Trainers' Guide for STLS Course

1. Introduction

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

● Senior TB Laboratory Supervisors

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

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

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

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

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

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

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

2. Training curriculum / Agenda

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

3. Trainers

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

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

Eligibility -

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

Chapter wise detailed instructions for Trainers

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

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

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

Module 1: Basics of TB and NTEP Virtual Session (4 hours)
Chapter 1.1	TB & TB Epidemiology	Virtual Session (60 min)
Emphasis Points	Differences between TB Infection and active TB Disease TB has many determinants- behavioral, socio economic, biological Vulnerable population for TB Concepts of TB Notification Rate and TB Incidence Rate
Post Session Activity	The participants may be asked to (i) enumerate the various determinants of TB and (ii) difference between TB Infection and TB Disease Give an exercise to calculate the Notification rate of a TU. In a TU with a population of 2 lakhs, 100 TB cases were diagnosed and reported during the year 2022.. A total of 90 people with TB were initiated on treatment, 5 died and 2 migrated before initiation of treatment.and 3 could not be contacted at all. What is the annual TB notification rate for that TU in 2021? [ Answer: 50 per lakh] Discuss - Can we call the above obtained Notification figure as the incidence of TB in that TU? If not Why? [Discussion Points: Notification and Incidence are not the same. Notification includes all diagnosed TB cases and reported to the system. It includes both new and previously treated cases. There may be cases diagnosed, but not reported. It is possible that there will be cases in the community not diagnosed at all.]
Chapter 1.2	NTEP	Virtual Session (45 min)
Emphasis Points	Explain what India is committed to achieve in 2025 in relation to SDG related to ending TB. Clarify that the country has preponed the 2030 SDG targets related to ending TB to 2025. Organizational structure of NTEP with broad functions of each institution (state level and below) Different stages in the patient’s life cycle need to be explained in detail and emphasis on the concept of continuum of care from ‘presumptive TB to post treatment follow up’. Concepts of ‘’Standards of TB Care’’ as a minimum set of care that every citizen in India should receive irrespective of where he/she seeks care from
Post Session Activity	Discuss- ‘What India is committed to achieve in 2025 in relation to ending TB?’’ [Clarify that the country is only trying to achieve the SDG goals related to Ending TB] Discuss- ‘Can Medical College be a PHI?’
Chapter 1.3	Integration of NTEP with Health System	Virtual Session (30 mins)
Emphasis Points	Need for integration of NTEP with the general health system & NHM and how that integration is envisioned.
Post Session Activity	Discuss - "What are the opportunities available to NTEP through Health & Wellness Centers? How could that be materialized’?
Chapter 1.4	Patient Management	Virtual Session (60 mins)
Emphasis Points	How the information of patients are managed through Ni-kshay (Enrollment, Request for Test).
Post Activity Session	Call two participants to demonstrate how they (1) enroll a subject and (2) request for Test in Ni-kshay Make all participants to view their task list in Ni-kshay and discuss how they are going to use the feature
Module 2	TB Diagnosis and Case Finding	Virtual Session (4 hours)
Chapter 2.1	Diagnostic Technologies	Virtual Session (30 min)
Emphasis Points	Names of different tests, their uses, advantages and disadvantages
Post Session Activity	Ask what are the advantages and disadvantages of FL- LPA over NAAT?
Chapter 2.2	Diagnostic Network & Hierarchy	Virtual Session (30 min)
Emphasis Points	Network and hierarchy of laboratories and their basic role
Post Session Activity	Ask “ how many sputum collection and transportation facilities are there in their concerned TU? Make one participant explain how it functions and what are the benefits out of it”?- Bring out the following benefits (1) prevents leaks in cascade of care (reduce loss from presumptive TB identification to TB Testing) (2) minimizes patient inconveniences (3) minimize patient Turnaround Time (4) reduce out of pocket expenditure (5) helps in infection control as people with symptoms need not travel
Chapter 2.3	Approaches to TB Case Finding	Virtual Session (30 min)
Emphasis Points	Differentiate between screening and testing. The three approaches may be discussed by giving suitable examples to fit into the three scenarios
Post Session Activity	Discuss the following scenarios and ask the participants which case finding those are (i) Screening for active TB in a Diabetic Clinic & testing those who screened positive (ii) Screening for active TB in an elderly home & testing those who screened positive (iii) Screening for active TB in cancer wards & testing those who screened positive
Chapter 2.4	TB Case Finding in NTEP	Virtual Session (30 min)
Emphasis Points	Diagnostic algorithm for Pulmonary TB- Role of Chest X ray as a screening tool and the need to complete the diagnostic algorithm. Classification of TB on the basis of site,diagnosis, drug resistance
Post Session Activity	Discuss: “What proportion of presumptive TB patients in your TU completes the diagnostic algorithm? What are the implications if the people are not completing the diagnostic algorithm?”
Chapter 2.5	Active Case Finding Campaign	Virtual Session (45 mins)
Emphasis Points	Step by step process in planning and execution of an ACF campaign with special emphasis on identification of target population, need for micro planning and need to prevent the leaks in the cascade of care.
Post Session Activity	Discuss how they monitor the ACF in their TU against ‘Cascade of Care? What are the measures they undertake to prevent the leaks in ‘’Cascade of care’’?

