Trainers' Guide for STLS Course

Trainers' Guide for STLS Course

1. Introduction

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

    Senior TB Laboratory Supervisors

 

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

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

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

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

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

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

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

2. Training curriculum / Agenda

 Sr. 

Module  

Chapters 

Training Modality 

  1. Duration 

(Hrs) 

Basics of TB and NTEP 

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

Virtual

4

 

 

TB Diagnosis and case finding in NTEP 

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

 Virtual

4

3

Specimen collection and Transportation

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

2


 

4

Smear Microscopy

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

 Physical

8

5

CBNAAT

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

 Physical

8

Truenat

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

 Physical

8

7

Ensuring Smooth functioning of Lab Services

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

3

8

Ensuring Quality TB lab services at TDCs

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

 Physical

3

9

Infection Prevention and Control [IPC]

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

2

10

TB Treatment and care

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

 Virtual

6

9

Public Health Action

  1. Public health actions for TB

 virtual

1

11

Supply Chain Management

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

 Virtual

2

12

Supervision, Monitoring & Evaluation

  1. Supportive supervision
  2. Evaluation 
Virtual

2

13

Private sector Engagement

  1. Private sector engagement in NTEP
Virtual

2

14

ACSM

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

2

15

Training

Training the Lab Technicians

 

2

 

3. Trainers

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

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

 Eligibility -

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

Chapter wise detailed instructions for Trainers 

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

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

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

 

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

Chapter 1.1

TB & TB Epidemiology

Virtual Session (60 min)

Emphasis Points

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

Post Session Activity

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

Chapter 1.2

NTEP

Virtual Session (45 min)

Emphasis Points

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

Post Session Activity

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

Chapter 1.3

Integration of NTEP with Health System  

Virtual Session (30 mins)

Emphasis Points

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

Post Session Activity

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

Chapter 1.4

Patient Management

Virtual Session (60 mins)

Emphasis Points

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

Post Activity Session

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

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

Module 2

TB Diagnosis and Case Finding

Virtual Session (4 hours)

Chapter 2.1

Diagnostic Technologies

Virtual Session (30 min)

Emphasis Points

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

Post Session Activity

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

Chapter 2.2

Diagnostic Network & Hierarchy

Virtual Session (30 min)

Emphasis Points

  • Network and hierarchy of laboratories and their basic role

Post Session Activity

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

Chapter 2.3

Approaches to TB Case Finding

Virtual Session (30 min)

Emphasis Points

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

Post Session Activity

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

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

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

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

Chapter 2.4

TB Case Finding in NTEP

Virtual Session (30 min)

Emphasis Points

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

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

 

Post Session Activity

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

 

Chapter 2.5

Active Case Finding Campaign

Virtual Session (45 mins)

Emphasis Points

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

Post Session Activity

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

Module 3: Specimen collection and transportation Virtual Session 

(Physical Session: 2 hour)

Chapter 3.1 

General concepts in SCT

Physical (45 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 3.2

Packaging and dispatching a sample to a C&DST lab 

Virtual (45 mins)

Emphasis Points 

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

Post Session Activity 

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

Module 4: Smear microscopy: 

Physical Session (8 hours )  

Chapter 4.1 

Collecting and storage of good quality specimen 

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

  • Role play for collection of sputum sample 

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

Chapter 4.2 

Sputum smear preparation 

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 4.3 

Staining sputum smear  

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 4.4 

Reading smear and reporting microscopy results  

 Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 4.5 

Maintenance of microscope 

Physical (30 mins)

Emphasis Points 

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

Post Session Activity 

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

Practical Exercise

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

 

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

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

Setting of training hall/Lab- 

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

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

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

 

Workflow:

Smear Microscopy: 

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

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

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

 

 

CBNAAT:

 

Truenat:

 

 

 

Module 5: CBNAAT 

(Physical Session: 08 hours)

Chapter 5.1 

CBNAAT as a rapid molecular diagnostic tool 

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 5.2 

Sample processing for CBNAA

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

  • Demonstration of sample processing

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

Chapter 5.3 

 

CBNAAT result interpretation and recording. 

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 5.4 

Troubleshooting in CBNAAT 

 

Physical (30 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 5.5 

Maintenance of CBNAAT 

 

Physical (60 mins)

Emphasis Points 

  • Need for maintenance, frequency, materials required.

Post Session Activity 

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

Module 6: Truenat 

(Physical Session: 08 hours)

Chapter 6.1 

Truenat as a rapid molecular diagnostic test 

 Physical (45 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 6.2 

Specimen processing for Truenat

 Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 6.3

Testing using the Truenat

Physical (60 mins)

Emphasis points

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

Post session Activity

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

Chapter 6.4 

Truenat result interpretation and recording. 

 Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 6.5 

Troubleshooting in Truenat 

 Physical (30 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 6.6 

Truenat instrument maintenance and record keeping. 

