Annexures
AnnexuresThe 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.
- Trainers' Guide for Health Volunteers Course
- Trainers' Guide for Pharmacists (SDS & DDS) Course
- Trainers' Guide for STS Course
- Trainers' Guide for STLS Course
- Trainers' Guide for LT (Microscopy & NAAT)
- Trainers Guide for CHO/MPW-PHI Course
- Trainers' Guide for Program Manager's course
- [Draft] Trainers' Guide for MO-TC Course
Guide for Course-coordinator on LMS
Guide for Course-coordinator on LMSThe Course coordinator's guide can be accessed here:
WIP
The role of course coordinator is of paramount importance for training the TB workforce using the modernized training system. S/he needs to coordinate with different stakeholders for smooth conduction of training.
For eg. Coordination with the trainer/facilitator for his/her availability for taking the training.
Coordination with ECHO relationship manager for the ECHO-zoom links for webinar. He needs to perform
Login to the platform:
Step 1: Open Swasth e-Gurukul | Spreading Knowledge Faster (swasth-egurukul.in)) on your browser window. (https://cms. swasth-egurukul.in)
Step 2: Enter your login credentials (Provided to you during your training). The dashboard page will open in the browser window.
Scheduling the course on Swasth-eGurukul:
1. Click on ‘Schedule a course’ and the tab will open which requires certain fields:
I. The field needs to be filled meticulously:
1. Course name: to be selected from the drop down menu. Select ‘Course Name’ for the target audience
2. Rename selected course name as ‘<Full State Name> State Health Volunteers training on NTEP <Month Year>’. For eg. Uttar Pradesh State Health Volunteers training on NTEP July 2021
3. Start Date: to be selected from the calendar. Date may be selected 2-3 days before the scheduled date of course starting. This will enable participants to complete enrolment, access and complete pre-test.
4. End date: to be selected from the calendar that pops up after clicking the field. The end date will be based on the number of days the course is expected to run.
5. Stage type: The frequency of sessions may be adjusted here. In Health Volunteers course it is recommended that the stage type is kept as Daily. On the basis of the stage type (daily/weekly/monthly) and the number of corresponding intervals between the start-date and the end-date, there will be a related number of stages available for dividing the course sessions into. Eg if the start date is 1/2/2021 and end date is 28/2/2021, corresponding to 28 days; setting stage type as daily will give 28 stages, and setting stage type as weekly will give 4 stages.
6. Certificate: The certificate for the course needs to be chosen from the list of templates available from the drop down menu.
7. State: This field helps filtering the training aspirants from a particular state. The registered trainees from the selected state will be able to join the course.
8. Moderator: From the drop-down menu, facilitator/trainer needs to be selected. One or multiple facilitator may be selected for the same course but for different sessions.
The facilitators are registered by the Project-admin and login credentials are created for them. After this, their names are included in the drop down menu.
The filled up fields appears like this (image below):
II.The next important step is setting the stages in which course needs to scheduled. Only on this particular date and chronology the course will become live on portal.
All the stages (at the level of chapters) needs to be set individually.
The dates and facilitator may be changed as per the training plan. Once the date is changed for a particular session inside a stage, all the dates for the subsequent sections changes automatically and is set to be after that date.(image below)
After clicking ‘Schedule’ the course scheduling progress tab opens. It may take while to schedule the course. Do not stop or refresh your browser window during this process.(image below)
Admitting trainees to a course:
1. On opening this tab, the course list is available. The course coordinator needs to click the course s/he has scheduled and the list of people who have enrolled for the course will be displayed.
2. The course-coordinator need to approve the trainees who have been shortlisted for this particular course (on the basis of training plan) and may disapprove the rest/non-qualified enrolees.(image below)
Scheduling webinars:
Webinars need to be scheduled inside the course for various virtual sessions that the participants need to join. The Course Coordinator needs to get in touch with the corresponding ECHO relationship manager to create the ECHO Meeting link.
1. The webinars are scheduled for the instructor to train the participants virtually using the ECHO-zoom link. The fields name is to be entered in a standardised manner.
2. Course: To be selected form the drop down menu. The course which has scheduled by the course-coordinator should be selected as the choice here.
3. Webinar title: The webinar to be titled in standardised manner as: Course name - Day 0 and so on. Eg. Uttar Pradesh State Health Volunteers training on NTEP July 2021 - Day0, Uttar Pradesh State Health Volunteers training on NTEP July 2021 - Day 1, etc.
4. Starting date and time:
a. The webinar may be scheduled on or after the start date of the course.
b. A webinar Day 0 may be planned as an ice-breaker session to establish rapport between and the trainer and the trainees and to explain the participants the structure of the training and to share other relevant details.
c. Upon scheduling the enrolled trainees will get the webinar link. The trainees also receive a reminder email from LMS on the day of webinar. The link will also be sent to the facilitators The trainees and facilitators may click the link and access the zoom meeting.
5. Duration of meeting: To be entered in minutes
6. Facilitator: It has to be selected from the drop down menu from the list of facilitators already added by project admin.
7. Use meeting licence: It has to be changed to “External” and the Echo zoom link provided by the ECHO relationship manager for the specific webinar needs to be entered here.
8. Webinar enrolment limit: By default, it has been set to 500. But, it may be changed depending on number of participants expected to join the webinar. After entering all these details, on clicking the ‘schedule’ button, the webinar is scheduled. (image below):
9. After scheduling, the tab displays the number of participants enrolled for course. The participants enrolled and approved for the course automatically becomes the recipient of webinar link. The course coordinator may see the list and status of webinar scheduled by him under the tab- ‘my webinars’(Image below)
Discussion board
It may be used by the trainees and trainer alike to post queries and respond to the comments and
queries. (Image below)
Monitoring the progress of Training
Training report: This tab gives the summary of scheduled courses. It also gives the overall summary
of the course progress, like how many trainees have enrolled for course, how many have started the
training, how many have completed the training, feedback received, etc. (Image below):
On clicking the course, the detailed training report of all the trainees opens. The course-coordinator
can see the progress of each trainee- the enrolment date, trainee’s progress on course, etc. This is
particularly helpful in reaching out to those trainees who are facing difficulty with the training.
(Image below):
Trainers' Guide for Health Volunteers Course
Trainers' Guide for Health Volunteers CourseTrainees
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
- Training Premises
- In-person
- virtual
- Mode of delivery
- Facilitator led
- Self learning
- Demonstrations
- 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.
Pre-training Preparation
Before starting a batch of training, the following preparations need to be completed.
- Creation/ confirmation/ Issue of Ni-kshay 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 |
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Session-1 (Introduction) |
Introduction and Overview of course 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
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30 mins |
Chapter 2: NTEP |
Emphasis points during the session
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15 mins |
Chapter 3-TB diagnosis and Case Finding |
Emphasis points during the session
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15 mins |
Chapter 4: Nikshay & Treatment Supporter |
Emphasis points during the session
Post Session Activity: |
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
Probes:
|
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
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40 mins |
Chapter 6- Treatment Adherence |
Emphasis points during the session
Post session activity:
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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. Probes: Probes Key message at the end of role play : |
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
Post Session activity
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25 mins |
Chapter 8: TB Arogya Sathi Application |
Emphasis points during the session
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20 mins |
Chapter 9- Counselling |
Post Session activity
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20 mins |
Chapter 10- Social inclusion and wellness activity |
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20 mins |
Chapter 11: Community Engagement |
Post Session activity
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20 mins |
Chapter 12: Linkages to Social Support Scheme |
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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: |
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.
