WHO Collaborating Centre in Tuberculosis Training National...

WHO Collaborating Centre in Tuberculosis Training

National Institute of Tuberculosis and Respiratory Diseases has been designated by the WHO as a WHO Collaborating Centre in Tuberculosis Training on 06 November

2014 (WHOCC No. IND-128) The NITRD-WHO CC was opened on World TB Day 2015 by Dr. Jagdish Prasad, Director General of Health Services (GOI), Dr. Md. Khurshid Alam Hyder, Regional Adviser, Tuberculosis, WHO-SEARO and Dr Sreenivas A.N., National Program Officer-TB, WHO India. Dr. Rohit Sarin, Director, NITRD, is the head of this Centre and the faculty from the different clinical, laboratory and public health departments of the Institute are participating members. WHO would be the technical partner for all activities carried out under the WHOCC. The current designation is for a period of four years. There are two key components to the NITRD-WHO collaborative activities:

I. Human resource development and dissemination of knowledge and skills in TB Control II. Participation in research to contribute to WHO’s evidence based strategies.

As part of this WHOCC, NITRD would enhance its existing training activities and take a lead role in conducting training programs on various aspects of TB on a regular basis, both for India and the Region. Addressing training needs of the Region would be an important objective of this Centre’s activities. A wide range of TB training programs would be offered under this venture including: i) Clinical management of Drug resistant TB (DR-TB) ii) Programmatic management of DR-TB iii) HIV-TB case management iv) Airborne infection control and v) Workshops on other diverse aspects of TB and TB control

Basic and advanced workshops in mycobacteriological laboratory methods would be a distinctive activity under this collaboration. The laboratory trainings would cover the entire breadth of TB diagnostics including microscopy, solid and liquid culture techniques (for both first and second line anti-TB drugs) and even latest molecular diagnostic methods like LPA and Cartridge based Nucleic Acid Tests. Training programs for different cadres for health care workers would be provided, tailoring to the needs of the trainees. NITRD would also undertake research focussed on development of novel rapid tests for diagnosis of TB, MDR-TB and XDR-TB as part of the WHO collaborative activities.

Schedules of different training programs planned at NITRD under this WHO CC are given in the ‘NITRD-WHOCC Training Schedules’ booklet.

Opening of the WHO Collaborating Centre in Tuberculosis

Training at NITRD on World TB Day 2015

Unveiling of the plaque by Dr. Jagdish Prasad, Director General of Health Services (GOI), Dr Md. Khurshid Alam Hyder, Regional Adviser, Tuberculosis, WHO-SEARO and

Dr Sreenivas A.N., National Program Officer- TB, WHO India

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Table of Contents

1. About NITRD-WHOCC in TB Training ........................................................................................ 1

2. Clinical Management Course on Drug Resistant TB ................................................................. 3

3. Training in programmatic management of drug resistant TB ........................................... 6

4. Laboratory Training on ZN Smear Microscopy ........................................................................... 9

5. Laboratory Training on LJ Culture and DST ............................................................................. 11

6. Laboratory Training on Detection, Identification and Drug Susceptibility Testing of M.tb by MGIT -960 ........................................................................................................... 16

7. Practical Course on the Rapid Molecular Detection of M. Tb and

its Resistance to Isoniazid and Rifampin by PCR-based Line Probe Assay ................... 20 8. Training on HIV-TB on new National TB guidelines ……………………………….27 9. Program for Training on Childhood Tuberculosis…………………………………………29 10. Air Born Infection Control Training/ Workshop ……………………………………30

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National Institute of Tuberculosis and Respiratory Diseases has

been designated by the WHO as a WHO Collaborating Centre in

Tuberculosis Training on 06 November 2014 (WHOCC No. IND-128)

Dr. Rohit Sarin, Director, NITRD, is the head of this Centre and the faculty from the different clinical, laboratory and public health departments of the Institute are participating members. WHO would be the technical partner for all activities carried out under the WHOCC. The current designation is for a period of four years.

