[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 |
|
Self-Reading/Virtual
|
6 |
2
|
TB Laboratories and Diagnostic technologies in NTEP |
|
Self-Reading/Virtual | 6 (including Lab/Field visit) |
3 | TB Diagnosis and Case finding |
|
Physical |
6
|
4 | TB Treatment |
|
Physical | 10(including field visit) |
5 | TB and comorbidity management |
|
Physical | 3 |
6 | Public Health Action |
|
Physical | 4 |
7 | TB Prevention |
|
Physical | 4 |
8 | Direct Benefit Transfer in NTEP |
|
Physical |
6
|
9 | Financial management and Planning |
|
Physical | 3 |
10 | Procurement, Supply Chain Management & Preventive Maintenance |
|
Physical | 6 |
11 | Partnerships, Corporate and Multisectoral engagement |
|
Physical | 4 |
12
|
ACSM and Community Engagement |
|
Physical | 4 |
13
|
Supervision, Monitoring and Evaluation |
|
Physical | 4 |
14 | Training and capacity development | Physical | 3 |
Trainers:
For this course, personnel that have been trained and certified by Central TB Division for conducting this course at national level may only act as trainers. These may include personnel from Central TB Division, National Institutes, Technical Partner Organizations, STDCs and Medical Colleges. Central TB Division will maintain the latest list of certified trainers and need to be referred to before conducting the training.
Trainers are selected based on the following aspects
- Ability to conduct training in an interactive and interesting manner.
- Strong knowledge about the NTEP and the various processes related to patient workflow, Ni-ksahay and Ni-kshay Aushadhi; demonstrated by completing the entire question bank related to the modules they are certified to train.
- Proficient in this Chapter- wise Training Guide.
- Well versed with the IT systems such as, Zoom (for video conferencing), Swasth-eGurukul (Learning Management System), Ni-kshay and Ni-kshay Aushadhi.
Chapter wise instructions for Trainers
The aim of providing chapter-wise detailed instructions provides the Trainers with the following:
- Module-wise and Chapter-wise, modality that may be adopted (Self-reading/virtual/ Physical/ In-person)
- The estimated time to complete the content.
- The key messages that a trainer should emphasize upon, while delivering the training
The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here.
Some exercises have also been provided with the relevant chapters that the trainees need to finish as the part of curriculum. The trainers should ensure that all the trainees finish these exercises individually and record it in appropriate response forms. All the exercise should be discussed by the trainers during the training.
This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.
Module 1: Basics of TB and NTEP | |
---|---|
Chapter 1.1 | TB & TB Epidemiology |
Emphasis Points | 1. Difference between Incidence and notification 2. Difference between Exposure to TB, infection and TB disease. |
Post Session Activity |
These exercises are to be given as assignments that trainees need to finish before start of 2nd module. Assignments:
|
Chapter 1.2 | NTEP |
Emphasis Points |
|
Post Session Activity |
Discuss- ‘What India is committed to achieve in 2025 in relation to ending TB?’’ [Clarify that the country is only trying to achieve the SDG goals related to Ending TB] Discuss- ‘Can Medical College/ IRL be a PHI?’[Clarify that any patient service delivery point will be a PHI, but program management units like STC, DTC, TU etc are not PHIs] Assignments:
|
Chapter 1.3 | Approaches to S&M in NTEP |
Emphasis Points | Discuss the importance of S&M. Emphasize that S&M of the different activities under NTEP will be discussed alongside the activity while discussing the content in the modules. |
Post-session activity |
Assignment: 1.3.1- Find the index score of your district using Nikshay for year 2022. |
Chapter 1.4 | Integration of NTEP with Health System |
Emphasis Points | Discuss the need for integration of NTEP with the general health system & NHM and how that integration is envisioned. |
Post-session activity |
Discuss - "What are the opportunities available to NTEP through Health & Wellness Centers? How could that be materialized? Assignments: 1.4.1-Write the organisation str of NTEP in your district. |
