IX. Training of RNTCP and NACP staff, NGO’s and General Health Care Staff
One of the pre–requisites for effective implementation of cross–referral system, is to train the staff directly involved in the programme i.e. Counsellors, Medical Officer VCTC, District TB Officer, Medical Officer–TB Control, TB treatment supervisor, TB Laboratory Supervisor and the Lab Technician of the DMC.

The objective of training NACP staff in RNTCP is to enable them to understand and be able to apply principles of diagnosis, treatment, monitoring, and reporting under RNTCP. Similarly the RNTCP staff if trained in HIV/AIDS will be able to understand and apply principles of HIV prevention and AIDS control, and specific concerns about diagnosis of TB in HIV–infected persons, about TB treatment in HIV–infected persons, and about the need for confidentiality. Further both the staff should be aware about the specific infection control measures to be taken for preventing the spread of TB and HIV infection.

One training was not sufficient, repeated discussion at individual programme reviews, joint review meetings were done. Supervisory visits helped to identify centre specific problems and resolve the issues.

Training of NACP staff
The NACP staff trained includes the Nodal Officers for HIV/AIDS, Medical Officers Incharge of VCTC and VCTC Counsellors. A two days training programme coupled with a field visit to Microscopy and DOT centre for District Nodal Officer and MO–VCTC. For Counsellors either one day training was taken or integrated into their basic induction training.

The training programmes for all the NACP staff started with the discussion on the need for HIV–TB Collaboration, Principles of RNTCP, Diagnosis and Treatment of TB. For the DNO’s and MO–VCTC, this was followed by lectures on Special issues in the diagnosis and treatment of HIV–TB patient, Infection Control Measures for TB and HIV, Anti–retroviral and anti–tuberculosis treatment. Initially when we did the training for the first time we took the participants for a field visit to Microscopy Centre and DOT Centre, but later on realised that we should take them to a VCTC also. Thus in the subsequent training programmes the participants were taken to VCTC also. Also three years back when we did the trainings, there were no operational guidelines for VCTC–RNTCP co–ordination, but as we became clearer on how to co–ordinate, this session was included in the training programme. The MO–VCTC were explained in detail about the reporting format and also given a feedback on the reports received from their VCTC. For the VCTC Counsellors, initially we took training only on aspects related to TB and explained them about reporting format. As we started implementing the programme we realised plenty of errors in reporting and understanding of the Counsellors and also with the field experience we realised the need to modify the training content. Initially we had done a separate one day training programme for Counsellors and subsequently the session on TB was integrated into their induction training curriculum. Now apart from the basic information on TB, we teach the counsellors how to fill the sputum requisition slip, Operationalisation of VCTC–RNTCP Co–ordination, documentation –record keeping, monthly report.

We also had undertaken a pilot project for developing the monitoring system for VCTC–RTNCP Surveillance system. During this pilot project we had 2 days training for Counsellors and STS, who came for the training simultaneously. The initial part i.e. 1 and1/2 days modular training was done separately and for the second half day the Counsellors and STS were brought together for discussing the operationalisation of VCTC–RNTCP Co–ordination. This greatly facilitated in establishing the co–ordination.

Training of RNTCP staff
The RNTCP staff trained includes the District TB Officers, MO–DTC, MO–TC and STS. Though STLS are not required to be trained as per action plan, we had trained the STLS too.

A two days training programme coupled with a field visit to VCTC for Medical Officers. The training programmes for all the RNTCP staff started with the discussion on the need for HIV–TB Collaboration, Epidemiology of HIV/AIDS, HIV Counselling and Testing Centre. For the DTO’s, MO–DTC and MO–TC, this was followed by discussion on Special issues in the diagnosis and treatment of HIV–TB patient and Infection Control Measures for TB and HIV.

The training for DTO’s was taken for 2 days in the lecture form coupled with a field visit to VCTC. For the MO–DTC/MO–TU and STS/STLS, training was 2 days of modular training along with refresher training on TB. The Medical Officers were taken for a visit to VCTC. For the STS/STLS a module –‘VCTC–RNTCP Co–ordination’ was jointly prepared by Maharashtra State TB Control Society and State AIDS Control Society. Facilitators Guide was prepared. For the Medical Officers, the training module on HIV/AIDS prepared by NACO was converted into module by adding exercises at the end of chapter. Chapters on Operationalisation of VCTC–RNTCP Co–ordination, Anti–TB and ART and Role of MO–TU were added. A Facilitator guide and supplementary training material was prepared by the State TB Society and AIDS Control Society.

Training of General Health Care staff
Training of General Health Care Staff is an ongoing activity. In Mumbai some training programmes for Medical Officers and paramedical staff of Public Health Department have been conducted. Since most of the Medical Officers and paramedical staff were already trained on HIV–TB only relevant aspects have been included. In rest of the Maharashtra, through the training on Clinical Management of HIV–AIDS, where a chapter on RNTCP has been added, Medical Officers are being trained. Similarly now in Mumbai, all trainings on HIV/AIDS for Medical Officers, Resident Doctors etc include discussion on TB.

Training of NGO’s
A one day joint sensitisation programme for both RNTCP and NACP NGO’s. In addition separate training programme for NGOs of TI was conducted at a later stage.

Training Material

• Training module on HIV–TB for District Nodal Officers and MO I/c VCTC’s –NACO publication.
• Training module on HIV–AIDS for Medical Officers –CTD publication.
• Treatment guidelines for TB in HIV infected –NACO/CTD publication.
• Standard Operative Procedures – Infection Control Measures – NACO publication.
• TB–HIV: A guide for Health worker – CTD publication.
• HIV–TB: A guide for Counsellors – NACO publication.
• The HIV–TB Co–infection– Programme Coordination guidelines for clinicians and standard operating procedures. – NACO/CTD publication.
• VCTC–RNTCP Operational Guidelines – Maharashtra State TB Society in collaboration with Maharashtra State AIDS Control Society and Mumbai District AIDS Control Society.
• Training Module for RNTCP Health Worker on HIV–TB, VCTC–RNTCP Co–ordination– Maharashtra State TB Society in collaboration with Maharashtra State AIDS Control Society.