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DOTS Supervisor Training Materials

By Amy Madore | 13 Oct, 2009 Last edited by Sophie Beauvais on 08 Nov 2009

Dear DR TB Community Members:

A GHDonline member is in search of resources for training DOTS supervisors. What training curricula do you use? Has your organization developed its own training materials for this purpose?

Thank you in advance for sharing your recommendations and/or resources.

The original post for this discussion is located in the TB IC community: www.ghdonline.org/ic/discussion/re-tb-infection-control-yahoo-message-dabsence/



Sandeep Ahuja Replied at 1:51 PM, 13 Oct 2009

Operation ASHA provides comprehensive training  to its counsellors for DOTS. The results are phenomenal: detection rate had doubled in two years, and default in urban slums has been reduced by 20-30 times to less than 2%.
We are now documenting the entire methodology. MIT-JPAL is assessing our impact through randomized control trials.

Operation ASHA has tied up with other NGOs to train their counsellors.
Sandeep Ahuja
CEO, Operation ASHA
   Fighting Tuberculosis Worldwide

Member, Coordinating Board
Stop TB Partnership
A partnership housed by the World Health Organization

Salem Barghout Replied at 11:35 PM, 13 Oct 2009

Dear All:

I would like to view your training materials. Can you please provide some information how/ where I can find them? Web site? Links etc.


Salem Barghout, MD

WHO Medical Officer (MDR-TB)
National TB Control Program
Islamabad, Pak

Rajbir Singh Replied at 6:22 AM, 14 Oct 2009

Dear Amy and colleagues,
Please visit at the website www.tbcindia.org for downloadable documents and
IEC resource material.

You may have to adapt the material as your country guidelines/policies may
be different.

In India all trainings in TB are conducted by Govt of India either at State
/ district level to maintain uniformity and quality standards. All willing
NGOs and private organizations, private practitioners undergo training for
their participation in National TB Control Program at Govt institutions only
with the standard training modules enlisted on the website mentioned above.

Hope you find the site useful.

If you are interested in material developed by German Leprosy & TB Relief
association, please feel free to communicate.


Dr. Rajbir Singh
Regional Medical coordinator North
German Leprosy & TB Relief Association India
B 2/17, Janakpuri, New Delhi - 110058

Sandeep Ahuja Replied at 5:13 PM, 16 Oct 2009

Dear Colleagues,
We have developed comprehensive training methodology for our counselors and program managers. This helps us in many ways. First, our results are excellent: default within 2% in urban slums for a year now, detection rate nearly double compared to the past, treatment success rate (excluding failures) as high as 95%.
We have hired a senior executive recently to document the entire training process. We are already implementing a TB program for The Prajnopaya Foundation (www.prajnopaya.org/). We have also arrived at an understanding with one of the largest international NGOs, which operates in over 50 countries. We will train their staff as master trainers. They will, in turn, build the capacity of other NGOs to replicate our model of TB treatment.
The training material+methodology will be documented over the next six months. We will also have a full-fledged training center to train employees for our expansion and other NGOs. We will be happy to share the material. As a sample, I am reproducing below the topics that are covered in an initial counseling session with a patient.


Points covered during an initial counseling session
• TB is NOT a terminal disease. The treatment is available and can cure a patient for the rest of his or her life.
• Treatment lasts for a period of 7-8 months. The patient and family members must commit to adhering to the entire treatment process including follow-up tests. Benefits of completing treatment include being cured, being able to work properly, receiving complimentary items and nutrition supplements. Furthermore, one does not spread the disease to loved ones.
• After treatment begins, symptoms will disappear within 6-8 weeks, but this does not mean that the patient has been cured. The bacteria that causes TB is still growing strong inside the body. Unless the treatment is completed for the entire 7-8 month time period, the bacteria will continue to grow strong and the symptoms will reappear.
• Not only that, missing doses or leaving the treatment midway can have serious consequences. The patient can become drug resistant. The treatment for MDR TB is very difficult and long, lasting up to 2 years. Furthermore, the medicines cost Rs. 1.5 lakhs and is not available free like the normal TB drugs. So, MDR is nearly impossible to treat and is fatal.
• Worse than that, an MDR patients can infect many others, possibly close family members, friends, colleagues, neighbors, and other loved ones with the same MDR strain of TB. Those persons are also not likely to survive.
• Therefore, the patient should not contract MDR. The only way to stop this menace is to adhere to the regimen religiously until the last dose and get final follow-up sputum test if advised by the counselor. In other words, not a single dose should be missed to the end of the treatment.
• Patients must come in 3 times per week, either MWF or TThS, for 8 weeks if CAT I or CAT III or 12 weeks if CAT II. After that the patient must come in once per week for medicines.
• After the first 2-3 months of treatment, the patient must go in for a follow up test as advised by the counselor at the TB hospital or microscopy centre within 1-2 days. Also, at the end of treatment completion or at any other time, the patient must go in for another follow up test if advised by the counselor.
• Experiencing side effects from the TB medicine is normal, especially from the first few doses. Side effects include giddiness, acidity, and/or vomiting.
• Patients should be encouraged to ask for necessary medicines to take care of these side-effects, which are available with the provider.
• The patient should be told about the precautions to be taken and the disposal of the sputum, to prevent transmission to other people.
• In case it is necessary for the patient to leave the town for a few days or a week, the provider must be contacted, who will give up to 1 week’s medicines. The provider will inform the counselor immediately about this, any time of the day or night. This should NOT happen frequently—only once in intensive phase of treatment.
• If the patient has to leave the area of the provider permanently because of any eventuality, his treatment can be transferred to another center near the new place of residence.
• In case of any problem, the patient is free to speak to the counselor any time between 8 a.m. to 10 p.m.
• The counselor must note on the treatment card, the permanent (home, village) address of the patient, the name of the contact person at that address, and the contact phone number.
• Family members and neighbors should be screened and advised to go for sputum test if necessary. Explain to patients the nature of symptoms to look out for. Patients should ask and encourage others to get tested at a diagnostic center.
• rophylactic dose may be provided to children in contact with the TB patient. In case of doubt about need and/or the dosage, Assistant Program Manager or STS should be contacted.
• The counselor has to provide to the patient the following:
- A book about symptoms of TB and precautions to be taken by the patient.
- Telephone number of the counselor
- Telephone number of the provider
- Telephone number of the STS

Nonkqubela Bantubani Replied at 5:16 AM, 17 Oct 2009

Dear Sandeep

Thank you very much for your input, as soon as the training material is available may you share with us?


Paul Zintl Moderator Emeritus Replied at 12:51 PM, 21 Oct 2009

Please note that there are also 9 curricula documents posted already on this community. Click on Training Curricula topic (on right) of the DR-Community home page, or at this link (http://www.ghdonline.org/get/search/?N=0+1000235+2020003+4294967268)

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