
  • The stock register may be shown and some participants may be asked to explain the information fields. 
 

Chapter 7.2

BIOMEDICAL WASTE MANAGEMENT IN A MICROSCOPY LAB

Physical (60 mins)

Emphasis point

  • Segregation of biomedical waste based on color coding of bins
  • What components should be discarded in which bag
  • Preparation and Use of disinfectants for different purposes

Post Session activity

  • Based on discussion, participants should be asked to prepare the line list of all the items to be disposed and the ideal way to dispose it
  •  Exercise on preparation of laboratory disinfectants

Chapter 7.3

Biomedical waste management in a NAAT lab 

Physical (60 mins)

Emphasis Points 

  •  Biosafety requirement; waste collection, disinfection and disposal

Post Session Activity 

  • Based on discussion, participants should be asked to prepare the line list of all the items to be disposed and the ideal way to dispose it- disinfectant type, duration, etc


Module 8: ENSURING QUALITY TB LAB SERVICES AT TDCS 

Physical Session (3 hours)

Chapter 8.1 

General concepts in quality assurance  

Physical (60 mins)

Emphasis Points 

  •  Need for quality, implication of false positives and false negatives, storage of slides, outline of QA processes

Post Session Activity 

  • Ask audience about issues and correction actions taken to maintain quality; 
  • List Good Laboratory Practices

Chapter 8.2 

External Quality Assurance

Physical (60 mins)

Emphasis Points 

OSE, RBRC,  

 

Post Session Activity 

   

Chapter 8.3

External Quality Assurance for NAAT

Physical (60 mins)

Emphasis Points 

Panel testing

 

Post Session Activity 

Envelopes and the content of the envelopes (received from NTI) may be shown.

Demonstrate on EQANAAT portal- how the information has to be shared.

 

Module 9: Infection prevention and control (IPC)     

Virtual Session (2 hours)

Chapter 9.1 

General concepts in IPC 

virtual (60 mins)

Emphasis Points 

  • Need for IPC; standard precautions, 

  • IPC at a DMC and at NAAT sites

Post Session Activity 

  • Demonstration of Respiratory hygiene
  • Demonstration of Hand hygiene
  • A virtual audit of cleaning practices in the lab can be carried out whether the good practices are followed in the participants lab or not

Chapter 9.2 

Airborne infection control 

virtual (60 mins)

Emphasis Points 

  •  Importance of AIC in TB laboratory, hierarchy of controls

Post Session Activity 

  • Demonstrate ventilation as AIC measure
  • Ask participants what administrative measures are taken at their centre for AIC and what actions they may take. They may be asked for some commitment and timelines to follow that.

Module 10: TB treatment and care 

Virtual Session (6 hours)

Chapter 10.1 

General concepts in TB treatment 

Virtual (60 mins)

Emphasis Points 

  • The treatment phases and significance of positive results for microscopy at the follow up testing
  • The importance of counseling for treatment initiation and follow up testing should be emphasized
  • Why testing is important after end of IP and CP and other follow up testing
  • Follow up-including long term follow up and the importance

Post Session Activity 

  • Discussion on need for long term follow up
  • Important components of counseling a TB patient for follow-up testing


 

Chapter 10.2 

ADR

Virtual (30 mins)

Emphasis Points 

  • Identification of some common ADRs due to anti-TB drugs

Post Session Activity 

  • The participants may be asked to enlist the different ADRs

Chapter 10.3

DS-TB Treatment and care

Virtual (30 mins)

Emphasis points

  • FDCs used for the treatment
  • Schedule for followup and end of treatment testing and significance

Post session activity

May clear the doubts/queries of the participants

Chapter 10.4

DR-TB Treatment

Virtual (30 mins)

Emphasis points

  • What is UDST?
  • Classification of DR-TB?
  • Regimens available for DR-TB?
  • Levels of facilities where treatment needs to be initiated.

Post Session activity

  • Ask participants for doubts and help them clear those doubts 

Chapter 10.5

Adherence to TB Treatment

Virtual (30 mins)

Emphasis points

  • Importance of Adherence monitoring
  • Different adherence recording and monitoring technologies

Post session activity

  • May also ask the participants about  the adherence recording in Nikshay and Tb Arogya Sathi Application

Chapter 10.6

Treatment Support

Virtual (30 mins)

Emphasis Points

  • Meaning of Treatment support
  • Significance of Treatment support Plan
  • Treatment Supporter to a Tb patient 
  • Nutritional support and counseling
  • Support for de addiction
  • Free TB Services for TB patient

Post-session Activity

  • The participants may be asked to find the nearest de-addiction facilities located to their place.

Chapter 10.7

TB and comorbidities

Virtual (30 mins)

Emphasis Points

  • Bi directional screening for TB-HIV, TB-Diabetes
  • Need for screening for tobacco and alcohol use among people with TB
  • Nutritional assessment for people with TB.
  • Need for and mechanism of Linkages of people with comorbidity (HIV, Diabetes, Malnutrition, Tobacco and alcoholism)

Post Session activity

  • Ask the participants to describe the existing mechanism at their TU to screen TB among the people visiting ICTC centers - how is the screening being done? How is it  ensured that all those referred for testing have undergone testing? Discuss if there is any scope for improvement.
  • Ask the participant to describe how diabetes testing is done among people with TB in their TU? What are the steps  if a person with TB is found to have diabetes? Who and how is diabetic control ensured for that person? Discuss if there are any ways to improve. 

Chapter 10.8 

TB preventive therapy 

Virtual (30 mins)

Emphasis Points 

  • Eligible people for TPT
  • Testing for TBI
  • Steps for Ruling out active TB before initiating TPT
  • Adherence monitoring and treatment support for those on TPT

Post Session Activity 

Discussions on target population and risk groups

Module 11: PUBLIC HEALTH ACTION  

 

Virtual (1 hour)

Chapter 11.1 

Public Health Actions for TB

 

virtual (60 mins)

Emphasis Points 

  • Why Public Health actions
  • Public Health actions taken after TB notification
  • Define contact tracing and contact investigation.
  • TB education for community
  • Counselling the TB patients and their family.
  • Dos and Don'ts for Tb pateint couonseling

Post Session Activity 

  • May ask any participant to enumerate the PHA
  • May ask participant what do they understand by a specific PHA and its importance
  • May ask the participant for what to counsel at different phases of patient care i.e Pre-treatment, during treatment and post treatment
  • A small role play or conversation to discuss about DOs and don'ts of patient counselling
     

Module 12: SUPPLY CHAIN MANAGEMENT  

 

Virtual (2 hours)

Chapter 12.1 

SUPPLY CHAIN MANAGEMENT IN NTEP

 

Virtual (60 mins)

