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

Introduction

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

  • TB & TB Epidemiology
  • NTEP
  • Approaches to S&M in NTEP
  • Integration of NTEP with Health System
  • Information Systems in NTEP

Self-Reading/Virtual


 

6

2



 

TB Laboratories and Diagnostic technologies in NTEP

  • Diagnostic Technologies and Lab Network
  • TB Detection centres
  • QA of TDC

Self-Reading/Virtual

6 (including Lab/Field visit)

3

TB Diagnosis and Case finding

  • TB Diagnosis and Case finding
  • General Concepts in TB Case Finding
  • Specimen collection and transportation
  • Approaches to TB Case Finding
  • Diagnostic Algorithms in NTEP
  • Active Case Finding Campaign
  • S&M for Case finding activities in NTEP

Physical

6



 

4

TB Treatment

  • Anti-TB Drug Formulations and regimens
  • ADRs to ATT
  • DS-TB Treatment and Care
  • Treatment Initiation
  • Treatment and post-treatment follow up
  • Treatment Support
  • Adherence Management

Physical

10(including  field visit)

5

TB and comorbidity management

  • National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke [NPCDCS]
  • TB and HIV
  • TB and Diabetes
  • TB and malnourishment
  • TB and Substance Abuse
  • TB and other comorbid conditions

Physical

3
 

6

Public Health Action

  • Patient Support
  • Contact tracing and investigation
  • Counselling
  • TB Arogya Sathi App

Physical

4

7

TB Prevention

  • IPC
  • TPT

Physical

4

 8

Direct Benefit Transfer in NTEP

  • General Concepts in DBT
  • Processes in DBT
  • Monitoring of DBT

Physical

6


 

9

Financial management and Planning

  • Overview of PIP
  • Needs assessment for Planning.
  • Preparing a PIP
  • Implementing the Plan
  • Financial expenditure and accounting

Physical

3
 

10

Procurement, Supply Chain Management & Preventive Maintenance

  • General Concepts in SCM
  • Information system for SCM in NTEP
  • Processes in SCM
  • Procurement in NTEP
  • QA in SCM

 Physical

6

11

Partnerships, Corporate and Multisectoral engagement

  •  General concepts in Partnership and MSE
  • Models of Partnership
  • Establishing Partnership
  • Multisectoral Engagement
  • Medical Colleges and NTEP

 Physical

4

 

12

 

ACSM and Community Engagement

  • ACSM
  • ACSM Activities
  • Social Inclusion and wellness activities
  • Community Engagement
  • PM TB Mukt Bharat Campaign

Physical

4

13

 

Supervision, Monitoring and Evaluation

Supervision

Monitoring

Programme Monitoring and Reviews

Physical

4

14

Training and capacity development

 

Training and capacity development

Physical

3

Trainers 

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

National trainers from National Institutes

National Consultants- Central TB Division

Trainers from select STDCs (identified by Central TB Division)

Select WHO consultants (from States)

Consultants (partner Organisations)

 

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 Program Managers’ and they must possess strong knowledge about the NTEP and the various processes related to patient workflow, Ni-ksahay and Ni-kshay Aushadhi.  The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure.

The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System), Ni-kshay and Ni-kshay Aushadhi.

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

 

These exercises are to be given as assignments that trainees need to finish before start of 2nd module.

 

Assignments:

1.1.1-Find the incidence of TB in India in preceding year. Please mention the source also.
1.1.2-What was the no of TB notifications in India for year 2021. Please mention the source that you used. Why incidence is not same as notification?
1.1.3-Download the notification register (Q1-2023) of your district. 
1.1.4-What are the Columns headings available in the register?
1.1.5-What are the options available under the filters for the 4 columns- a) patient status, b) key population, c)basisOfDiagnosis_FinalInterpretation, d) Treatment Outcome

Chapter 1.2 NTEP  
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.

What does a TU actually mean? 

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?’

Assignments:

1.2.1-Enumerate the 4 pillars/strategies mentioned in NSP (2017-2025).

1.2.2-Elaboorate the build component with respect to your district.

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.
1.3.2.-FInd the areas where the performance of district is less than the state average.

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.
1.4.2-Draw the district health system structure and how NTEP is integrated into it.

Chapter 1.5 Information Systems in NTEP  
Emphasis Points General introduction of the information available around NTEP  
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 hours)
Chapter 2.1 Diagnostic Technologies and Lab Network  
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? 

Ask “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.
3.1.2Learn about the different processes being followed in Nikshay for the same- i.e. adding test request, sample details and entering results in Ni-kshay.

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:

1) Microscopy Checklist:

a) Slide preparation, Storage of slides
b) Lab Register
c) Selection of slides for EQA & RBRC
b) Notification Register
c) Stock Register
d) Quality Control (QC) slides
e) Flow of pt and samples from OPD to MC and to CBAAT facility.

Select few entries in the lab register and validate it with information in Ni-kshay. 

 

2) NAAT Facility

a) The CBNAAT process overview
b) DOs and Don'ts while doing CBNAAT
c) Result entry in Ni-kshay

 

3) Turnaround time for the labs

 
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
  • 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 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.  
  • Process of Treatment Initiation and Transfer of patients 
Post-session Activity Request two participants to demonstrate in Demo Ni-kshay the ‘Transfer’ of patients using (i) Push and (ii) Pull methods. 
Chapter 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
  • Regimen and dose of drugs for managing DS-TB for adults and paediatric group and weight bands available 
  • Display all FDCs in NTEP and ensure the participants could identify all information related to it
  • Common adverse events of anti-TB drugs
Post-session Activity
  • Call one participant and ask to explain the step-by-step process for initiating treatment to a 50 Kg old adult diagnosed with pulmonary TB (Rif Sensitive). Write down all the steps in a flip chart/chatbox/Virtual whiteboard. Ask other members to comment on the missed steps and the order of steps. 
  • Call a second participant and ask to explain the follow up for the same patient.
Chapter 4.4 Overview of DR-TB   
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 4.5 Isoniazid [H] Mono/Poly DR-TB Regimen  
Emphasis Points  
Post-session Activity  
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 Discuss about the importance of adherence and how adherence is being reported, recorded and monitored through Ni-skahy.
Discuss about the Adherence dashboard.
 
Post-session Activity  
   
Module 5

TB and comorbidity management

 
Chapter 5.1 TB and HIV  
   
   
  TB and Diabetes  
   
   
  TB and malnourishment  
   
  TB and Substance Abuse  
   
  TB and other comorbid conditions  
   
Module 6 Public Health Action  
Chapter 6.1 Patient Support  
     
     
Chapter 6.2  Contact tracing and investigation  
   
   
Chapter 6.3 Counselling  
   
   
Chapter 6.4 TB Arogya Sathi App  
   
   
Module 7 TB Prevention  
Chapter 7.1 Infection Prevention and Control  
   
   
     
Chapter 7.2 TB Preventive Treatment  
   
 
  •  
Chapter 8.1 General Concepts in DBT  
   
   
Chapter 8.2 Processes in DBT  
   
   
Chapter 8.3 Monitoring of DBT  
   
   
Module Financial management and Planning  
Chapter 9.1 Overview of PIP  
   
   
Chapter 9.2 Needs assessment for Planning