There are two key components to the NITRD-WHO collaborative activities:

I. Human resource development and dissemination of knowledge and skills in TB

Control II. Participation in research to contribute to WHO’s evidence based strategies.

As part of this WHOCC, NITRD would enhance its existing training activities and take a lead role in conducting training programs on various aspects of TB on a regular basis, both for India and the Region. Addressing training needs of the Region would be an important objective of this Centre’s activities.

A wide range of TB training programs would be offered under this venture including:

i) Clinical management of Drug resistant TB (DR-TB) ii) Programmatic management of DR-TB iii) HIV-TB case management iv) Airborne infection control and v) Workshops on other diverse aspects of TB and TB control

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Basic and advanced workshops in mycobacteriological laboratory methods would be a distinctive activity under this collaboration. The laboratory trainings would cover the entire breadth of TB diagnostics including microscopy, solid and liquid culture techniques (for both first and second line anti-TB drugs) and even latest molecular diagnostic methods like LPA and Cartridge based Nucleic Acid Tests. Training programs for different cadres for health care workers would be provided, tailoring to the needs of the trainees. NITRD would also undertake research focussed on development of novel rapid tests for diagnosis of TB, MDR-TB and XDR-TB as part of the WHO collaborative activities.

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Clinical Management Course on Drug Resistant TB

Duration : 2 weeks Method : Lectures + field visits + ward visits + module discussion*

Day 1

Introduction to course

Pretest Questionnaire

Orientation about NITRD by visit to various departments (?)

Lecture on Epidemiology of TB, MDR-TB, RNTCP structure in India

Introduction about RNTCP: implementation aspects - Deptt of Epidemiology Day 2 Recap of the previous day FN: Laboratory visit – discussion and demonstration of LJ Media, MGIT, LPA, Gene

Xpert etc AN: Lecture on Bacteriological mechanism of Drug Resistance eg.

Mitchinson hypothesis, population hypothesis etc.: by Clinician

Day 3 Recap of the previous day FN : Lecture: How MDR-TB develops, clinical & operational cause etc.

Lecture: How to design MDR-TB regimen AN : Make round of MDR Ward

Case discussion of 1/2 cases

* The WHO PMDT modules would be referred to for clarification on different issues

in drug resistant TB

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Day 4 Recap of the previous day FN: Lecture ; How to design XDR-TB regimen

Lecture: Mode of action and ADR of MDR/XDR-TB Drugs

AN: Lecture: Introduction to PMDT

Visit to PMDT site of NITRD

Day 5 Recap of the previous day FN: Field visit to PMDT

Discussion + feed back AN: lecture on MDR-TB in special situations

Lecture on MDR-TB in children

(Saturday / Sunday: OFF)

Day 6 Recap of the previous day FN: Lecture on HIV-TB

Palliative therapy in MDR / XDR-TB AN: Case studies of MDR / XDR-TB: interactive case demonstration

Day 7 Recap of the previous day FN: OPD AN: Case studies non-TB diseases mimicking MDR-TB

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Day 8 Recap of the previous day FN: Ward Round and discussion of cases AN: Lecture on infection control

Visit for new MDR-Ward

Day -9 Recap of the previous day FN: Ward Round and discussion of cases AN: Lecture: Role of surgery in MDR/ XDR-TB

Day-10 Recap of the previous day FN: Country presentation

Post test Lunch AN: Discussion on pre and post test

Valedictory

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Training in Programmatic Management of Drug Resistant TB Duration: Two weeks