Emphasis Points 

  • Meaning and significance
  • Broad Principles of SCM
  • Flow of Supplies in NTEP
  • Procurement, its types 
  • GeM, Direct procurement, floating tender in GeM, 
  • Buffer stock, storage norms
  • Nikshay Aushadhi
  • Indenting 
  • Receipt of Supplies

Post Session Activity 

  • May ask any participant to enumerate the the broad principles in SCM
  • May also ask one participant to show how indenting and receipt of supplies is carried out in Nikshay Aushadhi
     

Chapter 12.2 

MAINTAINING SUPPLIES OF LAB CONSUMABLES AT TDC

 

Virtual ( 60 mins)

Emphasis Points 

  •  Lab Consumables
  • Consumables required at DMC
  • Consumables required at NAAT laboratories
  • Stock register and stock assessment at DMC

Post Session Activity 

  • May ask one participant to show how they are updating the stock register

Module 13: Supervision, Monitoring and Evaluation (Virtual Session: 2 hours)

Chapter 13.1 

Supervision 

Virtual (120 mins)

Emphasis Points 

  • Meaning of Supervision
  • Objectives of Supervision
  • Supportive Supervision
  • Role of different stakeholders in Supervision at the TU level
  • Role of STLS at the DMC
  • Monitoring and Evaluation of NAAT labs
  • Quality indicators of CBNAAT and Truenat lab

Post Session Activity 

  •  

Module 14      

Private Sector Engagement

Virtual Session ( 2 hours)

Chapter 14.1          

General Concepts

Virtual (60 mins)

Emphasis Points

  • Why private sector engagement is important and what is the Vision of NTEP on private sector engagement.

  • Explain PPSAs, Direct Option for engagement.

  • Explain STEPS

  • Emphasis on various options under partnership options

  • Regulations of Mandatory TB Notification and Schedule H1

Post Session Activity

  • Recollect Standards of TB Care in India and emphasize that the vision of NTEP with regard to private sector engagement is to ensure STCI to all patients. The choice of where to take treatment remains with the patient. Emphasize that more than the private sector, it is the NTEP who wants to engage with the private sector to ensure that all patients reaching them receive STCI.  Tell that TU is a population and ensuring STCI to all cases emerging from that population is the responsibility of STS. STS can engage the private sector to minimize his/her workload.
  • Ask each of the participants to think what model suits for private sector engagement in their TU and why
  • Discuss how information from schedule H1 could be used? (Clue: Most crucial field in the schedule H1 register is the name of the provider who prescribed it. Information from Schedule H1 register could be used to Identify the provider prescribing the anti TB drugs and prioritize for engagement, Identify missing TB cases)

Module 15

ACSM and Community Engagement

Virtual Session (2 hour)

Chapter 15.1

General Concepts in ACSM

Virtual (60 mins)

Emphasis Points

  • Differentiate clearly among Advocacy, Communication and Social Mobilization
  • Common approaches for ACSM for TB Elimination

Post Session Activity

 

Chapter 15.2

Guidelines and Protocols for ACSM activities

Virtual Session (30 mins)

Emphasis Points

Organising Community Meetings, Peer group interventions, ACSM activities in schools

Post Session Activity

Discuss experiences form 1-2 participants regarding organizing community meetings

Chapter 15.3

Community Engagement

Virtual (30 mins)

Emphasis Points

LSGs and their role in TB Elimination

TB Forums and what they can do

What role can TB Champions play?

Post Session Activity

Discuss what needs to be done to reduce stigma regarding TB in the community. Encourage everybody to discuss.

 

Abhimanyu

Comments

Abhimanyu Mon, 27/02/2023 - 10:40

1. Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for STLS in NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

    Senior TB Laboratory Supervisors

 

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State may decide to choose the approach which is most suitable for their State.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each module. An instructor-led session will also be conducted at the end of each module. This will help the trainees for better clarification of contents and to address the queries and doubts. 

For the training areas which require hand-holding of trainees like demonstration of processes- Specimen collection and transportation, smear microscopy, Using different NAAT, patient workflow in Ni-kshay, maintaining Lab Supplies, etc in-person training sessions need to be conducted.

The training course content has 15 modules and 56 chapters. Based on different modalities used for the training, the training delivery should take at least 40 hours.

For the purpose of assessment of trainees, a pretest before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto-generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes. .


 

 

2. Training curriculum / Agenda

 Sr. 

Module  

Chapters 

Training Modality 

  1. Duration 

(Hrs) 

Basics of TB and NTEP 


 

  1. TB & TB Epidemiology
  2. NTEP
  3. Integration of NTEP with Health System
  4. Patient Management


 

Virtual

4

 

 

TB Diagnosis and case finding in NTEP 

  1. TB Case Finding in NTEP
  2. Diagnostic Technologies
  3. Diagnostic Network and Hierarchy
  4. Approaches to TB Case Finding
  5. Active Case Finding Campaign

 

4

3

Specimen collection and Transportation

  1. General concepts in specimen collection & transportation
  2. Packaging & dispatching sample to a C&DST lab
 

1


 

4

Smear Microscopy

  1. Collection & Storage of Good Quality Specimen
  2. Sputum Smear Preparation
  3. Preparation of Staining solutions
  4. Staining Sputum Smear
  5. Reading Smear and Reporting Microscopy results

 

3

5

CBNAAT

  1. CBNAAT as a Rapid Molecular Diagnostic tool
  2. Sample processing for CBNAAT
  3. CBNAAT Result Interpretation and recording
  4. Troubleshooting in CBNAAT
  5. Maintenance of CBNAAT


 

 

3

Truenat

  1. Truenat as a Rapid Molecular Diagnostic Test
  2. Specimen processing for Truenat
  3. Truenat result Interpretation and recording
  4. Troubleshooting in Truenat
  5. Truenat Instrument maintenance and record keeping

 

3

7

Ensuring Smooth functioning of Lab Services

  1. Biomedical waste management in a microscopy lab
  2. Biomedical waste management in CBNAAT Lab
  3. Biomedical waste management in Truenat lab
  4. Record maintenance


 

 

2

8

Ensuring Quality TB lab services at TDCs

  1. General concepts in quality assurance
  2. External quality assurance


 

 

3

9

Infection Prevention and Control [IPC]

  1. General concepts in IPC
  2. Airborne Infection Control


 

 

1

10

TB Treatment and care

  1. Concepts in TB Treatment
  2. Adverse Drug Reactions with anti-TB Drugs
  3. Documentation of Treatment
  4. Extra Pulmonary TB (EPTB)
  5. Drug Sensitive TB (DS-TB)
  6. Drug Resistant TB (DR-TB)
  7. Follow up of TB patients
  8. Adherence monitoring
  9. Treatment Support
  10. TB & Comorbidities and special situations
  11. TB Preventive Treatment

 

3

9

Public Health Action

  1. Public health actions for TB

 

1

10 

DBT

  1. Overview of DBT
  2. Ni-kshay for DBT

 