Chapter 1.5 | Information Systems in NTEP |
Emphasis Points |
|
Post-session Activity | 1.5.1- Enlist the different stakeholders that are working with Nikshay and their specific roles in NI-kshay. |
Module 2 | TB Laboratories and Diagnostic technologies in NTEP |
Chapter 2.1 | Diagnostic Technologies and Lab Network |
Emphasis Points | Names of different tests, their uses, advantages and disadvantages |
Post-session Activity |
Discuss: what are the advantages and disadvantages of FL- LPA over NAAT? Discuss “how many sputum collection and transportation facilities are there in their concerned district? Make one participant explain how it functions and what are the benefits out of it”? - Bring out the following benefits (1) prevents leaks in cascade of care (reduce loss from presumptive TB identification to TB Testing) (2) minimizes patient inconveniences (3) minimize patient Turnaround Time (4) reduce out of pocket expenditure (5) helps in infection control as people with symptoms need not travel Assignment: 3.1.1Learn about the processes being followed in your district for sample transport from patient to TDC. |
Chapter 2.2 | TB detection Centres |
Emphasis Points | Discuss the consumables required for the Microscopy, CBNAAT and Truenat |
Post-session Activity |
Assignments: A Lab-visit needs to be organised for participants to see the different processes involved for testing. |
Chapter 2.3 | Specimen collection and transportation |
Emphasis Points |
The need for SCT, importance of cool chain requirement. Discuss how the delays can be reduced to improve the TAT overall |
Post Session Activity | May ask one of the participants to volunteer and demonstrate the different processes being followed in Nikshay for the same- i.e. adding test request, sample details and result updation in Ni-kshay. |
Chapter 2.4 | Quality Assurance of TDC |
Emphasis Points | Explain the process involved in EQA of microscopy. |
Post-session Activity |
Lab Field visit: A field visit should be organized to a lab to understand and discuss the following:
3) Obtain the Lab register from Nikshay and calculate the patient TurnAroundTime (referral to test reporting) for the lab and compare it with the Lab TurnAroundTime (Sample Receipt to Reporting) |
Module 3 |
TB Diagnosis and Case finding |
Chapter 3.1 | General Concepts in TB Case Finding |
Emphasis Points | Differentiate between screening and testing. |
Post-session Activity | |
Chapter 3.2 | Approaches to TB Case Finding |
Emphasis Points | Clearly differentiate the difference between the three different approaches- Active, Passive and Intensified. |
Post-session Activity |
(i) Screening for active TB in a Diabetic Clinic & testing those who screened positive (ii) Screening for active TB in an elderly home & testing those who screened positive (iii) Screening for active TB in cancer wards & testing those who screened positive |
Chapter 3.3 | Diagnostic Algorithms in NTEP |
Emphasis Points | Discuss how the algorithms to be read |
Post-session Activity | Ask the participants to look at details of 5 TB patients from their district and see whether complete diagnostic algo has been followed or not. |
Chapter 3.4 | Active Case Finding Campaign |
Emphasis Points | Step by step process in planning and execution of an ACF campaign with special emphasis on identification of target population, need for micro planning and need to prevent the leaks in the cascade of care. |
Post-session Activity | Discuss how ACF campaign is carried in participants district and how the activity can be carried out more effectively. |
Chapter 3.5 | S&M for Case finding activities in NTEP. |
Emphasis Points | Discuss the TB index dashboard. Discuss the TB Notification dashboard, |
Post-session Activity | The participants may be asked to access the TB index dashboard and TB notification dashboard from their logins and share their learnings with other audience. |
Module 4 | TB Treatment |
Chapter 4.1 | General Concepts in TB Treatment |
Emphasis Points |
It's an overview chapter explaining the concepts- Fixed Dose Combination, Intensive & Continuation Phase.