Competencies of the Health Volunteer
Competencies of the Health VolunteerThe following nine competencies are important to a health volunteer -
Sr No | Competency | Description/ activities pertaining to the said competency | Assessment of competency |
1 | Talk about TB |
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1. Observe the health volunteers talking about TB during home visits |
2 | Screen for TB using the 4 symptom complex |
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1. Observe a health volunteer screening for TB during home visits |
3 | Refer for diagnosis to the nearest TB Testing Centre. |
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1. Observe a referral process during the home visit, including recording of the information in Ni-kshay |
4 | Collect the sample from a presumptive TB and transport it to the testing facility |
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1. Check with the laboratory regarding the quality of samples collected by the health volunteer |
5 | Provide Treatment adherence Support for TB Treatment and TPT* |
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1. Review Ni-kshay / Treatment cards for Adherence scores of presently linked patients 2. Interview patients to check the kind of support they received |
6 | Counsel people who are on TB treatment/TPT and their family* |
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1. Interview with health volunteers to understand the current practice. |
7 | Detect Adverse Drug Reactions and Refer them for timely for management* |
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1. interview the linked patients regarding how ADR was managed for them. |
8 | Perform post-treatment follow-up* |
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1. Check whether previously linked Treatment completed patients have all their post treatment follow up due completed. |
9 | Use Ni-kshay for performing the actions related to the above |
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Check ability to login, enrol and refer patients to health facilities, sample collection and transportation and also mark treatment adherence in Ni-kshay during patient visit. |
The five (first four and last one) are core competencies of all volunteers while the remaining four (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.
Trainers' Guide for LT (Microscopy & NAAT)
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
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.
(Physical Session: 2 hour) | |
Post Session activity |
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Competencies of the Lab Technician (LT)
Competencies of the Lab Technician (LT)The following competencies are important to a LT
Trainers' Guide for Pharmacists (SDS & DDS)
Trainers' Guide for Pharmacists (SDS & DDS)Introduction
The purpose of this document is to provide the course coordinators and trainers for the “Course for Pharmacists and storekeepers in NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:
- State Drug Stores Pharmacists cum storekeepers
- District Drug Stores Pharmacists
This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State Office may decide to choose the approach which is most suitable for their State.
For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each chapter. An instructor-led session will also be conducted for each module. This will help the trainees for better clarification of contents and to address the queries and doubts of the training participants.
For the training areas which require handholding of trainees like demonstration of processes- like filling of forms, verification of supplies, stacking, etc. in-person training sessions need to be conducted.
Training curriculum / Agenda
Sr. |
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) |
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Chapter 1.1 |
TB & TB Epidemiology |
Virtual Session (26 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 1.2 |
NTEP |
Virtual Session (34 min) |
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Post Session Activity |
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Chapter 1.3 |
Diagnostic Technologies |
Virtual Session (16 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 1.4 |
Approaches to TB Case Finding |
Virtual Session (6 min) |
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Emphasis Points |
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Post Session Activity |
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Module 2 |
TB Treatment |
Virtual Session (203 min) |
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Chapter 7.1 |
General concepts in TB Treatment |
Virtual Session (45 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.2 |
DS-TB Treatment and care |
Virtual Session (10 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.3 |
DR-TB Treatment and care |
Virtual Session (20 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.4 |
Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen |
Virtual Session (14 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.5 |
Longer Oral M/XDR-TB Regimen |
Virtual Session (10 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.6 |
Isoniazid (H) Mono/Poly DR-TB Regimen |
Virtual Session (5 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.7 |
TB Infection treatment and care |
Virtual Session (14 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.8 |
TB-Comorbidities and special situations |
Virtual Session (26 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 2.9 |
General Concepts in Adherence Management |
Virtual Session (48 min) |
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Emphasis Points |
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Post Session Activity |
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Module 3: General concepts and Principles of SCM in NTEP Virtual Session (114 min) |
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Chapter 3.1 |
Key Concepts and Principles in SCM |
Virtual Session (33 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 3.2 |
Drugs and consumables in NTEP |
Virtual Session (14 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 3.3 |
Stores in NTEP |
Virtual Session (14 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 3.4 |
Patient-wise Boxes |
Virtual Session (29 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 3.5 |
Information Systems in NTEP SCM |
Virtual Session (10 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 3.6 |
Roles and responsibilities in SCM |
Virtual Session (14 min) |
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Module 4: Inventory Management in NTEP Physical Session (125 min) |
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Chapter 4.1 |
Overview of Inventory management in NTEP |
Physical Session (8 min) |
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Post Session Activity |
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Chapter 4.2 |
Indenting and receipt |
Physical Session (24 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 4.3 |
Issue and consumption |
Physical Session (48 min) |
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Emphasis Points |
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Chapter 4.4 |
Reporting of Stocks |
Physical Session (13 min) |
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Emphasis Points |
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Chapter 4.5 |
Expiry Management |
Physical Session (19 min) |
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Emphasis Points |
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Chapter 4.6 |
Stocking NTEP drugs in Private sector |
Physical Session (13 min) |
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Emphasis Points |
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Module 5: Procurement in NTEP Physical Session (39 min) |
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Chapter 5.1 |
Key concepts in Procurement |
Physical Session (13 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 5.2 |
Procurement Processes |
Physical Session (8 min) |
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Emphasis Points |
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Chapter 5.3 |
Government e-Marketplace [GeM] |
Physical Session (18 min) |
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Emphasis Points |
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Post Session Activity |
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Module 6: Logistics and Distribution of Drugs and consumables Physical Session (89 min) |
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Chapter 6.1 |
Flow of Supplies |
Physical Session (23 min) |
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Emphasis Points |
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Chapter 6.2 |
Packaging |
Physical Session (35 min) |
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Chapter 6.3 |
Return and Reconstitution |
Physical Session (18 min) |
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Chapter 6.4 |
Transportation |
Physical Session (13 min) |
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Module 7 |
Supervision, Monitoring and Evaluation and QA |
Physical Session (76 min) |
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Chapter 7.1 |
Quality Assurance of Drugs |
Physical Session (33 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 7.2 |
Monitoring of sub-stores |
Physical Session (10 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 7.3 |
Store Visits and Physical Verification |
Physical Session (15 min) |
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Emphasis Points |
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Post Session Activity |
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Chapter 7.4 |
Physical Session (13 min) |
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Emphasis Points |
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Post Session Activity |
|
|
||||
Chapter 7.5 |
Physical Session (5 min) |
|
||||
Emphasis Points |
|
|
||||
Post Session Activity |
|
|
Competencies of the Pharmacists
Competencies of the PharmacistsThe following competencies are essential to a Pharmacists
Trainers' Guide for STS Course
Trainers' Guide for STS CourseIntroduction
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 |
|
Virtual
|
4 |
2
|
TB Diagnosis and Case finding |
|
Virtual |
4
|
3 | TB Treatment and care |
|
Virtual |
4
|
4 | Adherence Management |
|
Physical | 4 |
5 | Public Health Action |
|
Physical |
4
|
6 | DBT |
|
Physical | 4 |
7 | Supervision, Monitoring and Evaluation |
|
Physical | 4 |
Supply Chain Management in NTEP |
|
Physical |
4
|
|
9 | Private sector Engagement |
|
Virtual |
2
|
10 | ACSM and Community Engagement |
|
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.
Trainer 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, for video conferencing (such as Zoom), Learning Management System (such as Swasth-eGurukul), 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 |
|
|
Post Session Activity |
|
|
Chapter 1.2 | NTEP | Virtual Session (45 min) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 1.3 | Integration of NTEP with Health System | Virtual Session(30 mins) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Module 2 | TB Diagnosis and Case Finding | Virtual Session (4 hours) |
Chapter 2.1 | Diagnostic Technologies | Virtual Session (30 min) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 2.2 | Diagnostic Network & Hierarchy | Virtual Session (30 min) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 2.3 | Approaches to TB Case Finding | Virtual Session (30 min) |
Emphasis Points |
|
|
Post Session Activity |
(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 |
|
|
Post Session Activity |
|
|
Chapter 3.2 | DS-TB Treatment and Care | Virtual Session ( 30 mins) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 3.3 | DR-TB Treatment and care | Virtual Session (30 mins) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 3.4 | Different DR-TB Regimens | Virtual Session (15 mins) |
Emphasis points |
|
|
Chapter 3.4 | TB Infection treatment and care | Virtual Session (30 min) |
Emphasis Points |
|
|
Post Session Activity | Role Play- Counseling for TPT | |
Chapter 3.5 | TB Co-morbidity and special situations | Virtual Session (30 min) |
Emphasis Points |
|
|
Post Session Activity |
|
|
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 |
|
|
Post Session Activity |
|
|
Chapter 4.3 |
|
Physical Session (60 mins) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 4.4 | Chapter: 99 DOTS | Physical Session (30 mins) |
Emphasis Points |
|
|
Post Session Activity |
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) |
|
||
|
||
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 |
|
|
Module 5: | Public Health Action | Physical Session (4 hours) |
Chapter 5.1 | Patient Support | Physical Session (60 min) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 5.3 | Contact Investigation | Physical Session (60 mins) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 5.4 | Counselling and Education | Physical Session (60 mins) |
Emphasis Points |
|
|
Post Session Activity |
|
|
Module 6: | DBT | Physical Session (4 hours) |
Chapter 6.1 | General Concepts in DBT | 60 mins |
Emphasis Points |
This is an overview chapter.