1

11 

Supply Chain Management

  1. Supply Chain Management in NTEP
  2. Maintaining Supplies of Lab consumables at TDC


 

 

1

12

Supervision, Monitoring & Evaluation

  1. Supportive supervision
  2. Evaluation


 

 

1

13

Private sector Engagement

  1. Private sector engagement in NTEP
 

1

14

ACSM

  1. Advocacy, Communication & Social Mobilization in NTEP
  2. Community engagement in NTEP
 

2

15

Training

Training the Lab Technicians

 

2

 

3. Trainers

         For this course, following personnel may be appointed as the trainers

  • STDC- Medical Officers
  • IRL Microbiologist
  • EQA Microbiologist
  • NRL Microbiologist
  • WHO consultants

 

Eligibility -

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about TB laboratories and related processes in NTEP. The Trainers should have completed the ‘Course for STLS on NTEP’’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System) and Nik-shay. The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure


 

Guide for Course-coordinator on LMS

Guide for Course-coordinator on LMS

The Course coordinator's guide can be accessed here: 

 

Abhimanyu

Trainers' Guide for CHO/MPW-PHI Course on NTEP

Trainers' Guide for CHO/MPW-PHI Course on NTEP

1. Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for CHO/MPW-PHI on NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

  • Community Health Officers (STationed at AB-HWCs)

  • Multi-purpose workers (stationed at PHI)

 

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State may decide to choose the approach which is most suitable for their State.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each module. An instructor-led session will also be conducted at the end of each module. This will help the trainees for better clarification of contents and to address the queries and doubts.

For the training areas which require handholding of trainees like demonstration of processes- Counselling about Specimen collection, patient workflow in Ni-kshay, etc in-person training sessions need to be conducted.

The training course content has 3 modules and 12 chapters. Based on different modalities used for the training, the training delivery should take at least 8 hours.

For the purpose of assessment of trainees, a pre-test before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes.

The training of CHOs/MPWs needs to be conducted at DTC/Block level wherever adequate facilities are available.

The batch size for Physical Session should not be more than 15 participants and not more than 30 participants for virtual sessions.

2. Training curriculum / Agenda

 Sr. 

Module  

Chapters 

Training Modality 

  1. Duration 

(Hrs) 

BASICS OF TB AND NTEP 

  1. EPIDEMIOLOGY AND BURDEN OF TB
  2. NTEP
  3. GENERAL CONCEPTS IN TB CARE IN INDIA
  4. TB AROGYA SATHI APP

Virtual

4

 

 

TB DIAGNOSIS AND CASE FINDING

  1. DIAGNOSTIC TECHNOLOGIES
  2. DIGNOSTIC NETWORK AND HIERARCHY
  3. APPROACHES TO TB CASE FINDING
  4. TB CASE FINDING IN NTEP

 Virtual

4

3

Specimen collection and Transportation

  1. General concepts in specimen collection & transportation
  2. Packaging & dispatching sample to a C&DST lab
Physical

2


 

4

Smear Microscopy

  1. Collection & Storage of Good Quality Specimen
  2. Sputum Smear Preparation
  3. Preparation of Staining solutions
  4. Staining Sputum Smear
  5. Reading Smear and Reporting Microscopy results
  6. Maintaining Supplies of Lab consumables at DMC

 Physical

8

5

CBNAAT

  1. CBNAAT as a Rapid Molecular Diagnostic tool
  2. Sample processing for CBNAAT
  3. CBNAAT Result Interpretation and recording.
  4. Troubleshooting in CBNAAT
  5. Maintenance of CBNAAT

 Physical

8

Truenat

  1. Truenat as a Rapid Molecular Diagnostic Test
  2. Specimen processing for Truenat
  3. Truenat result Interpretation and recording.
  4. Troubleshooting in Truenat
  5. Truenat Instrument maintenance and record keeping.

 Physical

8

7

Ensuring Smooth functioning of Lab Services

  1. Biomedical waste management in a microscopy lab
  2. Biomedical waste management in CBNAAT Lab
  3. Biomedical waste management in Truenat lab
  4. Record maintenance
Physical

2

8

Ensuring Quality Microscopy

  1. General concepts in quality assurance
  2. External quality assurance 

 Physical

3

9

Infection Prevention and Control [IPC]

  1. General concepts in IPC
  2. Airborne Infection Control
Virtual

1

10

TB TREATMENT, FOLLOW-UP AND PUBLIC HEALTH ACTIONS

  1. GENERAL CONCEPTS IN TB TREATMENT
  2. TB TREATMENT INITIATION AND FOLLOW-UP
  3. TB PREVENTIVE TREATMENT
  4. PUBLIC HEALTH ACTION
  5. TB & Comorbidities and special situations
  6. TREATMENT ADHERENCE

 Virtual

3

9

INTERACTING WITH PATIENTS

  1. COUNSELLING FOR COLLECTING SPUTUM SPECIMEN
  2. COMMUNICATING RESULTS TO THE PATIENT
  3. COUNSELLING THE TB PATIENTS
  4. STIGMA, DISCRIMINATION AND GENDER SENSITIVITY

 virtual

3

 3. Trainers

         For this course, following personnel may be appointed as the trainers

  • DTO
  • STLS

 Eligibility -

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about TB laboratories and related processes in NTEP. The Trainers should have completed the ‘Course for LT(Microscopy & NAAT) on NTEP’’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System) and Nik-shay. The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure

Chapter wise detailed instructions for Trainers 

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

  • Module-wise and Chapter-wise, modality that may be adopted (virtual/ Physical/ In-person)
  • The estimated time to complete the content.
  • The key messages that a trainer should emphasize upon, while delivering the training
  • The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

 

Abhimanyu

[Draft] Trainers' Guide for LT (Microscopy & NAAT)

[Draft] Trainers' Guide for LT (Microscopy & NAAT)

1. Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for Lab Technicians (Microscopy & NAAT) on NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

    Laboratory technicians (Microscopy & NAAT) working under NTEP (program staff and General health system staff)

 

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State may decide to choose the approach which is most suitable for their State.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each module. An instructor-led session will also be conducted at the end of each module. This will help the trainees for better clarification of contents and to address the queries and doubts. 

For the training areas which require hand-holding of trainees like demonstration of processes- Specimen collection and transportation, smear microscopy, Using different NAAT, patient workflow in Ni-kshay, maintaining Lab Supplies, etc in-person training sessions need to be conducted.

The training course content has  modules and 56 chapters. Based on different modalities used for the training, the training delivery should take at least 45 hours.

For the purpose of assessment of trainees, a pre-test before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes.

The training of LTs needs to be conducted at DTC where the required lab facilities are available.

The batch size for Physical Session should not be more than 7 participants and not more than 15 participants for virtual sessions.