Day 1

9.00am : Welcome & Introduction to the institute

10.30 am : RNTCP –Introduction to Indian TB program

1.00pm : Break for lunch

2.00pm : WHO Module A-Introduction to PMDT

Day 2

9.00am : Recap day 1

9.30am : WHO Module A-Introduction to PMDT

11.00am : : WHO Modules B – Detect cases of MDR –TB


2.00pm : WHO Modules B – Detect cases of MDR –TB

Day 3


9.30am : Interaction for microbiological aspects regarding MDR TB

National Reference Laboratory visit

To be planned by the department of microbiology


2.00Pm : WHO Module C –Treat MDR patient

Day 4


9.30am : Continue WHO Module C –Treat MDR patient


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2.00pm : Continue WHO Module C –Treat MDR patient

4.00pm : Lecture on Air borne infection

Day 5


9.30am : Visit to MDR Ward

Case study of MDR patients


2.00pm : WHO module -D Inform Patients about MDR-TB

Day 6


9.30 am : Visit to field

For decentralized patients

DOTS observation


2.00pm : Discussion of field visit

3.00pm : Lecture – PMDT-NITRD experience

Day 7


9.30am : Visit to ICTC & ART centre

Issues in MDR- TB in HIV patients


2.00pm : Observer for the Review panel meeting of the DR centre

Interaction with Review panel

4.00pm : lecture-ADR in MDR –TB treatment

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Day 8


9.30am : Visit to DR-Centre and interaction with DTO

12.00pm ` : Surgery in MDR-TB


2.00Pm : WHO module -E Continuing treatment

Day 9


9.30am : Visit to field

Home visit to MDR patient and other issues


2.00pm : MDR – TB in Children

4.00 pm : Lecture on Ethics and palliation in MDR-TB

Day 10

9.30am : Country presentation by participants

11.000am : Parking Lot

12.30pm : Valedictory - Meet the expert session to be adjusted as per the need of the training group - Role plays to be added during the training as per requirement

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Laboratory Training on ZN Smear Microscopy Duration : 4 days

Time from Time Description

Day 1

8.00 AM 8.30 AM Registration 9.00 AM 10.00 AM Welcome & Introductions, Workshop Goals, Objectives

10.00 AM 10.30 AM Pre-test 10:00 11:30 Tea break 11:30 12:30 Smear preparation 12.30PM 1.00PM Smear staining

1.00PM 2.00PM Lunch

2.00PM 3.00PM Smear examination 3.00PM 4.00PM Rechecking of results

4.00PM 4.30PM Daily evaluation

Day 2

9.00 AM 10.00 AM Panel Testing 10.00 AM 10.30 AM Panel Testing (contd)

10:30 11:30 Tea break 11:30 12:30 Rechecking of panel slides

12.30PM 1.00PM Over view of panel slides preparation

1.00PM 2.00PM Lunch 2.00PM 3.00PM

Basics of the Quality System

Concept ZN microscopy

3.00PM 4.00PM Overview of External Quality Assessment of ZN microscopy


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Day 3

8.00 AM 8.30 AM 9.00 AM 10.00 AM Exercise on sample collection in OPD

10.00 AM 10.30 AM Smear preparion on site

10:00 11:30 Tea break 11:30 12:30 Smear examination 12.30PM 1.00PM Smear examination rechecking 1.00PM 2.00PM Lunch 2.00PM 3.00PM Basics of the Quality System Concept 3.00PM 4.00PM Overview of External Quality Assessment 4.00PM 4.30PM Daily evaluation

Day 4

9.00 AM 10.00 AM Preparation of panel slides 10.00 AM 10.30 AM Tea break

10:30 11:30 Staining of panel slides

11:30 12:30 Smear examination of panel slides

12.30PM 1.00PM Discussion of slides 1.00PM 2.00PM Lunch 2.00PM 3.00PM Planning and Organizing External Quality Assessment Scheme 3.00PM 4.00PM Problem-Oriented Supervision and Problem Solving 4.00PM 4.30PM Daily evaluation 4.30PM 5.00PM Valedictory

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Laboratory Training on LJ Culture and DST Duration : 10 days