|
|
Post Session Activity |
|
|
Chapter 6.2 | Processes in DBT | 150 mins |
Emphasis Points |
|
|
Post Session Activity |
|
|
Module 7 | Supervision, Monitoring & Evaluation | Physical (4 hours) |
Chapter 7.1 | Supervision | 60 minutes |
Emphasis Points |
|
|
Post Session Activity |
|
|
Chapter 7.2 | Program Monitoring Indicators | 120 minutes |
Emphasis Points |
|
|
Post Session Activity |
Assignment: Each participant needs to calculate any 3 indicators in their TU based on real time data and interpret those indicators.
|
|
Module 8 | Supply Chain Management | Physical (4 hours) |
Chapter 8.1 | General Concepts | 60 mins |
Emphasis Points |
General Concepts of SCM
|
|
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 |
|
|
Post Session Activity |
|
|
Chapter 8.4 | Drug dispensation Module | 30 mins |
Emphasis Points |
|
|
Post Session Activity |
|
|
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 |
|
|
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 |
|
|
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. |
Competencies of the Senior Treatment Supervisor (STS)
Competencies of the Senior Treatment Supervisor (STS)The following competencies are essential to a STS
Trainers' Guide for STLS Course
Trainers' Guide for STLS Course1. 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
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.
(Physical Session: 2 hour) | |
Physical Session (8 hours ) | |
(Physical Session: 08 hours) | |||
Practical Exercise on CBNAAT | Physical (180 mins) |
(Physical Session: 08 hours) | |||
Practical Exercises on Truenat | Duration: 3 hours |
Physical (60 mins) | |||
Post Session activity |
|
||
Physical Session (3 hours) | |
Virtual Session (2 hours) | |
Virtual Session (6 hours) | |
Virtual (1 hour) | |
Virtual (2 hours) | |
Virtual (120 mins) |
Virtual Session ( 2 hours) |
Virtual (60 mins) |
Virtual Session (2 hour) |
Virtual (60 mins) |
Virtual Session (30 mins) |
Virtual (30 mins) |
Competencies of the STLS
Competencies of the STLSThe following competencies are essential to an STLS.
Trainers' Guide for CHO/MPW-PHI Course on NTEP
Trainers' Guide for CHO/MPW-PHI Course on NTEPIntroduction
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 NTEP 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 may also be conducted at the end of each module. This will help the trainees for better clarification of contents and to address the queries and doubts.
For the training areas which require handholding of trainees like demonstration of processes- Counselling about Specimen collection, patient workflow in Ni-kshay, etc. in-person training sessions need to be conducted.
The training course content has 3 modules and 16 chapters. Based on different modalities used for the training, the training delivery should take at least 8 hours.
For the purpose of assessment of trainees, a pre-test before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes.
The training of CHOs/MPWs needs to be conducted at DTC/Block level wherever adequate facilities are available.
The batch size for in-person Session should not be more than 15 participants and not more than 30 participants for virtual sessions.
Pre-training Preparation
Before starting a batch of training, the following preparations need to be completed.
- Creation of Nikshay Usernames to the Community Health Officers
- Preparation of Props (Drug Blister packs, PWB, Specimen collection container, falcon tube, Specimen carry bags, IEC Materials, etc.)
Chapter wise Trainers notes
The course is divided into three modules, with a total of 16 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 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 (180 mins) | ||
Chapter 1: Tuberculosis |
Emphasis points during the session
|
30 mins |
Chapter 2: NTEP |
Emphasis points during the session
|
15 mins |
Chapter 3-TB diagnosis and Case Finding |
Emphasis points during the session
Post Session Activity:
|
15 mins |
Chapter 4: Nikshay & Treatment Supporter |
Emphasis points during the session
Post Session Activity: |
20 mins |
Chapter 5: TB Arogya Sathi Application |
Emphasis points during the session
Post Session Activity:
|
30 mins |
Chapter 6: Patient Management in Ni-kshay |
Emphasis points during the session
Post Session Activity: Username: tbu-kadha01 Password: Test@123 |
60 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
Probes:
|
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: TB Treatment and Monitoring (150 mins) | ||
Chapter 7- General Concepts in TB treatment |
Emphasis points during the session
Post session activity:
|
30 mins |
Chapter 8: DS-TB Treatment and care
|
Emphasis points during the session
Post session activity:
|
30 mins |
Chapter 9: DR-TB treatment and care |
Emphasis points during the session
|
20 mins |
Chapter 10: Treatment Adherence |
Emphasis points during the session
Post session activity:
|
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. Probes: Probes Key message at the end of role play : |
30 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 (150 mins) | ||
Chapter 11 - Public Health Action |
Emphasis points during the session
Post Session activity
|
30 mins |
Chapter 12- Counselling |
Post Session activity.
|
20 mins |
Chapter 14- Social inclusion and wellness activity |
|
20 mins |
Chapter 15: Community Engagement |
Post Session activity
|
20 mins |
Chapter 16: Linkages to Social Support Scheme |
|
20 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: |
30 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 |
Trainers' Guide for Program Manager's course
Trainers' Guide for Program Manager's courseIntroduction
The purpose of this document is to provide the course coordinators and trainers for the ‘Course for Program Managers in NTEP’ guidance for planning and executing the training. The targeted trainees for this course would be:
- District Program Managers- District TB Officer (DTO)
-
State Program Managers- State TB Officer (STO)
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, the training institute may decide to choose the approach which is most suitable for their trainees.
The training of DTOs is to be conducted at National Institutes (NITRD/NTI) or at select STDCs across country as decided by Central TB Division. The training of STOs is however be conducted at the national Institutes only.
The batch size for Physical Session/Virtual Sessions should not be more than 25.
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.
Physical/In-person Sessions: 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 14 modules and 61 chapters. Based on different modalities used for the training, the training delivery should take at least 80 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.
Some exercises have also been formulated to assess and reinforce the learnings of the trainees based on their job requirements. These exercise will be communicated to the trainees either before the beginning of in-person sessions and the solutions of which will be discussed during the physical sessions.
The other exercises will be given to trainees during the conduct of the training and will be discussed simultaneously.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 |
|
Self-Reading/Virtual
|
6 |
2
|
TB Laboratories and Diagnostic technologies in NTEP |
|
Self-Reading/Virtual | 6 (including Lab/Field visit) |
3 | TB Diagnosis and Case finding |
|
Physical |
6
|
4 | TB Treatment |
|
Physical | 10(including field visit) |
5 | TB and comorbidity management |
|
Physical | 3 |
6 | Public Health Action |
|
Physical | 4 |
7 | TB Prevention |
|
Physical | 4 |
8 | Direct Benefit Transfer in NTEP |
|
Physical |
6
|
9 | Financial management and Planning |
|
Physical | 3 |
10 | Procurement, Supply Chain Management & Preventive Maintenance |
|
Physical | 6 |
11 | Partnerships, Corporate and Multisectoral engagement |
|
Physical | 4 |
12
|
ACSM and Community Engagement |
|
Physical | 4 |
13
|
Supervision, Monitoring and Evaluation |
|
Physical | 4 |
14 | Training and capacity development | Physical | 3 |
Trainers:
For this course, personnel that have been trained and certified by Central TB Division for conducting this course at national level may only act as trainers. These may include personnel from Central TB Division, National Institutes, Technical Partner Organizations, STDCs and Medical Colleges. Central TB Division will maintain the latest list of certified trainers and need to be referred to before conducting the training.