2. Training curriculum / Agenda

 Sr. 

Module  

Chapters 

Training Modality 

  1. Duration 

(Hrs) 

BASICS OF TB AND NTEP 

  1. EPIDEMIOLOGY AND BURDEN OF TB
  2. NTEP
  3. GENERAL CONCEPTS IN TB CARE IN INDIA
  4. TB AROGYA SATHI APP

Virtual

4

 

 

TB DIAGNOSIS AND CASE FINDING

  1. DIAGNOSTIC TECHNOLOGIES
  2. DIGNOSTIC NETWORK AND HIERARCHY
  3. APPROACHES TO TB CASE FINDING
  4. TB CASE FINDING IN NTEP

 Virtual

4

3

Specimen collection and Transportation

  1. General concepts in specimen collection & transportation
  2. Packaging & dispatching sample to a C&DST lab
Physical

2


 

4

Smear Microscopy

  1. Collection & Storage of Good Quality Specimen
  2. Sputum Smear Preparation
  3. Preparation of Staining solutions
  4. Staining Sputum Smear
  5. Reading Smear and Reporting Microscopy results
  6. Maintaining Supplies of Lab consumables at DMC

 Physical

8

5

CBNAAT

  1. CBNAAT as a Rapid Molecular Diagnostic tool
  2. Sample processing for CBNAAT
  3. CBNAAT Result Interpretation and recording.
  4. Troubleshooting in CBNAAT
  5. Maintenance of CBNAAT

 Physical

8

Truenat

  1. Truenat as a Rapid Molecular Diagnostic Test
  2. Specimen processing for Truenat
  3. Truenat result Interpretation and recording.
  4. Troubleshooting in Truenat
  5. Truenat Instrument maintenance and record keeping.

 Physical

8

7

Ensuring Smooth functioning of Lab Services

  1. Biomedical waste management in a microscopy lab
  2. Biomedical waste management in CBNAAT Lab
  3. Biomedical waste management in Truenat lab
  4. Record maintenance
Physical

2

8

Ensuring Quality Microscopy

  1. General concepts in quality assurance
  2. External quality assurance 

 Physical

3

9

Infection Prevention and Control [IPC]

  1. General concepts in IPC
  2. Airborne Infection Control
Virtual

1

10

TB TREATMENT, FOLLOW-UP AND PUBLIC HEALTH ACTIONS

  1. GENERAL CONCEPTS IN TB TREATMENT
  2. TB TREATMENT INITIATION AND FOLLOW-UP
  3. TB PREVENTIVE TREATMENT
  4. PUBLIC HEALTH ACTION
  5. TB & Comorbidities and special situations
  6. TREATMENT ADHERENCE

 Virtual

3

9

INTERACTING WITH PATIENTS

  1. COUNSELLING FOR COLLECTING SPUTUM SPECIMEN
  2. COMMUNICATING RESULTS TO THE PATIENT
  3. COUNSELLING THE TB PATIENTS
  4. STIGMA, DISCRIMINATION AND GENDER SENSITIVITY

 virtual

3

 

3. Trainers

         For this course, following personnel may be appointed as the trainers

  • DTO
  • STLS

 Eligibility -

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about TB laboratories and related processes in NTEP. The Trainers should have completed the ‘Course for LT(Microscopy & NAAT) on NTEP’’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System) and Nik-shay. The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure

Chapter wise detailed instructions for Trainers 

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

  • Module-wise and Chapter-wise, modality that may be adopted (virtual/ Physical/ In-person)
  • The estimated time to complete the content.
  • The key messages that a trainer should emphasize upon, while delivering the training
  • The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

 

Module 1: Basics of TB and NTEP                                              Virtual Session (4 hours)

Chapter 1.1

TB & TB Epidemiology

Virtual Session (60 min)

Emphasis Points

  • Differences between TB Infection and active TB Disease
  • TB has many determinants- behavioral, socio economic, biological
  • Vulnerable population for TB
  • Concepts of TB Notification Rate and TB Incidence Rate

Post Session Activity

  • The participants may be asked to (i) enumerate the various determinants of TB and (ii) difference between TB Infection and TB Disease 
  • Give an exercise to calculate the Notification rate of a TU. In a TU with a population of 2 lakhs, 100 TB cases were diagnosed and reported during the year 2022.. A total of 90 people with TB were initiated on treatment, 5 died and  2 migrated  before initiation of treatment.and 3 could not be contacted at all. What is the annual TB notification rate for that TU in 2021? [ Answer: 50 per lakh]
  • Discuss - Can we call the above obtained Notification figure as the incidence of TB in that TU? If not Why? [Discussion Points: Notification and Incidence are not the same. Notification includes all diagnosed TB cases and reported to the system. It includes both new and previously treated cases. There may be cases diagnosed, but not reported. It is possible that there will be cases in the community not diagnosed at all.]    

Chapter 1.2

NTEP

Virtual Session (45 min)

Emphasis Points

  • Explain what India is committed to achieve in 2025 in relation to SDG related to ending TB. Clarify that the country has preponed the 2030 SDG targets related to ending TB to 2025.
  • Organizational structure of NTEP with broad functions of each institution (state level and below)
  • Different stages in the patient’s life cycle need to be explained in detail and emphasis on the concept of continuum of care from ‘presumptive TB to post treatment follow up’.
  • Concepts of ‘’Standards of TB Care’’ as a minimum set of care that every citizen in India should receive irrespective of where he/she seeks care from

Post Session Activity

  • Discuss- ‘What India is committed to achieve in 2025 in relation to ending TB?’’ [Clarify that the country is only trying to achieve the SDG goals related to Ending TB]
  • Discuss- ‘Can Medical College be a PHI?’

Chapter 1.3

Integration of NTEP with Health System  

Virtual Session (30 mins)

Emphasis Points

  • Need for integration of NTEP with the general health system & NHM and how that integration is envisioned. 

Post Session Activity

  • Discuss - "What are the opportunities available to NTEP through Health & Wellness Centers? How could that be materialized’?

Chapter 1.4

Patient Management

Virtual Session (60 mins)

Emphasis Points

How the information of patients are managed through Ni-kshay (Enrollment, Request for Test). 

Post Activity Session

Call two participants to demonstrate how they (1) enroll a subject and (2) request for Test in Ni-kshay

Make all participants to view their task list in Ni-kshay and discuss how they are going to use the feature

Module 2

TB Diagnosis and Case Finding

Virtual Session (4 hours)

Chapter 2.1

Diagnostic Technologies

Virtual Session (30 min)

Emphasis Points

  • Names of different tests, their uses, advantages and disadvantages

Post Session Activity

  • Ask what are the advantages and disadvantages of FL- LPA over NAAT?