Module 3: Specimen collection and transportation Virtual Session		(Physical Session: 2 hour)
Chapter 3.1	General concepts in SCT	Physical (45 mins)
Emphasis Points	Need for transportation of specimen. Modes of transportation employed. The Process of Sputum collection Requirement for Cold chain The different items may be shown.
Post Session Activity	The participants may be asked to identify different items and the specification- Eg Thermocol box size, falcon tube size, etc.
Chapter 3.2	Packaging and dispatching a sample to a C&DST lab	Virtual (45 mins)
Emphasis Points	Triple layer packaging, cold/cool chain; specimen transport carriers-technical specifications and labeling; dispatch of samples-Ni-kshay
Post Session Activity	One participant may be asked to add test request(dispatching the sample to CDST lab) in Ni-kshay Few participants may be asked to demonstrate the triple layer packaging on negative sample/distilled water.

Module 4: Smear microscopy:		Physical Session (8 hours )
Chapter 4.1	Collecting and storage of good quality specimen	Physical (60 mins)
Emphasis Points	Necessary steps in accepting request for TB test; Explain spot and morning samples, necessary steps during specimen receipt at laboratory, storage
Post Session Activity	Role play for collection of sputum sample (Probes- Collect two specimens, patient education, dispensing sputum cup, labelling etc.)
Chapter 4.2	Sputum smear preparation	Physical (60 mins)
Emphasis Points	Steps involved and their details; Do’s and Don’t to be highlighted at each step Emphasis to be given to prepare smear within 6 inches of burning spirit lamp and using other AIC measures (Direction of airflow, position of exhaust fan with respect to working station.
Post Session Activity	May ask the different trainees to enumerate the different steps involved in Smear Microscopy. May ask the details of individual steps from different participants. Demonstrate good smears, smear thickness to visualize print through it
Chapter 4.3	Staining sputum smear	Physical (60 mins)
Emphasis Points	Describe staining process-ZN, FM; properties of well stained slide-ZN/FM, importance of quality stains and staining process.
Post Session Activity	Demonstrate the well stained slides-ZN/FM (dark room)

Chapter 4.4	Reading smear and reporting microscopy results	Physical (60 mins)
Emphasis Points	Steps involved, focusing slides, Use of Different objective lens, Paper based reporting in Lab register. Digital reporting in Ni-kshay Diagnostic Module
Post Session Activity	Worksheets to demonstrate and fill paper-based records. Demonstration on Ni-shay Diagnostic Module (Demo) May ask one of the participants to generate the DMC register.
Chapter 4.5	Maintenance of microscope	Physical (30 mins)
Emphasis Points	Elaborate why storage is essential, steps in cleaning, storage and maintenance of microscope, AMC, troubleshooting.
Post Session Activity	Demonstrate cleaning of the microscope May also ask some of the participants to demonstrate the handling and storage of microscope. May also ask the participants about the different problems encountered while handling the microscope and other participants about the causes and the other set of participants about the solutions/ways to fix.

