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 hand-holding 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 at least 45 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. 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) 

1 

Basics of TB and NTEP 


 

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


 

Virtual

4

2 

 

 

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

3

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

3

6 

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

3

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

2

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

1

10

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

 Virtual

3

9

Public Health Action
  1. Public health actions for TB

 virtual

2

10 

DBT
  1. Overview of DBT
  2. Ni-kshay for DBT

 Virtual

2

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

1

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 () 

 

Chapter 3.1 

General concepts in SCT

 

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 

 

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 in Ni-kshay
  • Few participants may be asked to demonstrate the triple layer packaging on negative sample/distilled water.

Module 3: Smear microscopy   Hybrid Session (xx min) 

 

Chapter 3.1 

Collecting and storage of good quality specimen 

 

  

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 to collect two specimens-patient education, dispensing sputum cup, labeling etc

Chapter 3.2 

Sputum smear preparation 

 

  

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 3.3 

Staining sputum smear 

 

  

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 3.4 

Reading smear and reporting microscopy results 

 

 

Emphasis Points 
  • Steps involved; focusing slides, 
  • 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 participant to generate the DMC register

Chapter 3.5 

Maintenance of microscope 

 

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.

Chapter 3.6 

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

 

 

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. 

Practical Exercise

The practical exercise should include the demonstration

 

Formation of batches:

Planning of exercise

Setting of training hall/Lab

Requirement of equipment, supplies, reagents, samples, etc

 

Workflow:

 

 

 



 

Comments

Abhimanyu Mon, 27/02/2023 - 10:40

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 hand-holding 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 at least 40 hours.

For the purpose of assessment of trainees, a pretest 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. .


 

 

2. Training curriculum / Agenda

 Sr. 

Module  

Chapters 

Training Modality 
  1. Duration 

(Hrs) 

1 

Basics of TB and NTEP 


 

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


 

Virtual

4

2 

 

 

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

 

4

3

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

1


 

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

 

3

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


 

 

3

6 

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

 

3

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


 

  

2

8

Ensuring Quality TB lab services at TDCs
  1. General concepts in quality assurance
  2. External quality assurance


 

 

3

9

Infection Prevention and Control [IPC]
  1. General concepts in IPC
  2. Airborne Infection Control


 

  

1

10

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

 

3

9

Public Health Action
  1. Public health actions for TB

 

1

10 

DBT
  1. Overview of DBT
  2. Ni-kshay for DBT

 

1

11 

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


 

 

1

12

Supervision, Monitoring & Evaluation
  1. Supportive supervision
  2. Evaluation


 

  

1

13

Private sector Engagement
  1. Private sector engagement in NTEP
  

1

14

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

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