Time from Time upto Description

Day 1

8.00 AM 8.30 AM Registration 9.00 AM 10.00 AM Welcome & Introductions, Workshop Goals, Objectives

10.00 AM 10.30 AM Pre-test 10:00 11:30 Tea break 11:30 12:30 Introduction to Mycobacterium 12.30PM 1.00PM specimen collection 1.00PM 2.00PM Lunch 2.00PM 3.00PM Hands on in homogenization of samples 3.00PM 4.00PM Hands on indigestion and decontamination procedures


Day 2 9.00 AM 10.00 AM Hands on in preparation of LJ culture media 10.00 AM 10.30 AM Hands on in Preparation of LJ culture media continued

10:30 11:30 Tea break 11:30 12:30 Hands on in bottling of LJ media 12.30PM 1.00PM Hands on in bottling of LJ media continued

1.00PM 2.00PM Lunch 2.00PM 3.00PM Hands on in inoculation procedures

3.00PM 4.00PM Hands on in incubation procedures


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Day 3

9.00 AM 10.00 AM Culture readings

10.00 AM 10.30 AM Culture reading contd

10:00 11:30 Tea break 11:30 12:30 Culture identification, Niacin & Nitrate test 12.30PM 1.00PM Culture identification contd Niacin & Nitrate test 1.00PM 2.00PM Lunch 2.00PM 3.00PM Culture identification contd HRCT & SQCT 3.00PM 4.00PM Culture identification contd HRCT & SQCT


Day 4 9.00 AM 10.00 AM Biosafety practice in the laboratory 10.00 AM 10.30 AM Introduction with essential equipments: uses and routine maintenance 10:30 11:30 Tea break

11:30 12:30 Required equipments, supplies, reagents and sterilization of materials to be used. Biosafety and working area 12.30PM 1.00PM Preparation of materials and reagents contd 1.00PM 2.00PM Lunch 2.00PM 3.00PM Quality control must be applied to: Laboratory arrangement, equipment, collection and transport of specimens, handling of specimens, stains, reagents and media 3.00PM 4.00PM Quality control must be applied contd


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Day 5

9.00 AM 10.00 AM Care and maintenance of essential equipment 10.00 AM 10.30 AM Bacterial suspension procedure details for the proportion method standard 10:00 11:30 Tea break 11:30 12:30 Preparation of mcfarland nephelometer barium sulfate Standard no.1 (paik, g. 1980) 12.30PM 1.00PM Preparation of loop for Inoculation for DST – Loop method 1.00PM 2.00PM Lunch 2.00PM 3.00PM DST by Proportion method: Preparation of inoculum & dilutions (loop method) 3.00PM 4.00PM Incubation and reading, interpretation of tests 4.00PM 4.30PM Daily evaluation Day 6 -

Monday 9.00 AM 10.00 AM Identification tests, by Susceptibility to p- nitrobenzoic acid (PNB) 2) Niacin test 3) catalase activity at 680C/pH 7. 10.00 AM 10.30 AM Tea break Preparation of drug stock solutions for 1

st

10:30 11:30 line ATT for proportion method 11:30 12:30 Preparation of drug stock solutions for 1

st

line ATT for proportion method cotd 12.30PM 1.00PM Preparation of drug stock solutions for 1

st

line ATT for proportion method cotd 1.00PM 2.00PM Lunch 2.00PM 3.00PM

preparation of drug containing media for

proportion method dst for 1st

line ATT drugs

3.00PM 4.00PM Preparation of drug media contd


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Day 7

8.00 AM 8.30 AM Preparation of drug stock solutions for 2nd

line ATT for proportion method cotd 9.00 AM 10.00 AM Preparation of drug stock solutions for 2

nd line ATT for proportion method cotd 10.00 AM 10.30 AM Preparation of drug stock solutions for 2

nd line ATT cotd 10:30 11:00 Tea break 11:00 12:30 Preparation of drug stock solutions for 2

nd line ATT for proportion method cotd 12.30PM 1.00PM Preparation of drug stock solutions for 2