Practical Exercise

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

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

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

Setting of training hall/Lab-

The Laboratory should be suitably equipped to demonstrate the various equipment, consumables. Requirement of equipment, supplies, reagents, samples, etc should be communicated to the lab incharge beforehand and same should be arranged before the start of the training.
The unnecessary items should be removed from the workstation before the training session.
The biosafety precautions should be followed meticulously during the demonstration. The spill management kit, etc should be in place to deal with any contingencies.

Workflow:

Smear Microscopy:

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

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

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

CBNAAT:

Truenat:

Module 5: CBNAAT		(Physical Session: 08 hours)
Chapter 5.1	CBNAAT as a rapid molecular diagnostic tool	Physical (60 mins)
Emphasis Points	Key components of CBNAAT, process overview of CBNAAT consumables required; in-built controls, other CBNAAT tests
Post Session Activity	The CBNAAT machine may be demonstrated. The participants may be asked to name and identify the different parts of the CBNAAT machine. The participants may be asked to identify the different consumables and ways to handle it. May ask the different tests that can be conducted using the CBNAAT equipment.
Chapter 5.2	Sample processing for CBNAA	Physical (60 mins)
Emphasis Points	Importance of complete sample liquefaction; processing for EP samples
Post Session Activity	Demonstration of sample processing CBNAAT cartridge loading may be demonstrated to the participants (with emphasis on DOs and Donts)
Chapter 5.3	CBNAAT result interpretation and recording.	Physical (60 mins)
Emphasis Points	Visualization of results; Interpretation of results Non-conclusive results-retesting procedure. Recording of results in Ni-kshay Recording of results in paper-based register
Post Session Activity	Discussion on need for new sample/use of left over sample for retesting. may ask one of the participants to demonstrate Recording of results in Ni-kshay
Chapter 5.4	Troubleshooting in CBNAAT	Physical (30 mins)
Emphasis Points	Interfering substances, Troubleshooting-errors, invalids, hardware problems, test failure without error codes; data backup should be discussed
Post Session Activity	Discuss what troubleshooting is possible in the lab and when technical support is required from the vendor
Chapter 5.5	Maintenance of CBNAAT	Physical (60 mins)
Emphasis Points	Need for maintenance, frequency, materials required.
Post Session Activity	Prepare and fill log for daily, monthly maintenance.
	Practical Exercise on CBNAAT		Physical (180 mins)

