Annexures

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

Guide for Course-coordinators on LMS
Cadre-wise Trainers' manual for different courses.
1. Trainers' Guide for Pharmacists (SDS & DDS) Course
2. Trainers' Guide for Health Volunteers Course
3. Trainers' Guide for STS Course
4. Trainers' Guide for STLS Course
5. Trainers' Guide for LT (Microscopy & NAAT)
6. Trainers Guide for CHO/MPW-PHI Course
7. [Draft] Trainers' Guide for Program Manager's course

Abhimanyu Mon, 16/01/2023 - 13:49

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	TB & TB Epidemiology NTEP Diagnostic Technologies Approaches to TB Case Finding TB Case Finding in NTEP	Virtual	3 hrs
2	TB Treatment	General concepts in TB Treatment DS-TB Treatment and care DR-TB Treatment and care Shorter Oral Bedaquiline containing MDR/RR-TB Regimen Longer Oral M/XDR-TB Regimen Isoniazid (H) Mono/Poly DR-TB Regimen TB Infection treatment and care Newer anti-TB Drugs in NTEP TB-Comorbidities and special situations General Concepts in Adherence Management	Virtual	3 hrs
3	General concepts and Principles of SCM in NTEP	Key Concepts and Principles in SCM Drugs and consumables in NTEP Stores in NTEP Patient-wise Boxes Information Systems in NTEP SCM Roles and responsibilities in SCM	Virtual	3 hrs (Includes 1 hr of Demonstration)
4	Inventory Management in NTEP	Overview of Inventory management in NTEP Indenting and receipt Issue and consumption Reporting of Stocks Expiry Management Stocking NTEP drugs in Private sector	Physical	6 hrs (Includes 3 hrs of Demonstration)
5	Procurement in NTEP	Key concepts in Procurement Procurement Processes Government e-Marketplace [GeM]	Physical	2 hrs (Includes 1 hr of Demonstration)
6	Logistics and Distribution of Drugs and consumables	Flow of Supplies Packaging Return and Reconstitution Transportation	Physical	4 hrs (Includes 2 hr of Demonstration)
7	Supervision, Monitoring and Evaluation and QA	Quality Assurance of Drugs Monitoring of sub-stores Store Visits Physical Verification 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: TB Arogya Sathi app and adherence recording 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 Fri, 07/10/2022 - 13:17

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:

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

Trainers

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

STS
TB HV
MO-PHI
MPHW/ Block Coordinators (NHM trainers)
DPC/ PPM Co-ordinators
NGO coordinators/ Supervisors
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

Traning Premises
1. In-person
2. virtual
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 treatment adherence, nutrition, ADR 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.

Creation/ confirmation/ Issue of Nikshay Usernames to the Health Volunteers
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: The TB Arogya Sathi App may be demonstrated to participants or videos can be displayed at the end of session. 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. 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 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 Tue, 27/09/2022 - 17:21

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	TB & TB Epidemiology NTEP Integration of NTEP with Health System	Virtual	4
2	TB Diagnosis and Case finding	TB Case Finding in NTEP Diagnostic Technologies Diagnostic Network and Hierarchy Approaches to TB Case Finding Active Case Finding Campaign	Virtual	4
3	TB Treatment and care	General concepts in TB Treatment DS-TB Treatment and care DR-TB Treatment and care TB Infection treatment and care TB-Comorbidities and special situations	Virtual	4
4	Adherence Management	Patient Management General Concepts in Adherence Management Adherence Support Adherence recording 99 DOTS Medication Event Reminder Monitor(MERM) Adherence Monitoring and follow-up Action	Physical	4
5	Public Health Action	Patient Support TB Arogya Sathi Application Contact Investigation Counseling and education AIC	Physical	4
6	DBT	General Concepts Processes in DBT	Physical	4
7	Supervision, Monitoring and Evaluation	Supervision Program Monitoring Indicators Monitoring	Physical	4
	Supply Chain Management in NTEP	General concepts in SCM Stocking Norms General Processes involved in SCM	Physical	4
9	Private sector Engagement	Overview of Private Sector Engagement Models for Private Sector engagement Partnership Options Regulations TB Mukt Panchayat Initiative	Virtual	2
10	ACSM and Community Engagement	General Concepts in ACSM Guidelines and Protocols for ACSM activities Community Engagement TB Champion Social Inclusion and wellness activities Engaging Family care givers 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.