nd line ATT cotd 1.00PM 2.00PM Lunch 2.00PM 3.00PM preparation of drug containing media for

proportion method dst for 2nd

line ATT drugs 3.00PM 4.00PM preparation of drug containing media for

proportion method dst for 2nd

line ATT drugs contd 4.00PM 4.30PM Daily evaluation

Day 8

9.00 AM 10.00 AM Preparation of drug stock solutions for 2nd line

ATT for absolute concentration method 10.00 AM 10.30 AM Preparation of drug stock solutions for 2

nd line ATT for absolute concentration method contd

10:30 11:00 Tea Break 11:30 12:30 Preparation of drug stock solutions for 2

nd line ATT for absolute concentration method contd 12.30PM 1.00PM Preparation of drug stock solutions for 2

nd line ATT for absolute concentration method contd 1.00PM 2.00PM Lunch 2.00PM 3.00PM Preparation of drug stock solutions for 2

nd line ATT for absolute concentration method cotd

3.00PM 4.00PM Preparation of drug stock solutions for 2nd line

ATT for absolute concentration method cotd


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Day 9

9.00 AM 10.00 AM Quality control of equipments, drugs, media 10.00 AM 10.30 AM Quality control of equipments, drugs, media contd 10:30 11:00 Tea break 11:00 12:30 Quality control of equipments, drugs, media contd 12.30PM 1.00PM Quality control of equipments, drugs, media contd 1.00PM 2.00PM Lunch 2.00PM 3.00PM Quality control handling of specimens Stains, reagents and media, bacteriological methods 3.00PM 4.00PM Quality control handling of specimens Stains, reagents and media, bacteriological methods contd 4.00PM 4.30PM Daily evaluation

Day 10

9.00 AM 10.00 AM Quality control Adequately trained, interested and committed staff Common-sense use of practical procedures a willingness to admit and rectify mistakes effective communication 10.00 AM 10.30 AM Quality control Adequately trained, interested and committed staff Common-sense use of practical procedures a willingness to admit and rectify mistakes effective communication contd. 10:30 11:00 Tea Break 11:30 12:30 Quality control digestion and decontamination 12.30PM 1.00PM Quality control digestion and decontamination contd 1.00PM 2.00PM Lunch 2.00PM 3.00PM Quality improvement, proficiency testing

3.00PM 4.00PM Quality improvement, proficiency testing contd 4.00PM 4.30PM Daily evaluation 4.30 PM 5.00PM Valedictory

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Laboratory Training on Detection, Identification and Drug Susceptibility Testing of Mycobacterium tuberculosis by

MGIT -960 Duration : 2 weeks Day 1 9 – 9:15 am – Welcome and Introductions

9:15 – 9:45 am – Course Pre-test 9:45 – 10:15 am – Introduction to TB and the course 10:15 – 10:35 am – Tea Break 10:35 – 11:45 pm –Biosafety in the TB laboratory (General and BSL2 & 3) 11:45 – 12:30 pm - Essential equipment: use and routine maintenance 12:30 – 1:30 pm – Lunch 1:30 - 5:00 pm – Laboratory split sessions

1) PPE 2) BSC 3) Liquid handling (assessment of skills, taped work areas,

colored water, pouring pipetting) Day 2 8:30 – 9:30 am – Reagents, media, QC & Troubleshooting

9:30 – 10:00 am – Tea break 10:00 – 12:30 pm – Laboratory preparation of NaOH, NaCitrate, PBS pH6.8

12:30 – 1:30 pm – Lunch 1:30 – 2:15 pm – Specimen collection, receipt and accessioning 2:15 – 5:00 pm – Laboratory session on specimen receipt, log in, work sheets and

continue practice pipetting (Provide copies of specimen processing SOP and job aid as homework reading)

Day 3

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8:30 – 10:00 am – Specimen processing and inoculation of solid and liquid media