Module 6: Truenat		(Physical Session: 08 hours)
Chapter 6.1	Truenat as a rapid molecular diagnostic test	Physical (45 mins)
Emphasis Points	Context setting and the relevance of the technology. Emphasis that it is an indigenous technology and focus of programme to adopt this technology Components of Truenat workstation, consumables required, process overview, inbuilt controls Storage conditions of the consumables also need to be discussed
Post Session Activity	The different components may be shown and the importance of each part/component may be discussed Exercise on forecasting laboratory consumables The participants may also be asked to explain the Truenat cartridge and importance of different chambers
Chapter 6.2	Specimen processing for Truenat	Physical (60 mins)
Emphasis Points	Importance of cleaning the workstation daily before and after starting the work Importance of sample pre-treatment, liquefaction, processing EP TB samples; DNA extraction; Amplification and Detection importance of complete liquefaction emphasis on critical steps in DNA extraction
Post Session Activity	One participant may be asked to demonstrate the cleaning the workstation(Unidirectional cleaning) Demonstrate the different steps involved in the specimen processing; Discussion with the participants about the Dos and Donts during the specimen processing
Chapter 6.3	Testing using the Truenat	Physical (60 mins)
Emphasis points	The different processes should be explained after unloading the cartridge, using autoanalyzer for MTB testing, handling elute, testing for Rif resistance. Emphasis should be on the best practices.
Post session Activity	The test can be demonstrated using the negative sample and participants should be given the opportunity to handle the equipment under the guidance and supervision of the trainer.
Chapter 6.4	Truenat result interpretation and recording.	Physical (60 mins)
Emphasis Points	Result visualization and interpretation; Recording-paper based & Ni-kshay
Post Session Activity	How to retrieve test results should be demonstrated. Discussion on need for new sample/use of leftover sample for retesting
Chapter 6.5	Troubleshooting in Truenat	Physical (30 mins)
Emphasis Points	Interfering substances, Troubleshooting-errors with Trueprep and Truelab; error classification, test failure without error codes
Post Session Activity	Discuss what troubleshooting is possible in the lab and when technical support is required from the vendor
Chapter 6.6	Truenat instrument maintenance and record keeping.	Physical (30 mins)
Emphasis Points	Need for maintenance, frequency, materials required; data backup.
Post Session Activity	Prepare and fill log for daily, weekly, monthly maintenance.
	Practical Exercises on Truenat		Duration: 3 hours

Module 7	ENSURING SMOOTH FUNCTIONING OF LAB SERVICES	Physical Session (3 hours)
Chapter 7.1	Maintaining Supplies of Lab Consumables at DMC; Consumables required at DMC.	Physical (60 mins)
Emphasis Points	Elaborate on consumables requires for sputum collection, slide preparation, staining and examination; stock registers; Technical specifications; Indenting supplies; Preparation of stains-ZN and FM.
Post Session activity	Exercise on inventory management for laboratory consumables Some participants may be asked to prepare the reagents following the instruction of the trainer. The stock register may be shown and some participants may be asked to explain the information fields.
Chapter 7.2	BIOMEDICAL WASTE MANAGEMENT IN A MICROSCOPY LAB	Physical (60 mins)
Emphasis point	Segregation of biomedical waste based on color coding of bins What components should be discarded in which bag Preparation and Use of disinfectants for different purposes
Post Session activity	Based on discussion, participants should be asked to prepare the line list of all the items to be disposed and the ideal way to dispose it Exercise on preparation of laboratory disinfectants
Chapter 7.3	Biomedical waste management in a NAAT lab	Physical (60 mins)
Emphasis Points	Biosafety requirement; waste collection, disinfection and disposal
Post Session Activity	Based on discussion, participants should be asked to prepare the line list of all the items to be disposed and the ideal way to dispose it- disinfectant type, duration, etc

Module 8: ENSURING QUALITY TB LAB SERVICES AT TDCS		Physical Session (3 hours)
Chapter 8.1	General concepts in quality assurance	Physical (60 mins)
Emphasis Points	Need for quality, implication of false positives and false negatives, storage of slides, outline of QA processes
Post Session Activity	Ask audience about issues and correction actions taken to maintain quality; List Good Laboratory Practices
Chapter 8.2	External Quality Assurance	Physical (60 mins)
Emphasis Points	OSE, RBRC,
Post Session Activity
Chapter 8.3	External Quality Assurance for NAAT	Physical (60 mins)
Emphasis Points	Panel testing
Post Session Activity	Envelopes and the content of the envelopes (received from NTI) may be shown. Demonstrate on EQANAAT portal- how the information has to be shared.

Module 9: Infection prevention and control (IPC)		Virtual Session (2 hours)
Chapter 9.1	General concepts in IPC	virtual (60 mins)
Emphasis Points	Need for IPC; standard precautions, IPC at a DMC and at NAAT sites
Post Session Activity	Demonstration of Respiratory hygiene Demonstration of Hand hygiene A virtual audit of cleaning practices in the lab can be carried out whether the good practices are followed in the participants lab or not
Chapter 9.2	Airborne infection control	virtual (60 mins)
Emphasis Points	Importance of AIC in TB laboratory, hierarchy of controls
Post Session Activity	Demonstrate ventilation as AIC measure Ask participants what administrative measures are taken at their centre for AIC and what actions they may take. They may be asked for some commitment and timelines to follow that.