Trainers are selected based on the following aspects
- Ability to conduct training in an interactive and interesting manner.
- Strong knowledge about the NTEP and the various processes related to patient workflow, Ni-ksahay and Ni-kshay Aushadhi; demonstrated by completing the entire question bank related to the modules they are certified to train.
- Proficient in this Chapter- wise Training Guide.
- Well versed with the IT systems such as, Zoom (for video conferencing), Swasth-eGurukul (Learning Management System), Ni-kshay and Ni-kshay Aushadhi.
Chapter wise 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 (Self-reading/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.
Some exercises have also been provided with the relevant chapters that the trainees need to finish as the part of curriculum. The trainers should ensure that all the trainees finish these exercises individually and record it in appropriate response forms. All the exercise should be discussed by the trainers during the training.
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 | |
---|---|
Chapter 1.1 | TB & TB Epidemiology |
Emphasis Points | 1. Difference between Incidence and notification 2. Difference between Exposure to TB, infection and TB disease. |
Post Session Activity |
These exercises are to be given as assignments that trainees need to finish before start of 2nd module. Assignments:
|
Chapter 1.2 | NTEP |
Emphasis Points |
|
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/ IRL be a PHI?’[Clarify that any patient service delivery point will be a PHI, but program management units like STC, DTC, TU etc are not PHIs] Assignments:
|
Chapter 1.3 | Approaches to S&M in NTEP |
Emphasis Points | Discuss the importance of S&M. Emphasize that S&M of the different activities under NTEP will be discussed alongside the activity while discussing the content in the modules. |
Post-session activity |
Assignment: 1.3.1- Find the index score of your district using Nikshay for year 2022. |
Chapter 1.4 | Integration of NTEP with Health System |
Emphasis Points | Discuss the 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? Assignments: 1.4.1-Write the organisation str of NTEP in your district. |
Chapter 1.5 | Information Systems in NTEP |
Emphasis Points |
|
Post-session Activity | 1.5.1- Enlist the different stakeholders that are working with Nikshay and their specific roles in NI-kshay. |
Module 2 | TB Laboratories and Diagnostic technologies in NTEP |
Chapter 2.1 | Diagnostic Technologies and Lab Network |
Emphasis Points | Names of different tests, their uses, advantages and disadvantages |
Post-session Activity |
Discuss: what are the advantages and disadvantages of FL- LPA over NAAT? Discuss “how many sputum collection and transportation facilities are there in their concerned district? 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 Assignment: 3.1.1Learn about the processes being followed in your district for sample transport from patient to TDC. |
Chapter 2.2 | TB detection Centres |
Emphasis Points | Discuss the consumables required for the Microscopy, CBNAAT and Truenat |
Post-session Activity |
Assignments: A Lab-visit needs to be organised for participants to see the different processes involved for testing. |
Chapter 2.3 | Specimen collection and transportation |
Emphasis Points |
The need for SCT, importance of cool chain requirement. Discuss how the delays can be reduced to improve the TAT overall |
Post Session Activity | May ask one of the participants to volunteer and demonstrate the different processes being followed in Nikshay for the same- i.e. adding test request, sample details and result updation in Ni-kshay. |
Chapter 2.4 | Quality Assurance of TDC |
Emphasis Points | Explain the process involved in EQA of microscopy. |
Post-session Activity |
Lab Field visit: A field visit should be organized to a lab to understand and discuss the following:
3) Obtain the Lab register from Nikshay and calculate the patient TurnAroundTime (referral to test reporting) for the lab and compare it with the Lab TurnAroundTime (Sample Receipt to Reporting) |
Module 3 |
TB Diagnosis and Case finding |
Chapter 3.1 | General Concepts in TB Case Finding |
Emphasis Points | Differentiate between screening and testing. |
Post-session Activity | |
Chapter 3.2 | Approaches to TB Case Finding |
Emphasis Points | Clearly differentiate the difference between the three different approaches- Active, Passive and Intensified. |
Post-session Activity |
(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 3.3 | Diagnostic Algorithms in NTEP |
Emphasis Points | Discuss how the algorithms to be read |
Post-session Activity | Ask the participants to look at details of 5 TB patients from their district and see whether complete diagnostic algo has been followed or not. |
Chapter 3.4 | Active Case Finding Campaign |
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 ACF campaign is carried in participants district and how the activity can be carried out more effectively. |
Chapter 3.5 | S&M for Case finding activities in NTEP. |
Emphasis Points | Discuss the TB index dashboard. Discuss the TB Notification dashboard, |
Post-session Activity | The participants may be asked to access the TB index dashboard and TB notification dashboard from their logins and share their learnings with other audience. |
Module 4 | TB Treatment |
Chapter 4.1 | General Concepts in TB Treatment |
Emphasis Points |
It's an overview chapter explaining the concepts- Fixed Dose Combination, Intensive & Continuation Phase.
|
Post-session Activity | Request two participants to demonstrate in Demo Ni-kshay the ‘Transfer’ of patients using (i) Push and (ii) Pull methods. |
Chapter 4.2 | ADRs to ATT |
Emphasis Points | Discuss about the aDSM available in Ni-kshay , the importance and how it is carried out. |
Post-session Activity | Ask one of the participants to demonstrate the adverse event module in Ni-kshay from reporting, management and outcome. |
Chapter 4.3 | DS-TB Treatment and Care |
Emphasis Points |
|
Post-session Activity |
|
Chapter 4.4 | Overview of DR-TB |
Emphasis Points |
Explain:
|
Post-session Activity | Ask participants for doubts and help them clear those doubts. |
Chapter 4.5 | Isoniazid [H] Mono/Poly DR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session Activity | May ask the participant to look at 2 TB patients (outcome declared) on H Mono/poly DR-TB regimen whether the follow-up sputum examination was done timely or not. |
Chapter | Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session activity | May ask participants to look at 2 TB patients (outcome declared) on shorter oral Bdq containing MDR/RR regimen whether all the relevant investigations for PTE and follow-up sputum examination were carried out timely. |
Chapter | Longer Oral M/XDR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session activity | May ask participants to look at 1 TB patient (outcome declared) on longer oral M/XDR regimen whether all the relevant investigations for PTE and follow-up sputum examination were carried out timely. |
Chapter 4.6 | Treatment Support |
Emphasis Points | Discuss the role of treatment supporter and how they can be registered in Nikshay, patient mapped. |
Post-session Activity | Ask the participants to practice the registration of treatment supporter and subsequent mapping of patients to the treatment supporters in demo-version in Ni-kshay. |
Chapter 4.7 | Adherence Management |
Emphasis Points |
|
Post-session Activity |
|
Chapter | Monitoring of Treatment |
Emphasis Points | Discuss the indicators used in monitoring the treatment- treatment initiation, outcome declaration. |
Post-session activity |
Exercise: Ask the participants to download the notification register for Q1-2023 and ask them to calculate the average delay in treatment initiation from date of diagnosis. Discuss how this delay can be minimised. |
Field Activity |
A 2nd field visit(Batch size- 5-7 participants) should be organised to the following
|
Module 5 |
TB and comorbidity management |
Chapter 5.1 | TB and HIV |
Emphasis Points | Bidirectional screening for TB-HIV |
Post-session activity | Ask the participants to describe the existing mechanism at their district to screen TB among the people visiting ICTC centres- 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. |
Chapter 5.2 | TB and Diabetes |
Emphasis Points | Bidirectional screening for TB-Diabetes |
Post-session activity | Ask the participant to describe how diabetes testing is done among people with TB in their district? 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 | TB and malnourishment |
Emphasis Point: | Discuss how malnourishment affects TB patient and role of Nutritional support in successful completion of treatment. |
Chapter | TB and Substance Abuse |
Emphasis Point: | Discuss how Alcohol and Tobacco Abuse affects TB and importance of linkage with the deaddiction centre. |
Post Session Activity | The participants may be asked to list the de-addiction centres and tobacco-caseation centres. |
Chapter | TB and other comorbid conditions |
Module 6 | Public Health Action |
Chapter 6.1 | Patient Support |
Emphasis Points | Various kinds of support the TB patient needs (nutritional support, psychosocial 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 6.2 | Contact tracing and investigation. |
Emphasis Points |
Discuss:
|
Post-session Activity |
|
Chapter 6.3 | Counselling |
Emphasis Points |
Discuss:
|
Post-session Activity |
|
Chapter 6.4 | TB Arogya Sathi App |
Emphasis Points |
Discuss the various information available in TB Arogya Sathi Application-
|
Post-session Activity | The participants may be requested to do a screening test on themselves and check the working of the application. |
Module 7 | TB Prevention |
Chapter 7.1 | Infection Prevention and Control |
Emphasis Points |
Discuss the following:
|
Post-session Activity |
|
Chapter 7.2 | TB Preventive Treatment |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | Ask the participants to download the Contact tracing register (for Q3-2022) and comment on the leakages in the cascade of care for TPT for your district. |
Chapter 8.1 | General Concepts in DBT |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | |
Chapter 8.2 | Processes in DBT |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | |
Chapter 8.3 | Monitoring of DBT |
Emphasis Points |
Discuss the following points:
|
Post-session Activity |
|
Module | Financial management and Planning |
Chapter 9.1 | Overview of PIP |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | May ask the participants for any doubts/queries. |
Chapter 9.2 | Needs assessment for Planning |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | May ask the participants to clear their doubts |
Chapter 9.3 | Preparing a PIP and Implementing the plan |
Emphasis Points | |
Post-session activity | May give one PIP format to the participants and ask them to fill it for their district. |
Chapter 9.4 | Financial expenditure and accounting |
Emphasis Points |
Explain the following.