Chapter 2.2

Diagnostic Network & Hierarchy

Virtual Session (30 min)

Emphasis Points

  • Network and hierarchy of laboratories and their basic role

Post Session Activity

  • Ask “ how many sputum collection and transportation facilities are there in their concerned TU? Make one participant explain how it functions and what are the benefits out of it”?- Bring out the following benefits (1) prevents leaks in cascade of care (reduce loss from presumptive TB identification to TB Testing)  (2) minimizes patient inconveniences (3) minimize patient Turnaround Time (4) reduce out of pocket expenditure (5) helps in infection control as people with symptoms need not travel

Chapter 2.3

Approaches to TB Case Finding

Virtual Session (30 min)

Emphasis Points

  • Differentiate between screening and testing. 
  • The three approaches may be discussed by giving suitable examples to fit into the three scenarios

Post Session Activity

  • Discuss the following scenarios and ask the participants which case finding those are

(i) Screening for active TB in a Diabetic Clinic & testing those who screened positive

(ii) Screening for active TB in an elderly home & testing those who screened positive

(iii) Screening for active TB in cancer wards & testing those who screened positive

Chapter 2.4

TB Case Finding in NTEP

Virtual Session (30 min)

Emphasis Points

Diagnostic algorithm for Pulmonary TB- Role of Chest X ray as a screening tool and the need to complete the diagnostic algorithm.

Classification of TB on the basis of site,diagnosis, drug resistance

 

Post Session Activity

 Discuss: “What proportion of presumptive TB patients in your TU completes the diagnostic algorithm? What are the implications if the people are not completing the diagnostic algorithm?”

 

Chapter 2.5

Active Case Finding Campaign

Virtual Session(45 mins)

Emphasis Points

Step by step process in planning and execution of an ACF campaign with special emphasis on identification of target population, need for micro planning and need to prevent the leaks in the cascade of care.

Post Session Activity

Discuss how they monitor the ACF in their TU against ‘Cascade of Care? What are the measures they undertake to prevent the leaks in ‘’Cascade of care’’? 

Module 3: Specimen collection and transportation Virtual Session 

(Physical Session: 2 hour)

Chapter 3.1 

General concepts in SCT

Virtual (45 mins)

Emphasis Points 

  • Need for transportation of specimen.
  • Modes of transportation employed.
  • The Process of Sputum collection
  • Requirement for Cold chain
  • The different items may be shown. 

Post Session Activity 

  • The participants may be asked to identify different items and the specification- Eg Thermocol box size, falcon tube size, etc. 

Chapter 3.2

Packaging and dispatching a sample to a C&DST lab 

Virtual (45 mins)

Emphasis Points 

  • Triple layer packaging, cold/cool chain; specimen transport carriers-technical specifications and labeling; dispatch of samples-Ni-kshay 

Post Session Activity 

  • One participant may be asked to add test request(dispatching the sample to CDST lab) in Ni-kshay
  • Few participants may be asked to demonstrate the triple layer packaging on negative sample/distilled water.

Module 4: Smear microscopy: Physical Session (8 hours ) 

 

Chapter 4.1 

Collecting and storage of good quality specimen 

Physical (45 mins)

Emphasis Points 

  • Necessary steps in accepting request for TB test; Explain spot and morning samples, necessary steps during specimen receipt at laboratory, storage

Post Session Activity 

  • Role play to collect two specimens-patient education, dispensing sputum cup, labelling etc.

Chapter 4.2 

Sputum smear preparation 

Physical (60 mins)

Emphasis Points 

  •  Steps involved and their details; Do’s and Don’t to be highlighted at each step
  • Emphasis to be given to prepare smear within 6 inches of burning spirit lamp and using other AIC measures (Direction of airflow, position of exhaust fan with respect to working station.

Post Session Activity 

  • May ask the different trainees to enumerate the different steps involved in Smear Microscopy.
  •  May ask the details of individual steps from different participants.
  •  Demonstrate good smears, smear thickness to visualize print through it
  •  

Chapter 4.3 

Staining sputum smear  

Physical (60 mins)

Emphasis Points 

  • Describe staining process-ZN, FM; properties of well stained slide-ZN/FM, importance of quality stains and staining process

Post Session Activity 

  •  Demonstrate the  well stained slides-ZN/FM (dark room)

Chapter 4.4 

Reading smear and reporting microscopy results  

 Physical (45 mins)

Emphasis Points 

  • Steps involved; focusing slides, 
  • different objective lens, 
  • paper based reporting in Lab register
  • Digital reporting in Ni-kshay Diagnostic Module

Post Session Activity 

  • Worksheets to demonstrate and fill paper-based records;
  •  Demonstration on Ni-shay Diagnostic Module(Demo) 
  • May ask one of the participant to generate the DMC register

Chapter 4.5 

Maintenance of microscope 

Physical (30 mins)

Emphasis Points 

  • Elaborate why storage is essential, steps in cleaning, storage and maintenance of microscope, AMC, troubleshooting. 

Post Session Activity 

  • Demonstrate cleaning of the microscope
  • May also ask some of the participants to demonstrate the handling and storage of microscope. 
  • May also ask the participants about the different problems encountered while handling the microscope and other participants about the causes and the other set of participants about the solutions/ways to fix.

Chapter 4.6 

Maintaining Supplies of Lab Consumables at DMC; Consumables required at DMC. 

Physical (60 mins) 

Emphasis Points

  •  Elaborate on consumables requires for sputum collection, slide preparation, staining and examination; stock registers; Technical specifications; Indenting supplies; Preparation of stains-ZN and FM

Post Session activity

  •  Exercise on inventory management for laboratory consumables
  • Some participants may be asked to prepare the reagents following the instruction of the trainer. 
  • The stock register may be shown and some participants may be asked to explain the information fields. 

Practical Exercise

The practical exercise should include the demonstration by the trainer first and then practical demonstration by the trainees should follow.

 

Formation of batches: Depending on the availability of infrastructure (Like Size of the room/lab, availability of microscopes, availability of Truenat/CBNAAT machines and the modules therein). 

Planning of exercise- The exercise should suitably be planned well in advance involving the lab technicians and other trainers.

Setting of training hall/Lab- 

  • The Laboratory should be suitably equipped to demonstrate the various equipment, consumables. Requirement of equipment, supplies, reagents, samples, etc should be communicated to the lab incharge beforehand and same should be arranged before the start of the training.

  • The unnecessary items should be removed from the workstation before the training session.

  • The biosafety precautions should be followed meticulously during the demonstration. The spill management kit, etc should be In place to deal with any contingencies.

