Trainers' Guide for LT (Microscopy & NAAT)

1. Introduction

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

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

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

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

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

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

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

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

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

2. Training curriculum / Agenda

Sr.	Module	Chapters	Training Modality	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

Competencies of the Lab Technician (LT)

The following competencies are important to a LT

Competency

Description/ activities pertaining to the said competency

Assessment of competency

Conduct laboratory tests for TB	Perform laboratory tests like AFB smear microscopy(ZN, FM), and NAAT (CBNAAT/ TruNAAT) as per NTEP guidelines Receive the sample in Ni-kshay/LIMS Record the test results in Ni-kshay/ LIMS	1. Direct observation of LT performing the tests 2. Assess as a part of QA (OSE/RBRC) results
Educate the individuals on collecting good quality sputum	Educate the clients on how to collect good quality sputum (where to collect, quantity desired, when to collect and how to collect)	1. Observe the demonstration by the LT where they educate people on the process of collecting good quality sputum.
Suggest appropriate tests to eligible individuals to detect TB/DR-TB/TBI	Encourage bi-directional screening for TB among high risk individuals like people living with HIV, diabetes, COVID-19, etc. Identify presumptive TB , Presumptive DR-TB Identify individuals eligible for TBI testing Suggest NAAT/LPA/CDST to people diagnosed with TB to detect DR-TB based on diagnostic algorithm Suggest appropriate diagnostic tests, based on diagnostic algorithm Request for Test through Ni-kshay	1. Interview with LT to identify the current practices 2. Observe the actual process while being in lab
Communicate the results properly to the beneficiaries	Communicate results properly to the health team -Communicate results properly to the person underwent the test	1. Interview with medical officer & STS to check the communication skill of LT
Pack the samples with triple layer and co-ordinate transportation to referral laboratories	Perform triple layer packing, labelling and coordinate transportation of samples	1. Observe the packing process while being at laboratory 2. Interview with referral laboratory to check the quality of packing done by the particular LT
Co-ordinate for making a diagnosis and initiating a person diagnosed with TB on treatment	Coordinate with medical officer to establish the diagnosis of TB Coordinate with STS to initiate prescribed regimen of TB treatment.	1. Interview with LT to identify the current practices 2. Interview with MO and STS to check LT's ability in coordination
Train paramedical staff/ community volunteers on sample collection, packaging and transport of sputum samples.	Train paramedical staff/ community volunteers on sample collection, packaging and transport of sputa samples.	1. Interview with volunteers to check LT's ability to train
Follow Standard Infection control Procedures, and Dispose off the laboratory waste as per bio-medical waste management protocols	Adherence to infection control procedures (handwashing, glove use, use of PPE, airborne infection control practices, etc) Ensure proper segregation, appropriate use of disinfectants, processing and disposal of lab waste material as per BMW management protocols	1. Direct observation of practices during duties, (good laboratory practices) 2. check methods of BMW management in laboratory
Raise the request for laboratory consumable stock replenishment	Monitor consumption trends and reagents/ supplies stock nearing expiry Coordinate with STLS for raising refill request. Update stock register/ indent register	1. Review of indents
Receive the lab consumable stock to designated TB detection center (TDC)	Carefully review issue voucher from STLS for details of supplies, expiry, etc. Follow First Expiry First Out (FEFO) principle while stocking and using the reagent/ consumable stocks, Update the relevant records	1. Review stock register in Ni-kshay Aushadhi
Maintain reports and registers as per NTEP requirements	Update in Ni-kshay details of beneficiaries who underwent testing Download and maintain laboratory register from Ni-kshay Maintain Quality Control Records(QCP/QCN checking records)	1. Check Ni-kshay Test records and extracted Laboratory Register for correctness, completeness and timeliness
Appropriately store consumables, slides, samples and equipment	Maintenance of Microscope/ CBNAAT/ TruNaat Slide storage for QA Storage of Biological specimen

Shahnawaz Tue, 28/05/2024 - 11:44