 Physical (30 mins)

Emphasis Points 

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

Post Session Activity 

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

  Practical Exercises on Truenat Duration: 3 hours

Module 7

ENSURING SMOOTH FUNCTIONING OF LAB SERVICES

Physical Session (3 hours)

Chapter 7.1 

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

Physical (60 mins)

Emphasis Points

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

 
Post Session activity

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

Chapter 7.2

BIOMEDICAL WASTE MANAGEMENT IN A MICROSCOPY LAB

Physical (60 mins)

Emphasis point

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

Post Session activity

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

Chapter 7.3

Biomedical waste management in a NAAT lab 

Physical (60 mins)

Emphasis Points 

  •  Biosafety requirement; waste collection, disinfection and disposal

Post Session Activity 

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


Module 8: ENSURING QUALITY TB LAB SERVICES AT TDCS 

Physical Session (3 hours)

Chapter 8.1 

General concepts in quality assurance  

Physical (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 8.2 

External Quality Assurance

Physical (60 mins)

Emphasis Points 

OSE, RBRC,  

 

Post Session Activity 

   

Chapter 8.3

External Quality Assurance for NAAT

Physical (60 mins)

Emphasis Points 

Panel testing

 

Post Session Activity 

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

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

 

Module 9: Infection prevention and control (IPC)     

Virtual Session (2 hours)

Chapter 9.1 

General concepts in IPC 

virtual (60 mins)

Emphasis Points 

  • Need for IPC; standard precautions, 

  • IPC at a DMC and at NAAT sites

Post Session Activity 

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

Chapter 9.2 

Airborne infection control 

virtual (60 mins)

Emphasis Points 

  •  Importance of AIC in TB laboratory, hierarchy of controls

Post Session Activity 

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

Module 10: TB treatment and care 

Virtual Session (6 hours)

Chapter 10.1 

General concepts in TB treatment 

Virtual (60 mins)

Emphasis Points 

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

Post Session Activity 

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


 

Chapter 10.2 

ADR

Virtual (30 mins)

Emphasis Points 

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

Post Session Activity 

  • The participants may be asked to enlist the different ADRs

Chapter 10.3

DS-TB Treatment and care

Virtual (30 mins)

Emphasis points

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

Post session activity

May clear the doubts/queries of the participants

Chapter 10.4

DR-TB Treatment

Virtual (30 mins)

Emphasis points

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

Post Session activity

  • Ask participants for doubts and help them clear those doubts 

Chapter 10.5

Adherence to TB Treatment

Virtual (30 mins)

Emphasis points

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

Post session activity

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

Chapter 10.6

Treatment Support

Virtual (30 mins)

Emphasis Points

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

Post-session Activity

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

Chapter 10.7

TB and comorbidities

Virtual (30 mins)

Emphasis Points

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

Post Session activity

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

Chapter 10.8 

TB preventive therapy 

Virtual (30 mins)

Emphasis Points 

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

Post Session Activity 

Discussions on target population and risk groups

Module 11: PUBLIC HEALTH ACTION  

 

Virtual (1 hour)

Chapter 11.1 

Public Health Actions for TB

 

virtual (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Module 12: SUPPLY CHAIN MANAGEMENT  

 

Virtual (2 hours)

Chapter 12.1 

SUPPLY CHAIN MANAGEMENT IN NTEP

 

Virtual (60 mins)

Emphasis Points 

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

Post Session Activity 

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

Chapter 12.2 

MAINTAINING SUPPLIES OF LAB CONSUMABLES AT TDC

 

Virtual ( 60 mins)

Emphasis Points 

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

Post Session Activity 

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

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

Chapter 13.1 

Supervision 

Virtual (120 mins)

Emphasis Points 

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

Post Session Activity 

  •  

Module 14      

Private Sector Engagement

Virtual Session ( 2 hours)

Chapter 14.1          

General Concepts

Virtual (60 mins)

Emphasis Points

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

  • Explain PPSAs, Direct Option for engagement.

  • Explain STEPS

  • Emphasis on various options under partnership options

  • Regulations of Mandatory TB Notification and Schedule H1

Post Session Activity

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

Module 15

ACSM and Community Engagement

Virtual Session (2 hour)

Chapter 15.1

General Concepts in ACSM

Virtual (60 mins)

Emphasis Points

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

Post Session Activity

 

Chapter 15.2

Guidelines and Protocols for ACSM activities

Virtual Session (30 mins)

Emphasis Points

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

Post Session Activity

Discuss experiences form 1-2 participants regarding organizing community meetings

Chapter 15.3

Community Engagement

Virtual (30 mins)

Emphasis Points

LSGs and their role in TB Elimination

TB Forums and what they can do

What role can TB Champions play?

Post Session Activity

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

 

Abhimanyu

Competencies of the STLS

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
  1. Direct observation of STLS performing the tests
  2. 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
  1. Check ability to access Ni-kshay records and calculate laboratory performance indicators
    Check previously reported Monthly indicators for NAAT and TDC
  2. Discuss with DTO in ability of STLS to monitor lab performance and suggest action points
Shahnawaz