10:00 – 10:30 am – Tea break 10:30 – 11:30 am – Introduction to MGIT 960 system and incubation of vials 11:30 – 12:00 pm – Disinfectants, spills and waste

management 12:00 – 12:30 pm – Spill Kit Assembly 12:30 – 1:30 pm – Lunch 1:30 – 5:00 pm – Laboratory split sessions:

1) Demonstration of specimen processing, inoculation and incubation (Two

work-stations, each with one facilitator processing, one facilitator providing

explanations and 2 – 3 participants observing)

2) Demonstration of the MGIT 960 Instrument Day 4 8:30am – 5:00pm – Hands-on processing of specimens by participants (Simulated or patient specimens)

Participants will work in groups of two. One participant will process two

sputum specimens and two blanks in the morning, and the other will process

the same number of specimens in the afternoon. Participants not processing

will be observing their team mate. 5 work stations will be used for 5

participants at a time.

Day 5 8:30 – 9:30 am – Debrief from specimen processing – Cabbage ball 9:30 – 10:30 am – Growth detection on solid media 10:30 – 11:00 am – Tea Break 11:00 – 11:30 am – Growth detection in the MGIT 960 11:30 – 12:30 pm – Recognizing false-positive specimens 12:30 – 1:30 pm – Lunch

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1:30 – 5:00 pm – Laboratory session – Growth on LJ, MGIT, BAP, Smears

Day 6 8:30 – 10:00 am – Identification methods for the M. tuberculosis

complex 10:00 – 10:30 am – Tea Break 10:30 – 12:30 am – Use of Capilia or SD Bioline for ID

12:30 – 1:30 pm – Lunch 1:30 – 2:30 pm – Molecular Biology Basics and line probe assays, MTBDR DVD

2:30 – 3:30 pm – PCR energizers 3:30 pm- 4:30 pm - Laboratory set up PCR for line probe 4:30 – 5:00 pm – PCR contamination control and Quality control

Day 7 8:30 – 9:30 am – Recording and reporting culture

results 9:30 – 10:30 am Quality assurance / Quality

indicators 10:30 – 11:00 am Tea break 11:00 – 12:30 pm Laboratory Layout exercise

12:30 – 1:30 pm – Lunch 1:30 – 2:30 pm – Laboratory Spill activities – in BSC, outside BSC, in MGIT 960

2:30 – 5:00 pm – Laboratory split session – MGIT QC and growth detection checks

Day 8

8:30 – 9:30 am – Introduction to drug susceptibility testing 9:30 – 10:15 am –Isolate submission, processing and rejection criteria for

DST 10:15 - 10:45 am – Tea break

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10:45 – 12:00 am - Principle of the MGIT960 DST system, preparation of drug vials

and inoculum, inoculation of vials, introduction of vials to the

instrument 12:00 – 1:00 pm – Lunch 1:30 – 4:30 pm – Laboratory split session (2 groups) – Demonstration of MGIT 960 DST setting up 4:30 pm – 5.00 pm Questions on MGIT DST

Day 9 8:30 – 9:45 am – Reading and reporting of MGIT 960 DST

9:45 – 10:15 am – Tea break 10:15 – 12:45 pm – Laboratory activities on MGIT DST set up 12:45 – 1:30 pm – Lunch 1:30 – 2:30 pm – QC of MGIT 960 DST and troubleshooting

2:30 – 5:00 pm – Laboratory activities on MGIT DST set up

Day 10 8:30 – 10:00 am – Descriptions of in-country labs (photos, layouts, etc.