|
Post-session Activity | |
Module | Procurement, Supply Chain Management & Preventive Maintenance |
Chapter | General Concepts in SCM |
Emphasis Points |
Explain the following concepts:
|
Post-session Activity | |
Chapter | Information system for SCM in NTEP |
Emphasis Points |
Discuss the following: Ni-kshay Aushadhi Different dashboards- State/district/Alert/Reports and features available at different levels. |
Post-session Activity | Ask the participants to open their district dashboard and look at the alert dashboard and share the finding with other participants. |
Chapter | Processes in NTEP |
Emphasis Points |
Discuss and demonstrate the participants the following processes:
|
Post-session Activity |
Ask the participant to demonstrate the following in demo version of Ni-kshay AUshadhi:
Ask the participants to demonstrate the following in demo version of Nikshay
Ask the participants to forecast the supplies (for DS-TB drugs) for next quarter on the basis of consumptions based in previous quarter in their district
|
Chapter | Procurement in NTEP |
Emphasis Points |
Explain the following points: Procurement- meaning and importance. Different types of procurement processes- Direct and tendering Government e-Marketplace - meaning and different processes involved. |
Post-session Activity | The trainer may demonstrate them the processes involved in GeM using the demo version/live version using their login credentials. |
Chapter | Quality Assurance in Supply Chain Management |
Emphasis Points |
Discuss the following points: Meaning and Processes involved in QA of drugs in NTEP Recording of QA of drugs in Ni-kshay AUshadhi Monitoring of drug stores Store visits in NTEP- checklist for store visits Physical verification of supplies and recording in Ni-kshay Aushadhi |
Post-session Activity | Ask the participant to open demo Ni-kshay aushadhi and demonstrate the recording of Physical Stock verification, and QA of drugs |
Module | Partnerships, Corporate and Multisectoral engagement |
Chapter 10.1 | General Concepts in Partnership and MSE |
Emphasis Points |
Discuss the following points:
|
Post-session activity | |
Chapter 10.2 | Models of Partnerships |
Emphasis Points |
Discuss the following-
|
Post session activity. | May ask the participants to clear their doubts. |
Chapter 10.3 | Establishing the partnerships |
Emphasis Points |
Discuss the following: Guidance Document on Partnership- Overview Undertaking a needs assessment Mapping of the stakeholders- meaning and process Partnership Options- meaning and significance. Steps to engage a service delivery. Partnership options available to Private sector engagement Bundling approach- meaning and significance Contract- Meaning, Types: input-based, Output-based, Fee for service contract, Steps for executing a contract. Budgeting for Partnership options Performance matrix for partnerships Verification and validation of invoices |
Post Session activity | The participants may clear their doubts. |
Multisectoral Engagement | |
Competencies of the Program Managers (PM) at district level
Competencies of the Program Managers (PM) at district levelThe following competencies are important to a PM
Competency | Description/ activities pertaining to the said competency | Assessment of competency |
---|---|---|
Implement the NTEP in the district |
|
|
Trainers Guides for Cadre wise Courses
Trainers Guides for Cadre wise Courses- Trainers' Guide for Health Volunteers Course
- Trainers' Guide for Pharmacists (SDS & DDS) Course
- Trainers' Guide for STS Course
- Trainers' Guide for STLS Course
- Trainers' Guide for LT (Microscopy & NAAT)
- Trainers Guide for CHO/MPW-PHI Course
- Trainers' Guide for Program Manager's course
- Trainers' Guide for MO-TC Course
Trainers' Guide for Course for MO-TC on NTEP
Trainers' Guide for Course for MO-TC on NTEPIntroduction
The purpose of this document is to provide the course coordinators and trainers for the ‘Course for Medical Officers- TB Control’ guidance for planning and executing the training. The targeted trainees for this course would be:
- Medical Officers- TB Control
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, the training institute may decide to choose the approach which is most suitable for their trainees.
-
The training of MO-TC is to be conducted at STDCs. The batch size for Physical Session/Virtual Sessions should not be more than 25.
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.
Physical/In-person Sessions: 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 13 modules and 53 chapters. Based on different modalities used for the training, the training delivery should take at least 60 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.
Some exercises have also been formulated to assess and reinforce the learnings of the trainees based on their job requirements. These exercise will be communicated to the trainees either before the beginning of in-person sessions and the solutions of which will be discussed during the physical sessions.
The other exercises will be given to trainees during the conduct of the training and will be discussed simultaneously.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 |
|
Self-Reading/Virtual
|
6 |
2
|
TB Laboratories and Diagnostic technologies in NTEP |
|
Self-Reading/Virtual | 6 (including Lab/Field visit) |
3 | TB Diagnosis and Case finding |
|
Physical |
6
|
4 | TB Treatment |
|
Physical | 10(including field visit) |
5 | TB and comorbidity management |
|
Physical | 3 |
6 | Public Health Action |
|
Physical | 4 |
7 | TB Prevention |
|
Physical | 4 |
8 | Direct Benefit Transfer in NTEP |
|
Physical |
6
|
9 | Procurement, Supply Chain Management & Preventive Maintenance |
|
Physical | 6 |
10 | Partnerships, Corporate and Multisectoral engagement |
|
Physical | 4 |
11
|
ACSM and Community Engagement |
|
Physical | 4 |
12
|
Supervision, Monitoring and Evaluation |
|
Physical | 4 |
13 | Training and capacity development | Physical | 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.
Trainer Eligibility
Trainers should have ability to conduct training in an interactive and interesting manner. The Trainers should have completed the ‘Course for MO-TC’ or Should have undergone training on 'Course for Program Managers in NTEP' 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, for video conferencing (such as Zoom), Learning Management System (such as Swasth-eGurukul), Ni-kshay and Ni-kshay Aushadhi.
Chapter wise 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 (Self-reading/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.
Some exercises have also been provided with the relevant chapters that the trainees need to finish as the part of curriculum. The trainers should ensure that all the trainees finish these exercises individually and record it in appropriate response forms. All the exercise should be discussed by the trainers during the training.
