WHO Sondalo Training Course for Tuberculosis Management and Control in Nepal
[Hotel Himalayan, Kupandole, 9-17 January 2018]
Facilitators
1. Prof. Dr. Giovanni Battista Migliori (For More Information)
2. Dr. Lia D'Ambrosia
3. Dr. Simon Tiberi
Organizers:
1. Save the Children International
2. National Tuberculosis Programme
3. WHO Collaborating Centre for TB and Lung Disease
Save the Children International in collaboration with National Tuberculosis Center and WHO Collaborating Center for TB and Lung Disease organized 10 days training course for the health workers mainly Chest Physician, Medical Officers and Public Health Professionals from various national hospitals, academies, D(P)HOs, and (I)NGOs. The objective of the training course was to update the level of understanding as well as to build the capacity of health workers for the prevention, treatment and control of tuberculosis in Nepal. Tuberculosis has been a major public health problem in Nepal. So the Ministry of Health (MoH) has prioritized National Tuberculosis Program (NTP) as a priority program of Nepal. In the recent year, causative agent of tuberculosis has developed resistance to various drug regimens and it has made treatment and control of TB much more difficult. Despite being a curable disease, it has emerged as a threatening disease. It has clearly reflected that need of proper planning, implementation and evaluation of TB Control Program to reduce the number of death tolls in the MDR/XDR TB era. So the main goal of the training program was to build the capacity of those health workers who manages the TB program, who are involved in diagnosis and treatment as well as advocates for the rights of TB patients.
[Hotel Himalayan, Kupandole, 9-17 January 2018]
Facilitators
1. Prof. Dr. Giovanni Battista Migliori (For More Information)
2. Dr. Lia D'Ambrosia
3. Dr. Simon Tiberi
Organizers:
1. Save the Children International
2. National Tuberculosis Programme
3. WHO Collaborating Centre for TB and Lung Disease
Save the Children International in collaboration with National Tuberculosis Center and WHO Collaborating Center for TB and Lung Disease organized 10 days training course for the health workers mainly Chest Physician, Medical Officers and Public Health Professionals from various national hospitals, academies, D(P)HOs, and (I)NGOs. The objective of the training course was to update the level of understanding as well as to build the capacity of health workers for the prevention, treatment and control of tuberculosis in Nepal. Tuberculosis has been a major public health problem in Nepal. So the Ministry of Health (MoH) has prioritized National Tuberculosis Program (NTP) as a priority program of Nepal. In the recent year, causative agent of tuberculosis has developed resistance to various drug regimens and it has made treatment and control of TB much more difficult. Despite being a curable disease, it has emerged as a threatening disease. It has clearly reflected that need of proper planning, implementation and evaluation of TB Control Program to reduce the number of death tolls in the MDR/XDR TB era. So the main goal of the training program was to build the capacity of those health workers who manages the TB program, who are involved in diagnosis and treatment as well as advocates for the rights of TB patients.
First day [09.01.2018, Tuesday]
Unit 5: Assess the Country Epidemiology
(including introduction to Situation and Gap analysis)
During the session, TB control priorities, different transmission patterns, TB interventions recommended by WHO, global and national TB targets and indicators were discussed. Similarly participants were facilitated to review the epidemiological data and also explained the approaches to identify the priorities and propose solutions to strengthen tuberculosis control program. Facilitator used the data of Fictitia through out the session for the illustration of epidemiological data.
Presentation 5.1:The Model of TB Transmission
Presentation 5.2:Epidemiology of Tuberculosis
Presentation 5.1:The Model of TB Transmission
Presentation 5.2:Epidemiology of Tuberculosis
Second day [10.01.2018, Wednesday]
First SessionUnit 6: Assess the Laboratory Network in the MDR/XDR TB Era
(for Xpert, Universal DST & rational use of new diagnostics)
During the session, organization and functioning of the laboratory network for the TB diagnosis and treatment follow-up was discussed to enable participants to assess the laboratories for TB diagnosis. Later the facilitators described the basic concepts of smear microscopy, culture, DST and other molecular methods. At the meantime, the principles of the quality assurance was explained and reviewed the quality assurance practice in the country. At the end of the presentation session, facilitator assigned group work to analyze laboratory organization and its functioning in the Fictitia. Likewise at the end, all the groups identified priorities and proposed solutions (recommendations) for the improvement of laboratory network on that country.