 

Workflow:

Smear Microscopy: 

CBNAAT:

Truenat:

 

 

 

Module 5: CBNAAT (Virtual session XX min)

Chapter 5.1 

CBNAAT as a rapid molecular diagnostic tool 

 

Emphasis Points 

  • Key components of CBNAAT, 
  • process overview of CBNAAT
  • consumables required; 
  • in-built controls, 
  • other CBNAAT tests

Post Session Activity 

  • The CBNAAT machine may be demonstrated.
  • The participants may be asked to name and identify the different parts of the CBNAAT machine 
  • The participants may be asked to identify the different consumables and ways to handle it.
  • May ask the different tests that can be conducted using the CBNAAT equipment

Chapter 5.2 

 

Sample processing for CBNAAT  

 

Emphasis Points 

  • Importance of complete sample liquefaction; 
  • processing for EP samples

Post Session Activity 

  • Demonstration of sample processing

  • CBNAAT cartridge loading may be demonstrated to the participants.


 

Chapter 5.3 

 

CBNAAT result interpretation and recording 

 

Emphasis Points 

  • Visualization of results;
  •  Interpretation; 
  • Non-conclusive results-retesting procedure; 
  • Recording of results in paper based register and in Ni-kshay

Post Session Activity 

  • Discussion on need for new sample/use of left over sample for retesting

Chapter 5.4 

Troubleshooting in CBNAAT 

 

 

Emphasis Points 

  •  Interfering substances, 
  • Troubleshooting-errors, invalids, hardware problems, test failure without error codes; data backup should be discussed

Post Session Activity 

  • Discuss what troubleshooting is possible in the lab and when technical support is required from the vendor

Chapter 5.5 

Maintenance of CBNAAT 

 

 

Emphasis Points 

  • Need for maintenance, frequency, materials required

Post Session Activity 

  • Prepare and fill log for daily, monthly maintenance

Module 6: Truenat (Virtual session XX min)

Chapter 6.1 

Truenat as a rapid molecular diagnostic test 

 

Emphasis Points 

  • Context setting and the relevance of the technology.
  • Emphasis that it is an indigenous technology and focus of programme to adopt this technology  
  • Components of Truenat workstation, consumables required, process overview, inbuilt controls
  • Storage conditions of the consumables also need to be discussed

Post Session Activity 

  • The different components may be shown and the importance of each part/component may be discussed
  •  Exercise on forecasting laboratory consumables 
  • The participants may also be asked to explain the Truenat cartridge and importance of different chambers

Chapter 6.2 

Specimen processing for Truenat

 

Emphasis Points 

  •  Importance of cleaning the workstation daily before and after starting the work
  • Importance of sample pre-treatment, liquefaction, processing EP TB samples; DNA extraction; Amplification and Detection
  • importance of complete liquefaction
  • emphasis on critical steps in DNA extraction

Post Session Activity 

  • One participant may be asked to demonstrate the cleaning the workstation(Unidirectional cleaning)
  • Demonstrate the different steps involved in the specimen processing;
  • Discussion with the participants about the Dos and Donts during the specimen processing

Chapter 6.3

Testing using the Truenat

 

Emphasis points

  • The different processes should be explained after unloading the cartridge, using autoanalyzer for MTB testing, handling elute, testing for Rif resistance.
  • Emphasis should be on the best practices.

Post session Activity

  • The test can be demonstrated using the negative sample and participants should be given the opportunity to handle the equipment under the guidance and supervision of the trainer.

Chapter 6.4 

Truenat result interpretation and recording. 

 

Emphasis Points 

  • Result visualization and interpretation; Recording-paper based & Ni-kshay

Post Session Activity 

  • How to retrieve test results should be demonstrated. 
  • Discussion on need for new sample/use of leftover sample for retesting

Chapter 6.5 

Troubleshooting in Truenat 

 

Emphasis Points 

  •  Interfering substances, Troubleshooting-errors with Trueprep and Truelab; error classification, test failure without error codes

Post Session Activity 

  • Discuss what troubleshooting is possible in the lab and when technical support is required from the vendor

Chapter 6.6 

Truenat instrument maintenance and record keeping. 

 

Emphasis Points 

Need for maintenance, frequency, materials required; data backup.

Post Session Activity 

Prepare and fill log for daily, weekly, monthly maintenance.

Module 7

ENSURING SMOOTH FUNCTIONING OF LAB SERVICES

 

Chapter 7.1

BIOMEDICAL WASTE MANAGEMENT IN A MICROSCOPY LAB

 

Emphasis point

  • Segregation of biomedical waste based on color coding of bins
  • What components should be discarded in which bag
  • Preparation and Use of disinfectants for different purposes

Post Session activity

  • Based on discussion, participants should be asked to prepare the line list of all the items to be disposed and the ideal way to dispose it
  •  Exercise on preparation of laboratory disinfectants

Chapter 7.2

Biomedical waste management in a NAAT lab 

 

Emphasis Points 

  •  Biosafety requirement; waste collection, disinfection and disposal

Post Session Activity 

  • Based on discussion, participants should be asked to prepare the line list of all the items to be disposed and the ideal way to dispose it- disinfectant type, duration, etc


Module 8: ENSURING QUALITY TB LAB SERVICES AT TDCS (Virtual session XX min) 

Chapter 8.1 

General concepts in quality assurance  

 

Emphasis Points 

  •  Need for quality, implication of false positives and false negatives, storage of slides, outline of QA processes

Post Session Activity 

  • Ask audience about issues and correction actions taken to maintain quality; 
  • List Good Laboratory Practices

Chapter 8.2 

External Quality Assurance

 

Emphasis Points 

OSE, RBRC,  

Post Session Activity 

 

Module 9: Infection prevention and control (IPC)         Virtual Session (xx min) 

Chapter 9.1 

General concepts in IPC 

 

Emphasis Points 

  • Need for IPC; standard precautions, 

  • IPC at a DMC and at NAAT sites

Post Session Activity 

  • Demonstration of Respiratory hygiene
  • Demonstration of Hand hygiene
  • A virtual audit of cleaning practices in the lab can be carried out whether the good practices are followed in the participants lab or not

Chapter 9.2 

Airborne infection control 

 

Emphasis Points 

  •  Importance of AIC in TB laboratory, hierarchy of controls

Post Session Activity 

  • Demonstrate ventilation as AIC measure
  • Ask participants what administrative measures are taken at their centre for AIC and what actions they may take. They may be asked for some commitment and timelines to follow that.

Module 10: TB treatment and care (Virtual session XX min)

Chapter 10.1 

General concepts in TB treatment 

 

Emphasis Points 

  • The treatment phases and significance of positive results for microscopy at the follow up testing
  • The importance of counseling for treatment initiation and follow up testing should be emphasized
  • Why testing is important after end of IP and CP and other follow up testing
  • Follow up-including long term follow up and the importance

Post Session Activity 

  • Discussion on need for long term follow up
  • Important components of counseling a TB patient for follow-up testing


 

Chapter 10.2 

ADR

 

Emphasis Points 

  • Identification of some common ADRs due to anti-TB drugs

Post Session Activity 

  • The participants may be asked to enlist the different ADRs

Chapter 10.3

DS-TB Treatment and care

 

Emphasis points

  • FDCs used for the treatment
  • Schedule for followup and end of treatment testing and significance

Post session activity

May clear the doubts/queries of the participants

Chapter 10.4

DR-TB Treatment

 

Emphasis points

  • What is UDST?
  • Classification of DR-TB?
  • Regimens available for DR-TB?
  • Levels of facilities where treatment needs to be initiated.