10:00 – 10:30 am – Tea Break 10:30- 11:30 am - MGIT DST checks and reading 11:30 – 12:00 pm – Post course test, Participant course evaluation 12:00 – 12:30 pm – Presentation of course certificates and closing ceremony 12:30 – 1:30 pm – Lunch

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Practical Course on the Rapid Molecular Detection of

M. tuberculosis and its Resistance to Isoniazid and Rifampin by

PCR-based Line Probe Assay Duration : 5 days Day 1

Lectures: 08:00-08:15 am Greeting of participants, course agenda

08:15-08:30 am Introduction of participants and facilitators

08:30-08:45 am Pre-course test 08:45-09:30 am Biosafety I.: biosafety in the TB laboratory 09:30-

10:00 am Biosafety II: disinfectants, spills, waste management 10:00-10:15 am Tea break 10:30-11:00 am Biosafety cabinet

Laboratory training: 11:00-01:00 pm Liquid handling exercises

01:00-02:00 pm Lunch break 02:000-2:30 pm Specimen preparation area (all participants) 02:30-05:00 pm Demonstration of specimen preparation for the Genotype MTBDR

Day 2

Lectures:

08:30-09:15 am

09:15-10:00 am

10:00-10:15 am

Essential instruments overview (set up, calibration,

maintenance) Specimen preparation for the Genotype MTBDR Tea break

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Laboratory training: 10:15-12:00 pm Sequence for donning and removing of personal protective

equipment (PPE), spill exercise (rotation)

Group A starts with PPE Group B starts with spill kit preparation, spill exercise

12:00-01:00 pm Lunch break

01:00-01:15 pm Reagent preparation area (all participants)

01:15-02:00 pm Demonstration of reagent preparation and adding of DNA

(amplification)

02:00-50:00 pm Hands on training on specimen preparation for the Genotype

MTBDR

Day 3

Lecture: 08:30-09:30 am Reagent preparation for the Genotype MTBDR 09:30-11:00 am Group A: Molecular biology basics

11:00-11:15 am Tea break 11:15-12:30 pm Group B: Molecular biology basics

Laboratory training: 09:30-11:00 am Group B: Reagent preparation for the Genotype MTBDR

(hands on) 11:00-11:15 am Tea break 11:15-12:30 pm Group A: Reagent preparation for the Genotype MTBDR

(hands on)

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12:30-01:30 pm Lunch break 01:30-02:00 pm Reagent preparation area (all participants) 02:00-

04:30 pm Demonstration of hybridization of amplified products 04:30-05:00 pm PCR laboratory layout exercise (handing out homework materials,

explaining task) Day 4

Lecture:

08:30-10:00 am Hybridization of amplified products 10:00-11:15 am Group A: Molecular mechanisms of INH and RMP drug resistance

11:15-11:30 am Tea break 11:30-1:00 pm Group A: Trouble shooting, contamination control 01:00-02:00 pm Lunch break 02:00-03:15 pm Group B: Molecular mechanisms of INH and RMP drug resistance 03:15-03:30 pm Tea break 03:30-05:00 pm Group B: Trouble shooting and contamination control

Laboratory training: 10:00-01:00 pm Group B: Hybridization of amplified products (hands on)

01:00-02:00 pm Lunch break 02:00-05:00 pm Group A: Hybridization of amplified products (hands on)

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Day 5

08:30-09:30 am Interpretation of results 09:30-10:30 pm Interpretation of participant`s results 10:30-10:45 am Tea break 11:45-12:15 pm Quality control of line probe assay 12:15 -1:00 pm Lunch 01:00- 02:00 pm Introduction to the “Book of life SOPs” 02:00-02.30 pm Organization of work flow 03:00-03:30 pm Post-course test and course evaluation 02:30-03:00 pm Presentation of certificates, closing

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Training on HIV-TB on new National TB guidelines ( to be undertaken in collaboration with RNTCP and NACO)

Duration : 2 days

Day 1

Time Topic

09:15--09:30 Pre-test and self-assessment of participants knowledge on training topics

Training overview

09:40--10:00 TB-HIV collaborative activities

Training objectives and curriculum plan

10:00--11:00 Aetiology, Pathogenesis and Natural Progression of TB Infection

11:00--11:15 Tea Break

11:15--12:15 Rationale for moving to Daily Regimen and Basics of daily ATT

12:15--13:15 Adverse Drug Reactions and Drug – Drug interactions

13:15--14:00 Lunch

14:00--16:45 Operational guidelines on management of TB in PLHIV at ART Centres (With Tea

break)

16:45--17:30 IPT: Rationale and Guidelines

08:30--09:00 Revision of Day one:

Recap and clarifying doubts from day one.