Presentation 6.1: Assessing the Laboratory Network
Presentation 6.2: Exercise to assess the Laboratory Network
Presentation 6.2: Exercise to assess the Laboratory Network
Second Session
Unit 7: Assess the Drug Management
(including Drug Quality and rational use of drugs)
The objective of the session was to enable the participants to assess the quality and rational use of the medicine as well as process of drug management in the MDR/XDR TB era. Intially the pharmaceutical management framework was explained. Thereafter issues on new drugs management, pharmacovigilance and drug quantification were discussed and also reviewed the national scenario. During the session, facilitator stressed mainly on the potential interventions to increase access and improved use of pharmaceutical services based on pharmaceutical management framework. Later group work was assigned to participants to work on team to focus on improving access to TB medicines in Fictitia.
Presentation 7.1: Assess the Drug Management
Presentation 7.2: Exercise to Assess Drug Management
Third Day [11.01.2018, Thursday]
First SessionUnit 8: Assess the Diagnosis, Treatment & Clinical Management of Adults & Children
The focus of the session was to equip participants with knowledge and skills to assess, diagnose, treat and manage the adults and children with TB. The session began with the WHO standards for the diagnosis, treatment and case management of TB. Meanwhile existing practice and program of TB management in Nepal was also discussed among the participants. Facilitator explained and differentiated the special characteristics of TB in children to that among adults for the proper prognosis of TB on time. Similarly facilitator highlighted the different strategies and approaches for preventing and managing TB in children. At the meantime, facilitator also discussed on the causes for the discontinuation of PAL program in Nepal despite the remarkable achievement of PAL in different countries around the globe. Facilitator also explained the role and contribution of PAL in improving case finding and treatment of TB. Similarly experiences of different countries implementing PAL was also shared.
Presentation 8.1.1: WHO Treatment Guideline [2017]
Presentation 8.1.2: Standards for the Clinical Management of TB
Presentation 8.2: Group Work to Assess the Diagnosis and Treatment Management
Presentation 8.3: TB in Children
Presentation 8.4: Practical Approach to Lung Health (PAL)
Presentation 8.5: Rational of Anti-TB Treatment
Second Session
Unit 9: Assess Recording and Reporting (R&R), Notifications, Vital Registration and Impact Evaluation
The objective of the session was to assess the recording and the reporting system, regulatory framework on place for case management, vital registration and impact evaluation of TB program. The session began with essential components/elements that must be on the recording and reporting tools (Forms/Formats) of TB program. Experience of different countries with poor recording and reporting system was shared during the session to identify issues and potential interventions. At the end, group work was assigned to all to identify the priority issues and all the potential interventions to strengthen and improve R&R system in the Nepalese context.
Presentation 9.1: Recording and Reporting for Tuberculosis
Presentation 9.2: New Recording and Reporting Forms [Post 2013]
Presentation 9.3: Group Work on Recording and Reporting
Forth Day [12.01.2018, Friday]
First Session
Unit 11: Assess MDR-/XDR-TB Prevention, Treatment and Control
The objective of the session was to enable participants to assess the MDR and XDR TB prevention, treatment and control. Different documents available on MDR and XDR TB management as well as recommended interventions by End TB strategy for MDR case management was explained. Further to clarify the participants on MDR/XDR TB, drug resistance to different drugs and their trends, laboratory services and treatment procedure that needs to adopted or changes and any appropriate actions to be taken by service providers was discussed.
Presentation 11.1: Address MDR/XDR-TB Prevention, Treatment and Control
Presentation 11.2: Group Work on Addressing MDR and XDR Tuberculosis
Second Session
Unit 13: Assess engagement of Public and Private Tuberculosis Providers
The objective of the session was to explain the rational and evidence of public private partnership and their engagement for the TB control. During the session, various PPM tools were also discussed. Taking TB treatment and service delivery practice in Nepal into consideration, facilitator requested participants to share approached for the implementation of PPM for the TB control in the private sector in Nepal. Later group work was assigned to each group to identify the potential interventions to initiate PPM to strengthen TB control in Nepal through public and private sector.
Presentation 13.1: TB Control in Private Sector and PPM Implementation
Presentation 31.2: Group Work on PPM: Tools, Rationale and Evidence
Fifth Day [14.01.2018, Sunday]
Unit 10: Epidemiology of HIV/AIDS and TB/HIVThe objective of the session was to clarify the epidemiological approaches and methods to assess the implementation the implementation of TB/HIV activities in the MDR/XDR TB era. At the beginning, interim policy documents currently available on MDR/XDR TB, their background and rationale was discussed. Similarly the WHO strategy for the universal access to the HIV prevention and care was explained. Facilitator also elaborated the 12 TB/HIV collaborative activities in detail. At the end, group was assign to identify problems and priority actions for TB/HIV collaborative activities.