Post Session activity

  • Ask participants for doubts and help them clear those doubts 

Chapter 10.5

Adherence to TB Treatment

 

Emphasis points

  • Importance of Adherence monitoring
  • Different adherence recording and monitoring technologies

Post session activity

  • May also ask the participants about  the adherence recording in Nikshay and Tb Arogya Sathi Application

Chapter 10.6

Treatment Support

 

Emphasis Points

  • Meaning of Treatment support
  • Significance of Treatment support Plan
  • Treatment Supporter to a Tb patient 
  • Nutritional support and counseling
  • Support for de addiction
  • Free TB Services for TB patient

Post-session Activity

  • Assigning a Treatment supporter to a patient in Niskahy may be demonstrated
  • The participants may be asked to find the nearest de-addiction facilities located to their place


 

Chapter 10.7

TB and comorbidities

 

Emphasis Points

  • Bi directional screening for TB-HIV, TB-Diabetes
  • Need for screening for tobacco and alcohol use among people with TB
  • Nutritional assessment for people with TB.
  • Need for and mechanism of Linkages of people with comorbidity (HIV, Diabetes, Malnutrition, Tobacco and alcoholism)

Post Session activity

  • Ask the participants to describe the existing mechanism at their TU to screen TB among the people visiting ICTC centers - how is the screening being done? How is it  ensured that all those referred for testing have undergone testing? Discuss if there is any scope for improvement.
  • Ask the participant to describe how diabetes testing is done among people with TB in their TU? What are the steps  if a person with TB is found to have diabetes? Who and how is diabetic control ensured for that person? Discuss if there are any ways to improve. 

Chapter 10.8 

TB preventive therapy 

 

Emphasis Points 

  • Eligible people for TPT
  • Testing for TBI
  • Steps for Ruling out active TB before initiating TPT
  • Adherence monitoring and treatment support for those on TPT

Post Session Activity 

Discussions on target population and risk groups

Module 11: PUBLIC HEALTH ACTION  

 

Chapter 11.1 

Public Health Actions for TB

 

 

Emphasis Points 

  • Why Public Health actions
  • Public Health actions taken after TB notification
  • Define contact tracing and contact investigation.
  • TB education for community
  • Counselling the TB patients and their family.
  • Dos and Don'ts

Post Session Activity 

  • May ask any participant to enumerate the PHA
  • May ask participant what do they understand by a specific PHA and its importance
  • May ask the participant for what to counsel at different phases of patient care i.e Pre-treatment, during treatment and post treatment
  • A small role play or conversation to discuss about DOs and don'ts of patient counselling
     

Module 12: SUPPLY CHAIN MANAGEMENT  

 

Chapter 12.1 

SUPPLY CHAIN MANAGEMENT IN NTEP

 

 

Emphasis Points 

  • Meaning and significance
  • Broad Principles of SCM
  • Flow of Supplies in NTEP
  • Procurement, its types 
  • GeM, Direct procurement, floating tender in GeM, 
  • Buffer stock, storage norms
  • Nikshay Aushadhi
  • Indenting 
  • Receipt of Supplies

Post Session Activity 

  • May ask any participant to enumerate the the broad principles in SCM
  • May also ask one participant to show how indenting and receipt of supplies is carried out in Nikshay Aushadhi
     

Chapter 12.2 

MAINTAINING SUPPLIES OF LAB CONSUMABLES AT TDC

 

 

Emphasis Points 

  •  Lab Consumables
  • Consumables required at DMC
  • Consumables required at NAAT laboratories
  • Stock register and stock assessment at DMC

Post Session Activity 

  • May ask one participant to show how they are updating the stock register.
  •  

Module 13: Supervision, Monitoring and Evaluation

Chapter 13.1 

Supervision

Emphasis Points 

  • Meaning of Supervision
  • Objectives of Supervision
  • Supportive Supervision
  • Role of different stakeholders in Supervision at the TU level
  • Role of STLS at the DMC
  • Monitoring and Evaluation of NAAT labs
  • Quality indicators of CBNAAT and Truenat lab

Post Session Activity 

  •  

Module 14      

Private Sector Engagement

Chapter 14.1          

General Concepts

Emphasis Points

  • Why private sector engagement is important and what is the Vision of NTEP on private sector engagement

  • Explain PPSAs, Direct Option for engagement.

  • Explain STEPS

  • Emphasis on various options under partnership options

  • Regulations of Mandatory TB Notification and Schedule H1

Post Session Activity

  • Recollect Standards of TB Care in India and emphasize that the vision of NTEP with regard to private sector engagement is to ensure STCI to all patients. The choice of where to take treatment remains with the patient. Emphasize that more than the private sector, it is the NTEP who wants to engage with the private sector to ensure that all patients reaching them receive STCI.  Tell that TU is a population and ensuring STCI to all cases emerging from that population is the responsibility of STS. STS can engage the private sector to minimize his/her workload.
  • Ask each of the participants to think what model suits for private sector engagement in their TU and why
  • Discuss how information from schedule H1 could be used? (Clue: Most crucial field in the schedule H1 register is the name of the provider who prescribed it. Information from Schedule H1 register could be used to Identify the provider prescribing the anti TB drugs and prioritize for engagement, Identify missing TB cases)

Module 15

ACSM and Community Engagement

Chapter 15.1

General Concepts in ACSM

Emphasis Points

  • Differentiate clearly among Advocacy, Communication and Social Mobilization
  • Common approaches for ACSM for TB Elimination

Post Session Activity

 

Chapter 15.2

Guidelines and Protocols for ACSM activities

Emphasis Points

Organising Community Meetings, Peer group interventions, ACSM activities in schools

Post Session Activity

Discuss experiences form 1-2 participants regarding organizing community meetings

Chapter 15.3

Community Engagement

Emphasis Points

LSGs and their role in TB Elimination

TB Forums and what they can do

What role can TB Champions play?

Post Session Activity

Discuss what needs to be done to reduce stigma regarding TB in the community. Encourage everybody to discuss.

 

Abhimanyu

[Draft] Trainers' Guide for Program Manager's course

[Draft] Trainers' Guide for Program Manager's course

[Draft] Trainers' Guide for Program Manager's course


 

Abhimanyu

Pillar 3: Supervision, Monitoring and Evaluation of training

Pillar 3: Supervision, Monitoring and Evaluation of training

This component provides guidance to program managers on how

  1. to monitor the status and performance of training
  2. to link up routine supervision of on ground activities and staff along with identification of training need
  3. to evaluate delivery of training in terms of quality and efficiency of processes. 