Module 10: TB treatment and care		Virtual Session (6 hours)
Chapter 10.1	General concepts in TB treatment	Virtual (60 mins)
Emphasis Points	The treatment phases and significance of positive results for microscopy at the follow up testing The importance of counseling for treatment initiation and follow up testing should be emphasized Why testing is important after end of IP and CP and other follow up testing Follow up-including long term follow up and the importance
Post Session Activity	Discussion on need for long term follow up Important components of counseling a TB patient for follow-up testing
Chapter 10.2	ADR	Virtual (30 mins)
Emphasis Points	Identification of some common ADRs due to anti-TB drugs
Post Session Activity	The participants may be asked to enlist the different ADRs
Chapter 10.3	DS-TB Treatment and care	Virtual (30 mins)
Emphasis points	FDCs used for the treatment Schedule for followup and end of treatment testing and significance
Post session activity	May clear the doubts/queries of the participants
Chapter 10.4	DR-TB Treatment	Virtual (30 mins)
Emphasis points	What is UDST? Classification of DR-TB? Regimens available for DR-TB? Levels of facilities where treatment needs to be initiated.
Post Session activity	Ask participants for doubts and help them clear those doubts
Chapter 10.5	Adherence to TB Treatment	Virtual (30 mins)
Emphasis points	Importance of Adherence monitoring Different adherence recording and monitoring technologies
Post session activity	May also ask the participants about the adherence recording in Nikshay and Tb Arogya Sathi Application
Chapter 10.6	Treatment Support	Virtual (30 mins)
Emphasis Points	Meaning of Treatment support Significance of Treatment support Plan Treatment Supporter to a Tb patient Nutritional support and counseling Support for de addiction Free TB Services for TB patient
Post-session Activity	The participants may be asked to find the nearest de-addiction facilities located to their place.
Chapter 10.7	TB and comorbidities	Virtual (30 mins)
Emphasis Points	Bi directional screening for TB-HIV, TB-Diabetes Need for screening for tobacco and alcohol use among people with TB Nutritional assessment for people with TB. Need for and mechanism of Linkages of people with comorbidity (HIV, Diabetes, Malnutrition, Tobacco and alcoholism)
Post Session activity	Ask the participants to describe the existing mechanism at their TU to screen TB among the people visiting ICTC centers - how is the screening being done? How is it ensured that all those referred for testing have undergone testing? Discuss if there is any scope for improvement. Ask the participant to describe how diabetes testing is done among people with TB in their TU? What are the steps if a person with TB is found to have diabetes? Who and how is diabetic control ensured for that person? Discuss if there are any ways to improve.
Chapter 10.8	TB preventive therapy	Virtual (30 mins)
Emphasis Points	Eligible people for TPT Testing for TBI Steps for Ruling out active TB before initiating TPT Adherence monitoring and treatment support for those on TPT
Post Session Activity	Discussions on target population and risk groups

Module 11: PUBLIC HEALTH ACTION		Virtual (1 hour)
Chapter 11.1	Public Health Actions for TB	virtual (60 mins)
Emphasis Points	Why Public Health actions Public Health actions taken after TB notification Define contact tracing and contact investigation. TB education for community Counselling the TB patients and their family. Dos and Don'ts for Tb pateint couonseling
Post Session Activity	May ask any participant to enumerate the PHA May ask participant what do they understand by a specific PHA and its importance May ask the participant for what to counsel at different phases of patient care i.e Pre-treatment, during treatment and post treatment A small role play or conversation to discuss about DOs and don'ts of patient counselling