Before Lunch Session
Unit 10.1: The objective of the session was to explain the epidemiology of HIV/AIDS at the global and regional context. Thereafter epidemiology of TB/HIV co-infection, its prevalence and global trends was described. With the evidences around the world, the implications of HIV/AIDS and TB/HIV epidemiology was elaborated to initiate the collaborative TB/HIV activities at country level.
Presentation 10.1: Epidemiology of HIV/AIDS and TB/HIV
Unit 10.2: During the session, the main elements of WHO interim policy on TB/HIV collaborative activities was reviewed. Based on the WHO interim policy on TB/HIV activities, facilitator discussed on the potential approaches & actions that could be implemented at the national scenario/context.
Presentation 10.2: WHO Policy on TB/HIV Collaborative Activities
Unit 10.3: The main objective of the session was to enable participants to adopt the WHO recommended interventions for the prevention of TB among PLHIVs. Core interventions to prevent the transmission of TB among HIV infections were listed. Facilitator encouraged participants to discuss and identify the priority actions for preventing TB transmission as a group work. Thereafter the group discussed and presented the interventions to be implemented at country level within the the framework of infection control.
Presentation 10.3: Prevent Transmission among Persons with HIV
Unit 10.4: During the session, the rational, effectiveness and feasibility of IPT was discussed. Implementation of IPT in the country was also discussed briefly. Then the facilitator explained the possible challenges for the implementation of IPT at that the programmatic level across the different countries and also shared the best possible alternatives to take action.
Presentation 10.4: Rational, Effectiveness and Feasibility of IPT
Unit 10.5: During the session, facilitator underlined the rational, effectiveness and feasibility of early diagnosis of TB patients among HIV infected persons. Facilitator also shared the hurdles for the diagnosis of TB among PLHIVs but also the stressed the mitigation measures. Similarly the facilitator also highlighted the need of patient attitude towards treatment adherence as well as the implementation of rational diagnostic algorithms for TB suspects. In addition to PTB, diagnostic challenges of Extra Pulmonary Tuberculosis was also discussed.
Presentation 10.5: Active/Early Diagnosis of TB among PLHIV
After Lunch Session
Unit 10.6: The objective of the session was to describe the rational, effectiveness and feasibility of HIV testing among TB patients in detail. During the session, possible constraints related to its implementation at programmatic level and ways to address such situations was discussed. Meanwhile current national practice was also discussed among the participants in the group. Thereafter at the end of the session, group work was assigned to identify the potential individual and program implications for starting the HIV testing among TB patients.
Presentation 10.6: HIV Testing for TB Patients
Unit 10.7: The objective of the session was to describe the rational, effectiveness and feasibility of Cotrimoxazole Preventive Therapy (CPT). Similarly the constraints and possible mitigation measures related to their implementation at programmatic level was also discussed. Potential individual and programmatic implications of its implementation were identified and discussed in detail.
Presentation 10.7: Cotrimoxazole Prevention Therapy (CPT)
Unit 10.8: During the session, participants were explained about the principles of Antiretroviral Therapy. Meantime a comprehensive strategy for the universal access for the prevention, treatment, care and support for ART program was also discussed. Different classes of HIV drugs that are available in markets and their pharmacodynamics were also elaborated. Similarly the implications and possible management of ART among TB patients with HIV was also discussed among the participants with supplementation of real stories of around the globe.
Presentation 10.8: Principles of Antiretroviral Therapy (ART)
Sixth Day [15.01.2018, Monday]
First Session
Unit 10: Epidemiology of HIV/AIDS and TB/HIV Continue........
Unit 10.9: The objective of the session was to clarify the participants on the rationale, effectiveness and feasibility of combined clinical management of TB/HIV co-infection. Facilitator stressed on the eligibility criteria and key clinical problems on combined management of those patients to ensure patients are properly managed by health workers. At the meantime, facilitator elaborated the possible constraints related to the implementation at programme level.
Presentation 10.9: Combined Clinical Management of TB/HIV Co-infection
Unit 10.10: This session was focused on describing and classifying the different models available for TB/HIV service delivery interventions that are practiced around the world. Facilitator encouraged the groups to discuss and identify potential intervention, that is most appropriate for the country, for TB/HIV service delivery in the country from among the available different models.
