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

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 2

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 3

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 4

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. 5

Clinical Management Course on Drug Resistant TB Duration : Method : 2 weeks 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 6

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: AN: OPD Case studies non-tb diseases mimicking MDR-TB 7

Day 8 Recap of the previous day FN: AN: Ward Round and discussion of cases Lecture on infection control Visit for new MDR-Ward Day -9 Recap of the previous day FN: AN: Ward Round and discussion of cases 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 8

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 1.00pm : Break for lunch 2.00pm : WHO Modules B Detect cases of MDR TB Day 3 9.00am : Recap day 2 9.30am : Interaction for microbiological aspects regarding MDR TB National Reference Laboratory visit To be planned by the department of microbiology 1.00pm : Break for lunch 2.00Pm : WHO Module C Treat MDR patient Day 4 9.00am : Recap day 3 9.30am : Continue WHO Module C Treat MDR patient 1.00pm : Break for lunch 9

2.00pm : Continue WHO Module C Treat MDR patient 4.00pm : Lecture on Air borne infection Day 5 9.00am : Recap day 4 9.30am : Visit to MDR Ward Case study of MDR patients 1.00pm : Break for lunch 2.00pm : WHO module -D Inform Patients about MDR-TB Day 6 9.00am : Recap day 5 9.30 am : Visit to field For decentralized patients DOTS observation 1.00pm : Break for lunch 2.00pm : Discussion of field visit 3.00pm : Lecture PMDT-NITRD experience Day 7 9.00am : Recap day 6 9.30am : Visit to ICTC & ART centre Issues in MDR- TB in HIV patients 1.00pm : Break for lunch 2.00pm : Observer for the Review panel meeting of the DR centre Interaction with Review panel 4.00pm : lecture-adr in MDR TB treatment 10

Day 8 9.00am : Recap day 7 9.30am : Visit to DR-Centre and interaction with DTO 12.00pm ` : Surgery in MDR-TB 1.00pm : Break for lunch 2.00Pm : WHO module -E Continuing treatment Day 9 9.00am : Recap day 8 9.30am : Visit to field Home visit to MDR patient and other issues 1.00pm : Break for lunch 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 11

Duration : 4 days Day 1 Laboratory Training on ZN Smear Microscopy Time from Time Description 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 Day 2 4.00PM 4.30PM Daily evaluation 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 4.00PM 4.30PM Daily evaluation 12

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 13

Duration : 10 days Laboratory Training on LJ Culture and DST Day 1 Time from Time upto Description 8.00 AM 8.30 AM Registration 9.00 AM 10.00 AM Welcome & Introductions, Workshop Goals, Objectives Day 2 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 4.00PM 4.30PM Daily evaluation 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 4.00PM 4.30PM Daily evaluation 14

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 4.00PM 4.30PM Daily evaluation 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 4.00PM 4.30PM Daily evaluation 15

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 Day 6 - Monday 4.00PM 4.30PM Daily evaluation 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 1 st line ATT drugs 3.00PM 4.00PM Preparation of drug media contd 4.00PM 4.30PM Daily evaluation 16

Day 7 8.00 AM 8.30 AM Preparation of drug stock solutions for 2 nd 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 2 nd line ATT drugs Day 8 3.00PM 4.00PM preparation of drug containing media for proportion method dst for 2 nd line ATT drugs contd 4.00PM 4.30PM Daily evaluation 9.00 AM 10.00 AM Preparation of drug stock solutions for 2 nd 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 2 nd line ATT for absolute concentration method cotd 4.00PM 4.30PM Daily evaluation 17

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 Day 10 3.00PM 4.00PM Quality control handling of specimens Stains, reagents and media, bacteriological methods contd 4.00PM 4.30PM Daily evaluation 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 18

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 19

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 20

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 21

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 22

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 23

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) 24

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) 25

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 26

Duration : 2 days Training on HIV-TB on new National TB guidelines ( to be undertaken in collaboration with RNTCP and NACO) 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 (With Tea break) Operational guidelines on management of TB in PLHIV at ART Centres 16:45--17:30 IPT: Rationale and Guidelines 08:30--09:00 09:00--12:00 (With tea break) Revision of Day one: Recap and clarifying doubts from day one. Recording & Reporting Tools For daily ATT 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: 27

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 28

Duration : 2 days Program on Training Childhood Tuberculosis DAY -1 Time Topic 0900-1100 Welcome and Inauguration (10min) 1100-1115 TEA Defining the magnitude of Problem Natural History of Disease 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 29

Duration ---- 10 days Air Born Infection Control Training/ Workshop 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 Mechanical Mix Modes Advantages with Practicality of each 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 30

Communication Demonstration Fit testing exercises DAY 5. Air velocity and measuring air changes Smoke test ACH calculation Practical Demonstration Group work DAYS 6, 7 DAY 8 After noon Break UVGI Equipment types Installation Maintenance Impact Effectiveness 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 31

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