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 | |
---|---|
Chapter 1.1 | TB & TB Epidemiology |
Emphasis Points | 1. Difference between Incidence and notification 2. Difference between Exposure to TB, infection and TB disease. |
Post Session Activity |
These exercises are to be given as assignments that trainees need to finish before start of 2nd module. Assignments:
|
Chapter 1.2 | NTEP |
Emphasis Points |
|
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/ IRL be a PHI?’[Clarify that any patient service delivery point will be a PHI, but program management units like STC, DTC, TU etc are not PHIs] Assignments:
|
Chapter 1.3 | Approaches to S&M in NTEP |
Emphasis Points | Discuss the importance of S&M. Emphasize that S&M of the different activities under NTEP will be discussed alongside the activity while discussing the content in the modules. |
Post-session activity |
Assignment: 1.3.1- Find the index score of your district using Nikshay for year 2022. |
Chapter 1.4 | Integration of NTEP with Health System |
Emphasis Points | Discuss the 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? Assignments: 1.4.1-Write the organisation str of NTEP in your district. |
Chapter 1.5 | Information Systems in NTEP |
Emphasis Points |
|
Post-session Activity | 1.5.1- Enlist the different stakeholders that are working with Nikshay and their specific roles in NI-kshay. |
Module 2 | TB Laboratories and Diagnostic technologies in NTEP |
Chapter 2.1 | Diagnostic Technologies and Lab Network |
Emphasis Points | Names of different tests, their uses, advantages and disadvantages |
Post-session Activity |
Discuss: what are the advantages and disadvantages of FL- LPA over NAAT? Discuss “how many sputum collection and transportation facilities are there in their concerned district? 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 Assignment: 3.1.1Learn about the processes being followed in your district for sample transport from patient to TDC. |
Chapter 2.2 | TB detection Centres |
Emphasis Points | Discuss the consumables required for the Microscopy, CBNAAT and Truenat |
Post-session Activity |
Assignments: A Lab-visit needs to be organised for participants to see the different processes involved for testing. |
Chapter 2.3 | Specimen collection and transportation |
Emphasis Points |
The need for SCT, importance of cool chain requirement. Discuss how the delays can be reduced to improve the TAT overall |
Post Session Activity | May ask one of the participants to volunteer and demonstrate the different processes being followed in Nikshay for the same- i.e. adding test request, sample details and result updation in Ni-kshay. |
Chapter 2.4 | Quality Assurance of TDC |
Emphasis Points | Explain the process involved in EQA of microscopy. |
Post-session Activity |
Lab Field visit: A field visit should be organized to a lab to understand and discuss the following:
3) Obtain the Lab register from Nikshay and calculate the patient TurnAroundTime (referral to test reporting) for the lab and compare it with the Lab TurnAroundTime (Sample Receipt to Reporting) |
Module 3 |
TB Diagnosis and Case finding |
Chapter 3.1 | General Concepts in TB Case Finding |
Emphasis Points | Differentiate between screening and testing. |
Post-session Activity | |
Chapter 3.2 | Approaches to TB Case Finding |
Emphasis Points | Clearly differentiate the difference between the three different approaches- Active, Passive and Intensified. |
Post-session Activity |
(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 3.3 | Diagnostic Algorithms in NTEP |
Emphasis Points | Discuss how the algorithms to be read |
Post-session Activity | Ask the participants to look at details of 5 TB patients from their TU and see whether complete diagnostic algo has been followed or not. |
Chapter 3.4 | Active Case Finding Campaign |
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 ACF campaign is carried in participants geography and how the activity can be carried out more effectively. |
Chapter 3.5 | S&M for Case finding activities in NTEP. |
Emphasis Points | Discuss the TB index dashboard. Discuss the TB Notification dashboard. |
Post-session Activity | The participants may be asked to access the TB index dashboard and TB notification dashboard from their logins and share their learnings with other audience. |
Module 4 | TB Treatment |
Chapter 4.1 | General Concepts in TB Treatment |
Emphasis Points |
It's an overview chapter explaining the concepts- Fixed Dose Combination, Intensive & Continuation Phase.
|
Post-session Activity | Request two participants to demonstrate in Demo Ni-kshay the ‘Transfer’ of patients using (i) Push and (ii) Pull methods. |
Chapter 4.2 | ADRs to ATT |
Emphasis Points | Discuss about the aDSM available in Ni-kshay , the importance and how it is carried out. |
Post-session Activity | Ask one of the participants to demonstrate the adverse event module in Ni-kshay from reporting, management and outcome. |
Chapter 4.3 | DS-TB Treatment and Care |
Emphasis Points |
|
Post-session Activity |
|
Chapter 4.4 | Overview of DR-TB |
Emphasis Points |
Explain:
|
Post-session Activity | Ask participants for doubts and help them clear those doubts. |
Chapter 4.5 | Isoniazid [H] Mono/Poly DR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session Activity | May ask the participant to look at 2 TB patients (outcome declared) on H Mono/poly DR-TB regimen whether the follow-up sputum examination was done timely or not. |
Chapter | Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session activity | May ask participants to look at 2 TB patients (outcome declared) on shorter oral Bdq containing MDR/RR regimen whether all the relevant investigations for PTE and follow-up sputum examination were carried out timely. |
Chapter | Longer Oral M/XDR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session activity | May ask participants to look at 1 TB patient (outcome declared) on longer oral M/XDR regimen whether all the relevant investigations for PTE and follow-up sputum examination were carried out timely. |
Chapter 4.6 | Treatment Support |
Emphasis Points | Discuss the role of treatment supporter and how they can be registered in Nikshay, patient mapped. |
Post-session Activity | Ask the participants to practice the registration of treatment supporter and subsequent mapping of patients to the treatment supporters in demo-version in Ni-kshay. |
Chapter 4.7 | Adherence Management |
Emphasis Points |
|
Post-session Activity |
|
Chapter | Monitoring of Treatment |
Emphasis Points | Discuss the indicators used in monitoring the treatment- treatment initiation, outcome declaration. |
Post-session activity |
Exercise: Ask the participants to download the notification register for Q1-2023 and ask them to calculate the average delay in treatment initiation from date of diagnosis. Discuss how this delay can be minimised. |
Field Activity |
A 2nd field visit(Batch size- 5-7 participants) should be organised to the following
|
Module 5 |
TB and comorbidity management |
Chapter 5.1 | TB and HIV |
Emphasis Points | Bidirectional screening for TB-HIV |
Post-session activity | Ask the participants to describe the existing mechanism at their district to screen TB among the people visiting ICTC centres- 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. |
Chapter 5.2 | TB and Diabetes |
Emphasis Points | Bidirectional screening for TB-Diabetes |
Post-session activity | Ask the participant to describe how diabetes testing is done among people with TB in their district? 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 | TB and malnourishment |
Emphasis Point: | Discuss how malnourishment affects TB patient and role of Nutritional support in successful completion of treatment. |
Chapter | TB and Substance Abuse |
Emphasis Point: | Discuss how Alcohol and Tobacco Abuse affects TB and importance of linkage with the deaddiction centre. |
Post Session Activity | The participants may be asked to list the de-addiction centres and tobacco-caseation centres. |
Chapter | TB and other comorbid conditions |
Module 6 | Public Health Action |
Chapter 6.1 | Patient Support |
Emphasis Points | Various kinds of support the TB patient needs (nutritional support, psychosocial 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 6.2 | Contact tracing and investigation. |
Emphasis Points |
Discuss:
|
Post-session Activity |
|
Chapter 6.3 | Counselling |
Emphasis Points |
Discuss:
|
Post-session Activity |
|
Chapter 6.4 | TB Arogya Sathi App |
Emphasis Points |
Discuss the various information available in TB Arogya Sathi Application-
|
Post-session Activity | The participants may be requested to do a screening test on themselves and check the working of the application. |
Module 7 | TB Prevention |
Chapter 7.1 | Infection Prevention and Control |
Emphasis Points |
Discuss the following:
|
Post-session Activity |
|
Chapter 7.2 | TB Preventive Treatment |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | Ask the participants to download the Contact tracing register (for Q3-2022) and comment on the leakages in the cascade of care for TPT for your geography. |
Chapter 8.1 | General Concepts in DBT |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | |
Chapter 8.2 | Processes in DBT |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | |
Chapter 8.3 | Monitoring of DBT |
Emphasis Points |
Discuss the following points:
|
Post-session Activity |
|
Module | Financial management and Planning |
Chapter 9.1 | Overview of PIP |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | May ask the participants for any doubts/queries. |
Chapter 9.2 | Needs assessment for Planning |
Emphasis Points |
Discuss the following points:
|
Post-session Activity | May ask the participants to clear their doubts |
Chapter 9.4 | Financial expenditure and accounting |
Emphasis Points |
Explain the following.