Presentation 10.10: Service Delivery in TB/HIV Collaborative Activities
Unit 10.11: The session was focused on surveillance system that are placed for TB/HIV collaborative activities. Facilitator explained the principles of TB/HIV surveillance. During the session, the major problem and constraints as well as potential opportunities for implementing TB/HIV coordinated surveillance were explained in detail.
Presentation 10.11.1: Surveillance in TB/HIV Collaborative Activities
Unit 10.11.2: Facilitator described the common elements & errors in the tools for HIV/AIDS and TB/HIV activities. Current country experiences on TB/HIV recording and reporting was also discussed. Participants described the existing recording and reporting system that are currently in function was discussed. Meantime steps and elements that are essential for the M&E for to assess the effectiveness in the implementation of TB/HIV activities was explained and discussed in detail.
Presentation 10.11.2: R&R and M&E for TB/HIV Activities
Presentation 10.12: Group Exercise to analyze TB/HIV Collaborative Activities
Second Session
Unit 12: Assess NTP Organization & Human Resource Development
The objective of the session was to enable participants to assess the NTP structure, human resources status and their capacity building needs in the MDR/XDR TB era. During the session, differrent human resources need for the NTP was discussed and outlined. Thereafter group work was assigned to participants to assess the TB situation in the given scenario and requested each group to suggest the structure of NTP program in the given scenario, human resources need and develop capacity building plan accordingly.
Presentation 12.1: Assess NTP Structure
Reading Material 12.1: NTP Structure
Presentation 12.2: Assess the Human Resource Development
Seventh Day [15.01.2018, Tuesday]
First Session
Unit 14: Assess engagement of Communities and Civil Society Organizations
During the session, different international policy documents like SDG, Universal Health Coverage (UHC), and their implications on TB prevention, treatment and control was discussed. Similarly the role and contribution of community and civil society organization for the implementation of MDR/XDR TB and TB/HIV activities were explained. Likewise the role of government on UHC and social protection for TB care and prevention was highlighted. In Nepal, the national initiative/practice for the engagement of communities and civil society in TB treatment and control was discussed. Through the group work, constraints and opportunities for the engagement of communities and civil society was brainstormed.
Presentation 14.1: Community Engagement
Presentation 14.2: Universal Health Coverage and Social Protection
Second Session
Unit 15: TB Infection Control for TB/HIV & MDR-/XDR_TB
The session was focused on infection control for MDR/XDR TB and TB/HIV. At the beginning, the role and contribution of infection control within the Stop TB strategy and for TB control was discussed mainly stressed on MDR/XDR TB and TB/HIV co-infection. Facilitator described the WHO infection control policy and underlined the key elements of infection control. Besides bio-safety levels of TB laboratories, general safety requirements for laboratory and issues of structural design of laboratories was also explained. Different types of personal protective equipment (PPE) that are essential for the safety of laboratory workers were also listed. Later respirator fit testing was performed. In the session, group work was assigned to determine the Air Changed per Hour (ACH) in the room. It was calculated using a device called venometer.
Presentation 15.1: Infection Control
Presentation 15.2: How to Calculate Air Changes per Hour (ACH)?
Presentation 15.3: Group Exercise on Infection Control
Third Session
Unit 16: Planning, Budgeting and M&E for MDR/XDR-TB and TB/HIV
(Based on NSP Toolkit)
This session was focused on explaining the participants on different steps/process of planning, implementation, monitoring and evaluation of TB program for its control and elimination. At the very beginning of the session, the role of M&E for the TB prevention and control was discussed along with the different elements of M&E were elaborated. Besides, the importance of National Strategic Plan (NSP)was also explained . At the meantime, steps of developing NSP including its 5 plans i.e. Core Plan, Budget Plan, M&E Plan, Operational Plan and Technical Assistance Plan were also explained in detail.
Presentation 16.1: National Strategic Plan for TB Control
Presentation 16.1: National Strategic Plan for TB Control
Reading Material 1: Toolkit to Develop a NSP for TB Prevention, Care and Control
Reading Material 2: Process for the Development of National TB Strategic Plan
Eighth Day [15.01.2018, Wednesday]
Unit 17: Reporting, Debriefing and Course Evaluation
Presentation 17.1: How to Write the Report?Presentation 17.2: Reporting Template?
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