Module 12: SUPPLY CHAIN MANAGEMENT		Virtual (2 hours)
Chapter 12.1	SUPPLY CHAIN MANAGEMENT IN NTEP	Virtual (60 mins)
Emphasis Points	Meaning and significance Broad Principles of SCM Flow of Supplies in NTEP Procurement, its types GeM, Direct procurement, floating tender in GeM, Buffer stock, storage norms Nikshay Aushadhi Indenting Receipt of Supplies
Post Session Activity	May ask any participant to enumerate the the broad principles in SCM May also ask one participant to show how indenting and receipt of supplies is carried out in Nikshay Aushadhi
Chapter 12.2	MAINTAINING SUPPLIES OF LAB CONSUMABLES AT TDC	Virtual ( 60 mins)
Emphasis Points	Lab Consumables Consumables required at DMC Consumables required at NAAT laboratories Stock register and stock assessment at DMC
Post Session Activity	May ask one participant to show how they are updating the stock register

Module 13: Supervision, Monitoring and Evaluation (Virtual Session: 2 hours)
Chapter 13.1	Supervision	Virtual (120 mins)
Emphasis Points	Meaning of Supervision Objectives of Supervision Supportive Supervision Role of different stakeholders in Supervision at the TU level Role of STLS at the DMC Monitoring and Evaluation of NAAT labs Quality indicators of CBNAAT and Truenat lab
Post Session Activity

Module 14	Private Sector Engagement	Virtual Session ( 2 hours)
Chapter 14.1	General Concepts	Virtual (60 mins)
Emphasis Points	Why private sector engagement is important and what is the Vision of NTEP on private sector engagement. Explain PPSAs, Direct Option for engagement. Explain STEPS Emphasis on various options under partnership options Regulations of Mandatory TB Notification and Schedule H1
Post Session Activity	Recollect Standards of TB Care in India and emphasize that the vision of NTEP with regard to private sector engagement is to ensure STCI to all patients. The choice of where to take treatment remains with the patient. Emphasize that more than the private sector, it is the NTEP who wants to engage with the private sector to ensure that all patients reaching them receive STCI. Tell that TU is a population and ensuring STCI to all cases emerging from that population is the responsibility of STS. STS can engage the private sector to minimize his/her workload. Ask each of the participants to think what model suits for private sector engagement in their TU and why Discuss how information from schedule H1 could be used? (Clue: Most crucial field in the schedule H1 register is the name of the provider who prescribed it. Information from Schedule H1 register could be used to Identify the provider prescribing the anti TB drugs and prioritize for engagement, Identify missing TB cases)
Module 15	ACSM and Community Engagement	Virtual Session (2 hour)
Chapter 15.1	General Concepts in ACSM	Virtual (60 mins)
Emphasis Points	Differentiate clearly among Advocacy, Communication and Social Mobilization Common approaches for ACSM for TB Elimination
Post Session Activity
Chapter 15.2	Guidelines and Protocols for ACSM activities	Virtual Session (30 mins)
Emphasis Points	Organising Community Meetings, Peer group interventions, ACSM activities in schools
Post Session Activity	Discuss experiences form 1-2 participants regarding organizing community meetings
Chapter 15.3	Community Engagement	Virtual (30 mins)
Emphasis Points	LSGs and their role in TB Elimination TB Forums and what they can do What role can TB Champions play?
Post Session Activity	Discuss what needs to be done to reduce stigma regarding TB in the community. Encourage everybody to discuss.

Abhimanyu Sun, 26/02/2023 - 22:37

Competencies of the STLS

The following competencies are essential to an STLS.