This section is being expanded and updated.

ManuMathew

Principles of Training Evaluation

Principles of Training Evaluation

The most widely used training evaluation method is the one provided by Donand Kirkpatric in 1959 & 1998 to assess the effects and impact of training programme at four different levels. These levels are arranged in the order of improvement in the desired work output by the individual due to training.

Level Component Objective Measure
I Reaction Participants satisfaction
II Learning Change in knowledge, skills & attitudes of the participants
III Behaviour Measuring the behavioural change in the participant
IV Results Assessing the impact of the training

Level-I Reaction Evaluation: 

The assessment of immediate effect of the training programme that need to be evaluated during or immediately after the training session. This will be ensured by providing a session evaluation checklist after each session in the training.  This can be implemented at two levels either orally or by written feedback. Immediately after each session separately or at the end of the day separately for each session / combined as per the objectives of the day’s schedule.

Date & Time of the session:  
Topic / Title:  
Faculty:  
A. Objective evaluation: Response
Very poor Poor Average Good Very good
1. The topic was relevant to me          
2. The topic was relevant to its contents          
3.Appropriate knowledge of the facilitator/ presenter          
4. Clarity in the facilitation/ presentation          
5. The contents of the discussion/ presentation were appropriate          
6. The contents were adequately covered           
7. Participant interaction : Aroused interest of the participant          
8. Participant interaction: Allowed participant questions           
B. Qualitative evaluation: Response
Enlist two best things of the session, you like most?

 

 

Enlist two important things you suggest for improvement?  
C: Overall Evaluation: Grade the overall performance of the presentation on 1-5 scale as above.
Very poor (1) Poor (2) Average(3) Good(4) Very good(5)

Level-II Learning: 

This type of evaluation is commonly performed by pre/post-test evaluation. A framed set of questions are put forth to the participants before they are exposed to any of the course content. This is pre-test evaluation. Pre-test evaluation provides valuable information about the status of knowledge and attitudes of the participants before attending the training programme. Then they are exposed to the training as per the schedule. At the end of the course again the same set of questions are provided to the participants and their scores are tallied to assess the performance of the training programme with respect to the knowledge and perception/attitudes of each of the participant. 
Following is the checklist for pre/post-test evaluation of the training programme to assess the performance of the programme. 

  1. The pre/post-test evaluation is to be done for assessment of the training programme and should never be viewed as the performance of the participant.
  2. The pre/post test questions should be alike and it should not differ, so as to evaluate the performance of individual trainee based on their performance before and after the training programme.
  3. The pre/post test questions should contain proportional representation of the course contents. Such questions can be derived from the curriculum contents as provided in the training design component of this document.
  4. The pre/post test questions should be in the form of multiple-choice questions (MCQ). These questions should be pretested and validated for quality and contents. Item analysis should be performed for the set of questions being used in the questionnaire.  
  5. The pre/post test questions should be based on the contents taught in the session, however some logical interpretations out of the didactic sessions can be expected but number of such questions should be only a few. 

The questions in the pre/post-test questionnaire need to be updated frequently. 10% revision of the questions according to the operational programme modifications being done time to time can be adjusted in the course contents as well as in the evaluation formats. Many times, it is felt that the participants should learn everything. Unfortunately, it is not possible to learn everything! Knowledge of human body and medicine, understanding of traditions and ways of behaving in a society, skills in administration and in educational methods are all relevant to health care staff. Learning all that is known in all of these fields would be beyond the scope of the most able student in the largest course.  Therefore, the choice has to be made about what details should be left out of the course. It is simply not possible to learn everything that is known about medical sciences and health care. So, some selection is essential.
The content evaluation of any session needs to be designed based upon:

  1. Work profile of the participant in the implementation of the programme.
  2. The expected level of improvement from the participant
Image
Training Evaluation- Level 2

To fulfil the above needs the technical content evaluation sheet require to be covering the must know, desirable to know and nice to know topics in appropriate proportions.  
The contents of any training session should address the need of the participants. 70% proportion of the content evaluation sheet should contain the basic programme expectation from the participant, which is the most important expected gain from the participant, desirable gain and nice to gain the knowledge need 20% and 10% proportion in the evaluation.

Level-III Behaviour: 

To assess the behaviour, change in the participants of the training programme, they should be allowed to work in their specified location and position. The performance of the worker in the field after the training programme can also be assessed by an assessment questionnaire. Such evaluation should be preferably carried out after 6-12 months of the training programme. The behaviour change assessment can only be performed with the cooperation from the supervisor of the person to be evaluated. To avoid subjective bias in the assessment of the behaviour change in the training participant, supervisors of the trainee can be blinded by the exact questions of evaluation. But the assessment of effectiveness of the training programme should invariably include the supervisor’s perception about the individual’s performance before and after the training programme in a positive manner.  Such evaluation can be performed based on several activities of the health personnel such as case finding activities, treatment compliance etc. Behavioural performance assessment can be done in two stages. 

  • Stage 1: Self-assessment of the performance: In this evaluation the individual is asked to assess his/her own performance with respect to contribution to various components of the programme. E.g., case finding, ensuring treatment compliance, stigma reduction in the community, patient education on DOT etc. This set of activities are pre designed into as per known enlisted components of the programme and individual contribution to these components.
  • Stage 2. Assessment by the supervisor: The assessment of the performance of an individual with respect to the self-assessment of the contribution towards various programme components. To avoid subjective bias the performance of several other individuals (employees) also can be asked.

The common observations between the self-assessment and supervisor’s assessment are enlisted and graded for further evaluation.  The pre and post training behavioural change can be noted and assessed for further evaluation of training. The requirement of training of an individual can be assessed based on the performance, weaker areas need to be identified and improved subsequently.
 

Level-IV: Result/ Impact
The ultimate impact of the training programme can also be assessed in the form of several indicators. This type of evaluation should be carried out every 6-12months. Performance of the trainees field area can be assessed by various indicators such as number of cases detected before the training and 12 months or more after the training keeping in mind the targets fixed for each area, proportion of paediatric cases among new cases detected and various other indicators listed in the training module. Initially these cases may increase due to detection of more cases due to training of the individual but eventually over a period of time the number of cases detected will decrease. Service components also will be increased such as proportion of private practitioners sensitised, proportion of total general out patients referred for testing, positivity rate, number of practitioners and subordinate staff trained etc. the implementation of innovative approaches for addressing specific field level problems required to be identified and appraised accordingly.

The National level Institutions/ CTD will assess the level III and level IV performance, while level I and level II performance need to be assessed at the respective training sites. The formats for the evaluation at the institution level should be in consultation with the training team as listed above. 

ManuMathew