[Draft] Trainer's guide for the Course for MO-PHI on NTEP
Introduction
Targeted Trainees: Medical Officer- PHI includes generally all Medical Officers placed at Government Health facilities at primary, secondary and tertiary levels. This does not include Medical Officers that have specified roles in the NTEP program, such as Medical Officers at, District / Nodal DRTB-Centres, Medical Colleges, MO-TC.
Qualified Trainers: Trainers may be other Medical Officers at the District Level or above that are prior identified by State such as DTOs, MO-TCs who are in-turn trained on their cadre's corresponding course on NTEP.
Trainers are selected based on their ability to conduct training in an interactive and interesting manner. The Trainers should have completed their own cadre-wise course, thorough with this trainers guide and must possess strong knowledge about the NTEP, and the various processes related to patient workflow and Ni-kshay. The Trainers should be well versed with the supporting IT systems such as those for video conferencing (Zoom/ Teams/ Google meet), Learning Management System (Swasth-eGurukul), Ni-kshay, etc.
Mode of Training: Training may be provided by utilizing the blended approach where a mix of training methods and modes may be used to execute the training.
Training Institution: The training of MO-PHI is to be organized by the District TB Centre.
Recommended Batch size: 25.
Training Duration: The training course content has 4 modules with a total of 18 chapters. A trainee needs to complete this course in about a total 16 hours. The Module wise breakup is provided below
Sr. |
Module |
Duration |
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1 | Basics of TB and NTEP | 2hrs |
2 | Case Finding and Diagnosis | 3hrs |
3 | TB Treatment and Management | 7hrs |
4 | Program Management and Programmatic actions | 4hrs |
Chapter wise detailed instructions for Trainers
Module 1: Basics of TB and NTEP | ||
Chapter 1.1 | TB & TB Epidemiology | Mode: Self Learning |
Emphasis Points |
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Post Session Activity |
Ak trainees: "Compare and discuss the prevalence of TB in your state and India" Refer to : National TB Prevalence survey 2019-2021 report, page 68 https://tbcindia.gov.in/WriteReadData/l892s/25032022161020NATBPSReport.pdf If there are other state specific estimates, discuss that. |
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Chapter 1.2 | NTEP | Mode: Self Learning |
Emphasis Points |
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Post Session Activity |
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Chapter 1.3 | Information Systems in NTEP | Mode: Self Learning |
Emphasis Points |
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Post Session Activity | Request all trainees to log into Ni-kshay using their institution's login credentials. Ask them to list various modules they are seeing on the page after logging in. | |
Module 2: Case Finding and Diagnosis | ||
Chapter 2.1 | General Concepts in TB Case Finding | Mode: Self Learning |
Emphasis Points |
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Post Session Activity |
Ask a few trainees: 'If you refer 10 individuals with TB symptoms for testing from the OPD, what proportion will actually undergo testing?" Ask a follow up question: "How do you know that the number is correct?" Ask a follow up question: "What could be done to ensure that 100% of the clients referred are tested?" [ Getting information of all individuals with presumed TB either in Ni-kshay or other methods, specimen collection and transportation to prevent the leaks in cascade of care, monitoring the results against the line list of individuals with presumed TB] |
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Chapter 2.2 | Diagnostic Technologies and Lab Network | Mode: Self Learning |
Emphasis Points |
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Post Session Activity | Arrange a Visit to (a) Microscopy Centre and understand the External Quality Assurance activities (RBRC, OSE) happening (b) CB NAAT facility and observe the testing process (c) TrueNAT facility and observe the testing process | |
Chapter 2.3 | Diagnostic Specimen | Mode: Self Learning |
Emphasis Points |
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Post Session Activity | Discuss: What is the Turn Around Time for various tests in your institution? How is that compared against the benchmark? How could we reduce it further? | |
Chapter 2.4 | Active Case Finding Campaign | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
"A medical officer was reviewing the ACF data done in their field area. Total individuals mapped for ACF were 10,000; total individuals screened using TB symptoms were 8000. Out of them 400 were found to have TB symptoms. 200 underwent testing and 20 were diagnosed as TB, all were initiated on treatment" Provide them the scenario. Ask them to comment on the data. Discuss: Where is the biggest leaks in cascade? (significant leak in people with TB symptoms not underwent a test). What measures will you take as MO-PHI to minimize the gap? |
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Module 3: TB Treatment and Management | ||
Chapter 3.1 | General Concepts in TB Treatment | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
Physically check the Fixed Dose Combinations available in the program [4 FDC, 3 FDC, Pediatric drugs] Perform treatment initiation, and outcome declaration in demo version of Ni-kshay and restart a case to reinitiate the case on a new episode. |
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Chapter 3.2 | TB Treatment and Care | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
A 30-year-old female with 66 Kg, newly diagnosed to have drug sensitive pulmonary TB. 1. What pre-treatment evaluation will you advise before initiating the client on treatment? 2. Initiate and the treatment and prescribe the treatment on the demo version of Ni-kshay 3. Schedule clinical and laboratory follow-up for the client. What all will you will assess when she comes for the follow up? |
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Chapter 3.3 | Treatment Support | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
Discuss: How do you generally assign treatment supporter to your patient? Is that in consultation with the patient? Discuss: How many treatment supporters are in your area? What do you think about the quality of treatment support they provide? Share some experiences |
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Chapter 3.4 | Adherence Management | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity |
On the demo version of Ni-kshay, Mark adherence for a person on TB Treatment; 5 days as manually reported as taken and 5 days as manually reported as missed. Login to Ni-kshay using your institutional credentials. Comment on the treatment adherence pattern of the patients under anti-TB treatment in your area. |
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Chapter 3.5 | TB and comorbid conditions | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: How many people with diabetes are visiting your institution on a month? Are they all been screened for TB? Share your experiences related to screening for TB among the people with diabetes. How could we ensure that all people with diabetes reaching a health facility are screened for TB? | |
Chapter 3.6 | Infection Prevention & Control | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: What are the various administrative measures for air borne infection control in your institutions? Is it adequate? Is there a scope for improvement? | |
Chapter 3.7 | TB Preventive Therapy | Mode: Self / virtual instructor led |
Emphasis Points |
TB Preventive Therapy is permitted only after ruling out TB TB preventive therapy is available for people at high risk of TB but is not currently diseased, such as contacts and PLHIV |
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Post Session Activity | Discuss: What proportion of eligible contacts in your area are initiated on TPT? Out of those whom you initiated, what proportion completes the TPT? What needs to be done to improve the situation | |
Module 4: Program Management and Programmatic actions | ||
Chapter 4.1 | Public Health Actions | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: What are the some of the communication practices towards a person affected with TB you wish to see changed from your colleagues/staff of your health facility? | |
Chapter 4.2 | Patient Support | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: How should we support a person with TB with alcohol use disorder? Share your experiences related to your team's support in managing such clients. | |
Chapter 4.3 | Social Inclusion and wellness activities | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: Do you think gender inequality in TB care exists in your area? As a MO-PHI, what can you do to address the same? | |
Chapter 4.4 | Programme Monitoring | Mode: Self / virtual instructor led |
Emphasis Points |
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Post Session Activity | Discuss: Is the Panchayat/Local Body where your health facility is located progressing towards ending TB? Discuss using data. |
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