|
Post-session Activity | |
Module | Procurement, Supply Chain Management & Preventive Maintenance |
Chapter | General Concepts in SCM |
Emphasis Points |
Explain the following concepts:
|
Post-session Activity | |
Chapter | Information system for SCM in NTEP |
Emphasis Points |
Discuss the following: Ni-kshay Aushadhi Different dashboards- State/district/Alert/Reports and features available at different levels. |
Post-session Activity | Ask the participants to open their TU dashboard and look at the alert dashboard and share the finding with other participants. |
Chapter | Processes in NTEP |
Emphasis Points |
Discuss and demonstrate the participants the following processes:
|
Post-session Activity |
Ask the participant to demonstrate the following in demo version of Ni-kshay AUshadhi:
Ask the participants to demonstrate the following in demo version of Nikshay
Ask the participants to forecast the supplies (for DS-TB drugs) for next quarter on the basis of consumptions based in previous quarter in their TU. |
Chapter | Quality Assurance in Supply Chain Management |
Emphasis Points |
Discuss the following points: Meaning and Processes involved in QA of drugs in NTEP Recording of QA of drugs in Ni-kshay AUshadhi Monitoring of drug stores Store visits in NTEP- checklist for store visits Physical verification of supplies and recording in Ni-kshay Aushadhi |
Post-session Activity | Ask the participant to open demo Ni-kshay aushadhi and demonstrate the recording of Physical Stock verification, and QA of drugs |
Competencies of the Medical Officers TB Centre- [MO-TC]
Competencies of the Medical Officers TB Centre- [MO-TC]Following are the competencies required for a Medical Officer TC
Competency | Description/ activities pertaining to the said competency | Assessment of competency |
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[Draft] Trainer's guide for the Course for MO-PHI on NTEP
[Draft] Trainer's guide for the Course for MO-PHI on NTEPIntroduction
Targeted Trainees: Medical Officer- PHI includes generally all Medical Officers placed at Government Health facilities at primary, secondary and tertiary levels. This does not include Medical Officers that have specified roles in the NTEP program, such as Medical Officers at, District / Nodal DRTB-Centres, Medical Colleges, MO-TC.
Qualified Trainers: Trainers may be other Medical Officers at the District Level or above that are prior identified by State such as DTOs, MO-TCs who are in-turn trained on their cadre's corresponding course on NTEP.
Trainers are selected based on their ability to conduct training in an interactive and interesting manner. The Trainers should have completed their own cadre-wise course, thorough with this trainers guide and must possess strong knowledge about the NTEP, and the various processes related to patient workflow and Ni-kshay. The Trainers should be well versed with the supporting IT systems such as those for video conferencing (Zoom/ Teams/ Google meet), Learning Management System (Swasth-eGurukul), Ni-kshay, etc.
Mode of Training: Training may be provided by utilizing the blended approach where a mix of training methods and modes may be used to execute the training.
Training Institution: The training of MO-PHI is to be organized by the District TB Centre.
Recommended Batch size: 25.
Training Duration: The training course content has 4 modules with a total of 18 chapters. A trainee needs to complete this course in about a total 16 hours. The Module wise breakup is provided below
Sr. |
Module |
Duration |
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1 | Basics of TB and NTEP | 2hrs |
2 | Case Finding and Diagnosis | 3hrs |
3 | TB Treatment and Management | 7hrs |
4 | Program Management and Programmatic actions | 4hrs |
Chapter wise detailed instructions for Trainers
Module 1: Basics of TB and NTEP | ||
Chapter 1.1 | TB & TB Epidemiology | Mode: Self Learning |
Emphasis Points |
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Post Session Activity |
Ak trainees: "Compare and discuss the prevalence of TB in your state and India" Refer to : National TB Prevalence survey 2019-2021 report, page 68 https://tbcindia.gov.in/WriteReadData/l892s/25032022161020NATBPSReport.pdf If there are other state specific estimates, discuss that. |
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Chapter 1.2 | NTEP | Mode: Self Learning |
Emphasis Points |
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Post Session Activity |
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Chapter 1.3 | Information Systems in NTEP | Mode: Self Learning |
Emphasis Points |
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Post Session Activity | Request all trainees to log into Ni-kshay using their institution's login credentials. Ask them to list various modules they are seeing on the page after logging in. | |
Module 2: Case Finding and Diagnosis | ||
Chapter 2.1 | General Concepts in TB Case Finding | Mode: Self Learning |
Emphasis Points |
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Post Session Activity |
Ask a few trainees: 'If you refer 10 individuals with TB symptoms for testing from the OPD, what proportion will actually undergo testing?" Ask a follow up question: "How do you know that the number is correct?" Ask a follow up question: "What could be done to ensure that 100% of the clients referred are tested?" [ Getting information of all individuals with presumed TB either in Ni-kshay or other methods, specimen collection and transportation to prevent the leaks in cascade of care, monitoring the results against the line list of individuals with presumed TB] |
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Chapter 2.2 | Diagnostic Technologies and Lab Network | Mode: Self Learning |
Emphasis Points |
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Post Session Activity | Arrange a Visit to (a) Microscopy Centre and understand the External Quality Assurance activities (RBRC, OSE) happening (b) CB NAAT facility and observe the testing process (c) TrueNAT facility and observe the testing process | |
Chapter 2.3 | Diagnostic Specimen | Mode: Self Learning |
Emphasis Points |
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Post Session Activity | Discuss: What is the Turn Around Time for various tests in your institution? How is that compared against the benchmark? How could we reduce it further? | |
Chapter 2.4 | Active Case Finding Campaign | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
"A medical officer was reviewing the ACF data done in their field area. Total individuals mapped for ACF were 10,000; total individuals screened using TB symptoms were 8000. Out of them 400 were found to have TB symptoms. 200 underwent testing and 20 were diagnosed as TB, all were initiated on treatment" Provide them the scenario. Ask them to comment on the data. Discuss: Where is the biggest leaks in cascade? (significant leak in people with TB symptoms not underwent a test). What measures will you take as MO-PHI to minimize the gap? |
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Module 3: TB Treatment and Management | ||
Chapter 3.1 | General Concepts in TB Treatment | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
Physically check the Fixed Dose Combinations available in the program [4 FDC, 3 FDC, Pediatric drugs] Perform treatment initiation, and outcome declaration in demo version of Ni-kshay and restart a case to reinitiate the case on a new episode. |
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Chapter 3.2 | TB Treatment and Care | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
A 30-year-old female with 66 Kg, newly diagnosed to have drug sensitive pulmonary TB. 1. What pre-treatment evaluation will you advise before initiating the client on treatment? 2. Initiate and the treatment and prescribe the treatment on the demo version of Ni-kshay 3. Schedule clinical and laboratory follow-up for the client. What all will you will assess when she comes for the follow up? |
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Chapter 3.3 | Treatment Support | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
Discuss: How do you generally assign treatment supporter to your patient? Is that in consultation with the patient? Discuss: How many treatment supporters are in your area? What do you think about the quality of treatment support they provide? Share some experiences |
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Chapter 3.4 | Adherence Management | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
On the demo version of Ni-kshay, Mark adherence for a person on TB Treatment; 5 days as manually reported as taken and 5 days as manually reported as missed. Login to Ni-kshay using your institutional credentials. Comment on the treatment adherence pattern of the patients under anti-TB treatment in your area. |
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Chapter 3.5 | TB and comorbid conditions | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: How many people with diabetes are visiting your institution on a month? Are they all been screened for TB? Share your experiences related to screening for TB among the people with diabetes. How could we ensure that all people with diabetes reaching a health facility are screened for TB? | |