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 “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) “If you are not taking the medicines properly, you will definitely die”. (Clue: It's a coercive/threatening language and should be avoided) “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 Sun, 26/02/2023 - 22:33

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	Duration (Hrs)
1	Basics of TB and NTEP	TB & TB Epidemiology NTEP Integration of NTEP with Health System	Virtual	4
2	TB Diagnosis and case finding in NTEP	TB Case Finding in NTEP Diagnostic Technologies Diagnostic Network and Hierarchy Approaches to TB Case Finding Active Case Finding Campaign	Virtual	4
3	Specimen collection and Transportation	General concepts in specimen collection & transportation Packaging & dispatching sample to a C&DST lab	Physical	2
4	Smear Microscopy	Collection & Storage of Good Quality Specimen Sputum Smear Preparation Preparation of Staining solutions Staining Sputum Smear Reading Smear and Reporting Microscopy results	Physical	8
5	CBNAAT	CBNAAT as a Rapid Molecular Diagnostic tool Sample processing for CBNAAT CBNAAT Result Interpretation and recording Troubleshooting in CBNAAT Maintenance of CBNAAT	Physical	8
6	Truenat	Truenat as a Rapid Molecular Diagnostic Test Specimen processing for Truenat Truenat result Interpretation and recording Troubleshooting in Truenat Truenat Instrument maintenance and record keeping	Physical	8
7	Ensuring Smooth functioning of Lab Services	Biomedical waste management in a microscopy lab Biomedical waste management in CBNAAT Lab Biomedical waste management in Truenat lab Record maintenance	Physical	3
8	Ensuring Quality TB lab services at TDCs	General concepts in quality assurance External quality assurance	Physical	3
9	Infection Prevention and Control [IPC]	General concepts in IPC Airborne Infection Control	Virtual	2
10	TB Treatment and care	Concepts in TB Treatment Patient Management Adverse Drug Reactions with anti-TB Drugs Documentation of Treatment Extra Pulmonary TB (EPTB) Drug Sensitive TB (DS-TB) Drug Resistant TB (DR-TB) Follow up of TB patients. Adherence monitoring Treatment Support TB & Comorbidities and special situations TB Preventive Treatment	Virtual	6
9	Public Health Action	Public health actions for TB	virtual	1
11	Supply Chain Management	Supply Chain Management in NTEP Maintaining Supplies of Lab consumables at TDC	Virtual	2
12	Supervision, Monitoring & Evaluation	Supportive supervision Evaluation	Virtual	2
13	Private sector Engagement	Private sector engagement in NTEP	Virtual	2
14	ACSM	Advocacy, Communication & Social Mobilization in NTEP 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 Sun, 26/02/2023 - 22:37

Comments

1. Introduction The purpose…

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

1. Introduction

● 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 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.

2. Training curriculum / Agenda

Sr.	Module	Chapters	Training Modality	Duration (Hrs)
1	Basics of TB and NTEP	TB & TB Epidemiology NTEP Integration of NTEP with Health System Patient Management	Virtual	4
2	TB Diagnosis and case finding in NTEP	TB Case Finding in NTEP Diagnostic Technologies Diagnostic Network and Hierarchy Approaches to TB Case Finding Active Case Finding Campaign		4
3	Specimen collection and Transportation	General concepts in specimen collection & transportation Packaging & dispatching sample to a C&DST lab		1
4	Smear Microscopy	Collection & Storage of Good Quality Specimen Sputum Smear Preparation Preparation of Staining solutions Staining Sputum Smear Reading Smear and Reporting Microscopy results		3
5	CBNAAT	CBNAAT as a Rapid Molecular Diagnostic tool Sample processing for CBNAAT CBNAAT Result Interpretation and recording Troubleshooting in CBNAAT Maintenance of CBNAAT		3
6	Truenat	Truenat as a Rapid Molecular Diagnostic Test Specimen processing for Truenat Truenat result Interpretation and recording Troubleshooting in Truenat Truenat Instrument maintenance and record keeping		3
7	Ensuring Smooth functioning of Lab Services	Biomedical waste management in a microscopy lab Biomedical waste management in CBNAAT Lab Biomedical waste management in Truenat lab Record maintenance		2
8	Ensuring Quality TB lab services at TDCs	General concepts in quality assurance External quality assurance		3
9	Infection Prevention and Control [IPC]	General concepts in IPC Airborne Infection Control		1
10	TB Treatment and care	Concepts in TB Treatment Adverse Drug Reactions with anti-TB Drugs Documentation of Treatment Extra Pulmonary TB (EPTB) Drug Sensitive TB (DS-TB) Drug Resistant TB (DR-TB) Follow up of TB patients Adherence monitoring Treatment Support TB & Comorbidities and special situations TB Preventive Treatment		3
9	Public Health Action	Public health actions for TB		1
10	DBT	Overview of DBT Ni-kshay for DBT		1
11	Supply Chain Management	Supply Chain Management in NTEP Maintaining Supplies of Lab consumables at TDC		1
12	Supervision, Monitoring & Evaluation	Supportive supervision Evaluation		1
13	Private sector Engagement	Private sector engagement in NTEP		1
14	ACSM	Advocacy, Communication & Social Mobilization in NTEP 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 -

Guide for Course-coordinator on LMS

The Course coordinator's guide can be accessed here:

Course Coordinator guide_Updated_11Nov.pdf (1.31 MB)

Abhimanyu Mon, 16/01/2023 - 13:53

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 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.

