• Course information

    Place of training
    In your project/mission
    Duration
    Duration 5.5 days (with possibility to add two to three weeks of post training clinical mentoring)
    Dates
    To be agreed on between mission and SAMU during the request process
    Number of participants
    20 maximum
    Language
    English or French (according to mission context)
    Target group
    Medical coordinators, medical doctors, clinical officers and nurses in programmatic and/or clinical key roles with regard to DR-TB management
    Application

    To your local SAMU mission HIV/TB adviser (focal point) or the SAMU learning unit coordinator at olivier.bluteau@joburg.msf.org

  • Background

    By offering an on-site training in a mission:

    • We can offer a “tailor-made” training based on specific needs of the project/mission
    • We contribute to greater access to training opportunities (especially national employees)
    • We use the project context and field work as a learning place (eg. clinical ward rounds)
    • We harness the provision of learning on-site in a project to maximise the transfer of theory to practice in the workplace
    • By doing this we speed up participant’s learning process
    • We use and build synergies from existing project and team dynamics

    We sustain learning and good practices and increase opportunities for a positive impact for the project.

    A two to three week clinical mentoring/bedside teaching (with a SAMU ID specialist, Dr. Sylvie Jonckheere) can be attached to this one week training to follow and accompany participants in their learning in the workplace. This option can be made on request from the mission/project and will be assessed according to SAMU resources available.

    Background

    Drug-resistant TB (DR-TB) is a recognized threat throughout the world and occupies an increasing priority role in MSF operations. 

    The introduction and roll out of rapid tests for TB and drug-resistance detection are improving the early diagnosis of TB/DRTB, including among patients co-infected with HIV.  New drugs have been approved for use in MDR and XDRTB patients, and in 2016 new WHO recommendations on the use of a shorter DRTB regimen have been released.  MSF, in collaboration with MoH counterparts, is one of the main actors worldwide introducing and scaling up the access to these new drugs and new regime, while advocating for shorter, more effective and less toxic treatments.  Several clinical trials, aiming to find better treatments for DRTB, are ongoing or in the pipeline, including two MSF-driven initiatives.

    Models of care and adherence strategies for DRTB continue to evolve, and management of DR TB patients through decentralised ambulatory and even community based treatment models have been demonstrated as cost-effective.

    Despite all this, countries and projects keep experiencing relevant challenges in the clinical and programmatic management of DRTB and we need to ensure that health care workers build the skills to respond to the increasing DR-TB needs and challenges, including the management of patients co-infected with HIV and correct use of new drugs. 

    This training aims to improve the programmatic and clinical knowledge related to management of DR-TB in your project (MoH and MSF health care workers).

    Who Can Apply?

    • Currently this training is available to any projects/mission providing DRTB care
    • This is currently available in both English and French speaking projects/missions

    Target Group

    • Medical coordinators, medical doctors, clinical officers and nurses in programmatic and/or clinical key roles with regard to DR-TB management
    • Ministry of Health representatives, medical doctors and nurses associated with an MSF project
    • Representatives from headquarters (e.g. cells medical polyvalent)

    Note:
    Since learning can also be a reflective process on actual and past experiences, we encourage participants to attend this training only when they are already working in the position. Under these circumstances real transfer happens, namely the application of acquired knowledge that impacts performance in the workplace.

  • Objectives

    General Objective

    • To contribute to the provision of quality DR-TB clinical care within a resource-limited context

    Intermediate Objectives

    • Increase knowledge related to programmatic and clinical management of DR-TB in resource-limited settings
    • Share practical experience amongst participants, especially related to the most challenging aspects of DR-TB management
    • Review different models of DR-TB care (e.g. urban vs. rural), with a focus on ambulatory/community-based models
  • Content

    This is primarily a clinical not a programmatic course. However, where appropriate to the clinical learning, programmatic elements can be incorporated.

    Drawing from a large database of training materials, a default package has been designed, based on the current needs and training experiences in the MSF DRTB projects.

    The main added value of on-site training is to propose tailor-made content adapted to the project context and to the participants’ needs. Therefore, modification of this standard package will be made according to a needs analysis, and the content will be streamlined according to identified priorities.

    This will be a collaborative work, well in advance, between the DRTB managers of the mission/project, the intended participants and the SAMU DRTB advisor.

    Mission and project coordinators/managers remain fully responsible for post training implementation and follow up

    • Comprehensively cover issues related to DR-TB (and to a lesser extent, drug-sensitive TB)
    • Selected topics to be run in 2 branches: clinical (80%) and programmatic (20%)
    • Focus on new diagnostic tools, new TB drugs and regimens for MDR and XDR TB

    Basic (default) package modules:

    • DRTB: epidemiology, global burden & epidemic control
    • Diagnosis of DR-TB
    • DR-TB case-finding strategies
    • Principles of DR-TB treatment
    • Short course regimen
    • Complicated DR-TB treatment: Modification for pre & XDR TB and co-morbidity
    • HIV and DR-TB including IRIS and possible drug interaction
    • DR-TB in child & ado
    • Managing side effects of 2nd line TB drugs
    • Monitoring/screening to detect side effects early
    • Principles of Monitoring & evaluation
    • Patient support, counselling, support group, psychosocial support & palliative care
    • Infection Control
    • Models of DR-TB care
    • Ethics and human rights
  • Pedagogic Approach

    Trainers

    The course is overseen only by the SAMU DRTB advisor and, when needed, the SAMU training coordinator. Trainers are chosen in collaboration with the on-site team where the training is occurring. The options comprise the SAMU clinical training coordinator, the SAMU DRTB advisor, experienced local staff, and other experienced external specialist clinicians when possible.

    Pedagogic Approach

    Interactive methodologies, clinical case history review, group and individual work.

    The core of the training week is interactive learning in a classroom but bedside or outpatient teaching should be incorporated into the training whenever possible. The group as a peer to peer source of learning, and the presenters as learning facilitators are also important pillars of the proposed teaching method.