09:00--12:00 Recording & Reporting Tools

(With tea For daily ATT break) For IPT

12:00--13:15 Need for Airborne Infection Control & PPE (Personal Protective Equipment)

13:15--14:00 Lunch

14:00--15:45 Managerial, Administrative & Environmental measures of AIC

15:45--16:00 Tea Break

16:00--17:00 Revised ART initiation guidelines and SACEP referral mechanism

17:00--17:15 Planning for field visit:

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Facility risk assessment tool discussed on site

Day 3 8:30--11:30 (With tea M&E Hands on Training break) 11:30--14:00 Field visit to ART centre 14:00--14:30 Lunch 14:30--15:00 Post-test /self-assessment / end of training assessment

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Program on Training Childhood Tuberculosis

Duration : 2 days

DAY -1

Time Topic 0900-1100 Welcome and Inauguration (10min)

Defining the magnitude of Problem

Natural History of Disease 1100-1115 TEA

1115-1300 Pulm TB Diagnostic Part 1 (Symptoms, Radiology, TST)

1300-1400 LUNCH 1400-1600 TB Diagnostic Part II- Microbiology

Newer Rapid tests (GeneXpert, LPA, MGIT), MOTT/M.tb Hands-on –Lab visit

1600-1615 TEA

1615-1800 Pulm TB Diagnostic algorithm case based

DAY-2 0900-1100 Lymph node TB Diagnostics

Pleural TB Diagnostics 1100-1115 TEA

1115-1300 CNS TB Diagnostics

Abdominal TB Diagnostics 1300-1400 LUNCH 1400-1600 Treatment of TB- RECENT TREATMENT GUIDELINES

Monitoring of Treatment-Defining response & Non response

Management of adverse effect 1600-1615 TEA

1615-1800 Drug resistant TB When to suspect and how to manage MDR and XDR-

Special Conditions Neonate of mother with TB

Special Conditions- HIV TB

Prevention of TB

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Air Born Infection Control Training/ Workshop

Duration ---- 10 days

Evaluation ----- Pre- Test, Post Test and feedback Performa

Programme Schedule

Time Topic

DAY (1)

8:30 am to 9:00 am Registration

9:00 am to 10:00 am Pre- Test

10:00 to 10:30 am Inauguration+ Tea 11:00 am to 11:40 1. Air Dynamics

2. Bio-aerosol behaviour 3. National Air borne Infection control guidelines

DAY (2) 1. Risk Assessment of air bone infections

Risk assessment of infrastructure, Person TB Burden in India TB in HCW with prevention

After noon 2. Hierarchy of Infection control

Administrative Environmental Personal Protection

DAY 3. Ventilation Designs

Natural Advantages with Mechanical Practicality of each Mix Modes each

Afternoon Visit to Demonstrate ventilation designs

Wd.6 MDR Wd. Private Wd. Bio-safety labs

DAY 4. Surgical Masks VS respirators

Fir testing Comfort

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Communication Demonstration Fit testing exercises

DAY 5. Air velocity and measuring air changes

Smoke test ACH calculation

Practical Demonstration

Group work DAYS 6, 7 Break

DAY 8 UVGI Equipment types Installation Maintenance Impact Effectiveness

After noon Practical Demonstration of UUGI DAY 9 Bio-Safety Labs Cabinets

Morning Class - 1 Infrastructure with

2 safety of product and

3 person.

Movement of air flow in all

Afternoon Demonstration of BSL-1,2,3 labs

DAY 10. BM Waste Introduction New Guidelines Percales Categorization Legal Implications

Visit to wards BMW plant Observations Presentation

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