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	Duration (Hrs)
1	BASICS OF TB AND NTEP	EPIDEMIOLOGY AND BURDEN OF TB NTEP GENERAL CONCEPTS IN TB CARE IN INDIA TB AROGYA SATHI APP	Virtual	4
2	TB DIAGNOSIS AND CASE FINDING	DIAGNOSTIC TECHNOLOGIES DIGNOSTIC NETWORK AND HIERARCHY APPROACHES TO TB CASE FINDING TB CASE FINDING IN NTEP	Virtual	4
3	Specimen collection and Transportation	General concepts in specimen collection & transportation Packaging & dispatching sample to a C&DST lab	Physical	2
4	Smear Microscopy	Collection & Storage of Good Quality Specimen Sputum Smear Preparation Preparation of Staining solutions Staining Sputum Smear Reading Smear and Reporting Microscopy results Maintaining Supplies of Lab consumables at DMC	Physical	8
5	CBNAAT	CBNAAT as a Rapid Molecular Diagnostic tool Sample processing for CBNAAT CBNAAT Result Interpretation and recording. Troubleshooting in CBNAAT Maintenance of CBNAAT	Physical	8
6	Truenat	Truenat as a Rapid Molecular Diagnostic Test Specimen processing for Truenat Truenat result Interpretation and recording. Troubleshooting in Truenat Truenat Instrument maintenance and record keeping.	Physical	8
7	Ensuring Smooth functioning of Lab Services	Biomedical waste management in a microscopy lab Biomedical waste management in CBNAAT Lab Biomedical waste management in Truenat lab Record maintenance	Physical	2
8	Ensuring Quality Microscopy	General concepts in quality assurance External quality assurance	Physical	3
9	Infection Prevention and Control [IPC]	General concepts in IPC Airborne Infection Control	Virtual	1
10	TB TREATMENT, FOLLOW-UP AND PUBLIC HEALTH ACTIONS	GENERAL CONCEPTS IN TB TREATMENT TB TREATMENT INITIATION AND FOLLOW-UP TB PREVENTIVE TREATMENT PUBLIC HEALTH ACTION TB & Comorbidities and special situations TREATMENT ADHERENCE	Virtual	3
9	INTERACTING WITH PATIENTS	COUNSELLING FOR COLLECTING SPUTUM SPECIMEN COMMUNICATING RESULTS TO THE PATIENT COUNSELLING THE TB PATIENTS 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 Mon, 10/04/2023 - 09:27

[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.

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.

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	Duration (Hrs)
1	BASICS OF TB AND NTEP	EPIDEMIOLOGY AND BURDEN OF TB NTEP GENERAL CONCEPTS IN TB CARE IN INDIA TB AROGYA SATHI APP	Virtual	4
2	TB DIAGNOSIS AND CASE FINDING	DIAGNOSTIC TECHNOLOGIES DIGNOSTIC NETWORK AND HIERARCHY APPROACHES TO TB CASE FINDING TB CASE FINDING IN NTEP	Virtual	4
3	Specimen collection and Transportation	General concepts in specimen collection & transportation Packaging & dispatching sample to a C&DST lab	Physical	2
4	Smear Microscopy	Collection & Storage of Good Quality Specimen Sputum Smear Preparation Preparation of Staining solutions Staining Sputum Smear Reading Smear and Reporting Microscopy results Maintaining Supplies of Lab consumables at DMC	Physical	8
5	CBNAAT	CBNAAT as a Rapid Molecular Diagnostic tool Sample processing for CBNAAT CBNAAT Result Interpretation and recording. Troubleshooting in CBNAAT Maintenance of CBNAAT	Physical	8
6	Truenat	Truenat as a Rapid Molecular Diagnostic Test Specimen processing for Truenat Truenat result Interpretation and recording. Troubleshooting in Truenat Truenat Instrument maintenance and record keeping.	Physical	8
7	Ensuring Smooth functioning of Lab Services	Biomedical waste management in a microscopy lab Biomedical waste management in CBNAAT Lab Biomedical waste management in Truenat lab Record maintenance	Physical	2
8	Ensuring Quality Microscopy	General concepts in quality assurance External quality assurance	Physical	3
9	Infection Prevention and Control [IPC]	General concepts in IPC Airborne Infection Control	Virtual	1
10	TB TREATMENT, FOLLOW-UP AND PUBLIC HEALTH ACTIONS	GENERAL CONCEPTS IN TB TREATMENT TB TREATMENT INITIATION AND FOLLOW-UP TB PREVENTIVE TREATMENT PUBLIC HEALTH ACTION TB & Comorbidities and special situations TREATMENT ADHERENCE	Virtual	3
9	INTERACTING WITH PATIENTS	COUNSELLING FOR COLLECTING SPUTUM SPECIMEN COMMUNICATING RESULTS TO THE PATIENT COUNSELLING THE TB PATIENTS 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 Wed, 15/03/2023 - 11:48

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

Abhimanyu Mon, 11/09/2023 - 12:47