Competency	Description/ activities pertaining to the said competency	Assessment of competency
Conduct laboratory tests for TB	Perform laboratory tests like AFB smear microscopy (ZN, FM) and NAAT (CBNAAT/ TruNAAT) as per NTEP guidelines Receive the sample in Ni-kshay/LIMS Record the test results in Ni-kshay/ LIMS	Direct observation of STLS performing the tests Verify at DTC regarding error rates of STLS' during RBRC process/Panel Testing.
Conduct On Site Evaluation (OSE) for Quality Assurance in TB laboratories	Plan & conduct On site Evaluation (OSE) visits for Quality Assurance in all TDCs Document the details of OSE and provide action-oriented feedback Advocate at various levels to ensure that the actions are taken as per the feedback provided	1. Review OSE reports & actions taken against the recommendations 2. Interview LT to understand STLS' ability in performing OSE
Manage supply chain of lab consumables in TU.	Monitor and identify health facilities with laboratory consumable stock nearing expiry and assist respective lab technicians to raise refill request Review indent requests from labs, take stock of available stock, and (forecasted requirements from other indenting units) follow the First Expiry First Out (FEFO) principle while stocking and issuing consumable stocks, updating the relevant records (physical). Review forecast estimates of supplies permitted for local procurement Coordinate with DTC store pharmacist for issuance of relevant consumable stock as per request	1. Interview STLS' to check the current practices 2. Review the stock register, intend register, issue register 3. Interview LT's regarding stock outs
Prepare chemical reagents for AFB staining	Prepare batches of laboratory chemical reagents (5% Phenol, etc.) Prepare QC slides Record batch wise and expiry wise quantities in stock register Update receipts/ issues of respective stocks on stock register	1. Direct observation of stain preparation 2. Direct observation at various laboratories regarding practices regarding chemical reagents
Conduct Random Blinded Random Rechecking (RBRC) activity	Collect RBRC sample slides from respective TB detection centers Read the given slides (blinded and from another TB Unit/ STLS) and fill Annexure C. Assist DTO/ MO-DTC in verification and finalization of RBRC final report. Investigate errors and submit reports Do Umpire reading of discordance slide when designated as Umpire	1. Check RBRC reports (annexures B,C,D) and errors investigation reports 2. Interview with STSL to understand the current practices 3. Interview with LTs to check STLS's ability in conducting RBRC
Conduct the trainings for LTs	Contribute in training needs assessment/ planning of respective training calendar at district level for LTs Train LT's based on the curriculum provided by NTEP	1. Check Training Management Information System, training plan and training reports 2. Interview with LTs to check STLS' ability in training
Establish sample collection and transportation system in respective areas	Map various TB testing technologies in respective health facilities Identify specimen collection centers based on need Identify transportation mechanism Train the team to collect, package in triple layer and transport samples Monitor and assure quality of the specimen collection & transportation system	1.Interview with STLS to understand the current practices 2.Review the plan for specimen collection & transportation 3.Observe current practices in the geography
Periodically update the Health Facility registration in respective geographical territory	Update Ni-kshay profile section of all health facilities classified as laboratories in allocated geographical territory (services, GIS location, contact details, names, bank details, etc.) Add/ register new laboratory facility on Ni-kshay	1. Review health facility status in Ni-kshay
Plan and conduct Active TB case Finding (ACF) campaigns in respective geographies	Perform mapping of vulnerable populations/ individuals Identify and train pool of community volunteers, ASHAs, on active TB case finding campaign Prepare team wise daily micro-plan/ calendar of ACF activities including plan for door-to-door visits, sample collection and transportation to linked TB laboratories Monitor the process and provide supportive supervision to ensure quality of services and prevent leaks in cascade of care Coordinate for reporting the data on Ni-Kshay on ACF modules	1. Review Ni-kshay ACF data, review micro-plans and ACF documents
Reporting and Monitoring of Laboratory performance under the geography	Monitor performance and quality of testing at TDCs under the assigned geography Reporting monthly lab indicators for NAAT and TDCs Support the DTO and MO-TC for taking necessary actions to maintain and improve laboratory performance	Check ability to access Ni-kshay records and calculate laboratory performance indicators Check previously reported Monthly indicators for NAAT and TDC Discuss with DTO in ability of STLS to monitor lab performance and suggest action points

Shahnawaz Fri, 10/05/2024 - 15:12