Chapter 3.6 | Infection Prevention & Control | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: What are the various administrative measures for air borne infection control in your institutions? Is it adequate? Is there a scope for improvement? | |
Chapter 3.7 | TB Preventive Therapy | Mode: Self / virtual instructor led |
Emphasis Points |
TB Preventive Therapy is permitted only after ruling out TB TB preventive therapy is available for people at high risk of TB but is not currently diseased, such as contacts and PLHIV |
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Post Session Activity | Discuss: What proportion of eligible contacts in your area are initiated on TPT? Out of those whom you initiated, what proportion completes the TPT? What needs to be done to improve the situation | |
Module 4: Program Management and Programmatic actions | ||
Chapter 4.1 | Public Health Actions | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: What are the some of the communication practices towards a person affected with TB you wish to see changed from your colleagues/staff of your health facility? | |
Chapter 4.2 | Patient Support | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: How should we support a person with TB with alcohol use disorder? Share your experiences related to your team's support in managing such clients. | |
Chapter 4.3 | Social Inclusion and wellness activities | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: Do you think gender inequality in TB care exists in your area? As a MO-PHI, what can you do to address the same? | |
Chapter 4.4 | Programme Monitoring | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: Is the Panchayat/Local Body where your health facility is located progressing towards ending TB? Discuss using data. |
Competencies of MO-PHI
Competencies of MO-PHI# | Competency | Description/ activities pertaining to the said competency | Assessment methods |
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1 | Diagnose TB Correctly and completely based on NTEP guidelines/Standards of TB Care in India | - Identify individuals vulnerable to develop TB disease and TB Infection. - Screen for TB using 4 symptom complex and Chest X ray and identify presumptive TB - Prescribe appropriate diagnostic test to diagnose TB/ EP-TB, DR-TB, paediatric TB and TB Infection to the eligible based on NTEP guidelines/ Standards of TB Care in India - Enroll a person in Ni-kshay and request for Test through Ni-kshay based on NTEP Diagnostic algorithms and requirements for UDST - Enter the diagnosis details of clinically diagnosed TB in Ni-kshay - Implement Intensified Case Finding in the Facility |
1. Verification of case records in Ni-kshay to check whether correct tests are prescribed and the diagnosis is complete including testing for drug resistance 2. Interview with Medical Officer to understand his/her practice in relation to diagnosis of TB and adherence to diagnostic algorithm and request appropriate tests. 3. Assess OPD referral rates of presumptive TB Cases and random prescription audits for referral for TB Testing of presumptive TB Cases 4. Interviews with people affected with TB under care of the MO to check whether cases are diagnosed completely based on referral for testing and test results. 5. Review of Test Request (Referral for testing) Registers to check for appropriate referral of patients or their samples for higher diagnostic tests which are not available in the current health facility. |
[Draft] Trainers Guide for Course for Senior DR-TB/TB-HIV Supervisor on NTEP
[Draft] Trainers Guide for Course for Senior DR-TB/TB-HIV Supervisor on NTEPIn Development
Competencies of Sr DR-TB/TB-HIV Supervisor
Competencies of Sr DR-TB/TB-HIV SupervisorThe following competencies are essential to a Sr DR-TB/TB-HIV Supervisor.
# | Competency | Description | Assessment Method |
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1 | Monitor and coordinate for DST/DRT Testing for all Notified TB Cases | - Identify individuals pending various DST/ DRT tests from Notification Register/ Patient wise Lab register based on NTEP guidelines - Coordinate with various field staff to obtain samples and transport them to linked Laboratory and to obtain valid results, and ensure Patient TATs are within norms - Reinitiate new epsiodes and initiate request for Test through Ni-kshay |
Evaluate knowledge, attitude, and practices based on a review of the status of DST/DRT Testing performance in the district. |
2 | Coordinate to initiate appropriate DRTB treatment by referral to relevant PHI and coordinate with field staff for patient support | - Check the reports of various laboratory investigations and coordinate to establish the diagnosis of DRTB - Refer a person with TB to the appropriate DRTB Centre/ ART Centre/ health facility for Clinical followup/ Treatment initiation and ensure appropriate HF Linkage in Ni-Akshay -Co-ordinate to identify an appropriate treatment supporter and health facility in consultation with the medical officer, field staff and beneficiary -Document the treatment initiation and details of prescription in Ni-kshay |
1. Verification of case records in Ni-kshay to check whether correct regimens are prescribed when new diagnostic information is available 2. Interview with patients under care of the individual to check whether treatment initiation is as per NTEP guidelines |
3 | Counsel the people who are presumptive DRTB/ diagnosed with/ on treatment for, DR-TB and their family | Through home visits Counsel the people with presumptive DR-TB/ people diagnosed with or on treatment of DR-TB and TB-HIV on: -Early and complete Diagnosis of DRTB, correct and complete Treatment of DRTB, -Treatment Adherence, -Co-morbidity management including regular Treatment and follow-up with ART for PLHIV -Airborne Infection Control, -Contact Investigation, -TB Preventive Therapy for contacts, -Adverse Drug Reaction monitoring and management -Social welfare measures |
1. Interview with people affected with TB/TBI to check STS's ability to counsel |
4 | Monitor the treatment adherence of people on DR-TB treatment and initiate timely retrieval actions |
-Monitor treatment adherence records on Niksay on a day to day basis -Identify people who have missed doses -Investigate reasons for missed doses and trouble shoot -Initiate timely retrieval actions wherever required |
1. Review Ni-kshay adherence calenders 2. Interview with treatment supporters and patients who missed doses |
5 | Coordinate timely Clinical and Laboratory follow-up of DR-TB patients according to NTEP Guidelines | Clinical Followup Laboratory Followup Treatment outcomes Long Term Post Treatment Outcomes |
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6 | Monitor Status of completion of comorbidity Testing for All notified TB patients | Coordinate with NTEP staff for timely completion of comorbidity testing | . Review in Ni-kshay reports and register |
7 | Monitor and Raise a request for drug stock and consumables replenishment at particular health facility | - To monitor adherence to stocking norms and identify health facility for impending stockouts or with drug stock nearing expiry and assist respective PHI drug store to raise refill request. - Coordinate with DTC/ State drug store pharmacist for issuance of relevant drug stock as per request |
1. Review indent and issue register of Ni-Kshay Aushadhi |
8 | Support the DTO in organizing the District level Comorbidity Committees and ensure optimal performance of TB Comorbidity activities |
-Prepare and maintain a directory of ICTCs, ART Centres, Community Care Centres, NCD clinics, private health facilities and NGOs working for HIV , in the district and collaborating NTEP Centres -Coordinating the meeting with relevant stakeholders and preparing action points -To oversee that action points are implemented
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9 | Build capacity of District staff (STS/ TBHV, MPHW, TS/HV, CHO) on DR-TB Services | - Support in the training of Peripheral staff |
1.Competency Assessment |
10 | Assist DTO to monitor the NTEP in the district | - Use Ni-kshay dashboards and other program reccords, and interpret key performance indicators of NTEP in the faility/geography -Perform time, place, person analysis and identify areas for improvement ` -Assist MO in Monitoring the input and process indicators related to the output/outcome indicator and suggest corrective actions - Conduct supportive supervision and help in building the capacity of treatemnet supporters with an intention to improve quality of services. - Assist Medical Officer in providing timely and actionable feedback to health sub-centers and reporting field staff (ANM, ASHA, TB-HV, STS, STLS, MPW, HA, etc.) - Support the staff in taking the corrective actions leading to an improvement in quality of services" |
1. Interview with DTO/ MO-DTC to check ability in supporting monitoring 2. Verification of review meeting minutes & documentation of feedback provided |