|
Post-session Activity | Request two participants to demonstrate in Demo Ni-kshay the ‘Transfer’ of patients using (i) Push and (ii) Pull methods. |
Chapter 4.2 | ADRs to ATT |
Emphasis Points | Discuss about the aDSM available in Ni-kshay , the importance and how it is carried out. |
Post-session Activity | Ask one of the participants to demonstrate the adverse event module in Ni-kshay from reporting, management and outcome. |
Chapter 4.3 | DS-TB Treatment and Care |
Emphasis Points |
|
Post-session Activity |
|
Chapter 4.4 | Overview of DR-TB |
Emphasis Points |
Explain:
|
Post-session Activity | Ask participants for doubts and help them clear those doubts. |
Chapter 4.5 | Isoniazid [H] Mono/Poly DR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session Activity | May ask the participant to look at 2 TB patients (outcome declared) on H Mono/poly DR-TB regimen whether the follow-up sputum examination was done timely or not. |
Chapter | Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session activity | May ask participants to look at 2 TB patients (outcome declared) on shorter oral Bdq containing MDR/RR regimen whether all the relevant investigations for PTE and follow-up sputum examination were carried out timely. |
Chapter | Longer Oral M/XDR-TB Regimen |
Emphasis Points | Discuss the regimen composition and duration, inclusion-exclusion criterion, replacement sequence and the follow-up examination. |
Post-session activity | May ask participants to look at 1 TB patient (outcome declared) on longer oral M/XDR regimen whether all the relevant investigations for PTE and follow-up sputum examination were carried out timely. |
Chapter 4.6 | Treatment Support |
Emphasis Points | Discuss the role of treatment supporter and how they can be registered in Nikshay, patient mapped. |
Post-session Activity | Ask the participants to practice the registration of treatment supporter and subsequent mapping of patients to the treatment supporters in demo-version in Ni-kshay. |
Chapter 4.7 | Adherence Management |
Emphasis Points |
|
Post-session Activity |
|
Chapter | Monitoring of Treatment |
Emphasis Points | Discuss the indicators used in monitoring the treatment- treatment initiation, outcome declaration. |
Post-session activity |
Exercise: Ask the participants to download the notification register for Q1-2023 and ask them to calculate the average delay in treatment initiation from date of diagnosis. Discuss how this delay can be minimised. |
Field Activity |
A 2nd field visit(Batch size- 5-7 participants) should be organised to the following
|
Module 5 |
TB and comorbidity management |
Chapter 5.1 | TB and HIV |
Emphasis Points | Bidirectional screening for TB-HIV |
Post-session activity | Ask the participants to describe the existing mechanism at their district to screen TB among the people visiting ICTC centres- how is the screening being done? How is it ensured that all those referred for testing have undergone testing? Discuss if there is any scope for improvement. |
Chapter 5.2 | TB and Diabetes |
Emphasis Points | Bidirectional screening for TB-Diabetes |
Post-session activity | Ask the participant to describe how diabetes testing is done among people with TB in their district? What are the steps if a person with TB is found to have diabetes? Who and how is diabetic control ensured for that person? Discuss if there are any ways to improve. |
Chapter | TB and malnourishment |
Emphasis Point: | Discuss how malnourishment affects TB patient and role of Nutritional support in successful completion of treatment. |
Chapter | TB and Substance Abuse |
Emphasis Point: | Discuss how Alcohol and Tobacco Abuse affects TB and importance of linkage with the deaddiction centre. |
Post Session Activity | The participants may be asked to list the de-addiction centres and tobacco-caseation centres. |
Chapter | TB and other comorbid conditions |
Module 6 | Public Health Action |
Chapter 6.1 | Patient Support |
Emphasis Points | Various kinds of support the TB patient needs (nutritional support, psychosocial support, support for deaddiction, travel support) and how STS could help in offering the same |
Post-session activity | Give a scenario: A 62 year old woman from a Tribal community affected with TB. Ask all participants to list out all the Government schemes/initiatives which can support her during the treatment period? Write down all schemes in a flip chart/Chatbox/Virtual board |
Chapter 6.2 | Contact tracing and investigation. |
Emphasis Points |
Discuss:
|
Post-session Activity |
|
Chapter 6.3 | Counselling |
Emphasis Points |
Discuss:
|
Post-session Activity |
|
Chapter 6.4 | TB Arogya Sathi App |
Emphasis Points |
Discuss the various information available in TB Arogya Sathi Application-
|
Post-session Activity | The participants may be requested to do a screening test on themselves and check the working of the application. |
Module 7 | TB Prevention |
Chapter 7.1 | Infection Prevention and Control |
Emphasis Points | |
Post-session Activity | |
Chapter 7.2 | TB Preventive Treatment |
Emphasis Points | |
Post-session Activity | |
Chapter 8.1 | General Concepts in DBT |
Emphasis Points | |
Post-session Activity | |
Chapter 8.2 | Processes in DBT |
Emphasis Points | |
Post-session Activity | |
Chapter 8.3 | Monitoring of DBT |
Emphasis Points | |
Post-session Activity | |
Module | Financial management and Planning |
Chapter 9.1 | Overview of PIP |
Emphasis Points | |
Post-session Activity | |
Chapter 9.2 | Needs assessment for Planning |
Emphasis Points | |
Post-session Activity |
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