Step 4.1 – Develop and implement a training curriculum and strategy
A high-quality TPT programme requires skilled staff for performing the tests. Clinical staff need training in all steps of the cascade of care, including how to identify target populations eligible for TPT, provide counselling and education, perform and interpret TB infection tests, collect and transport blood samples for IGRAs, and undertake medical evaluation and CXR to determine eligibility for treatment after testing. For countries adopting IGRAs, additional training for the laboratory tasks will be needed and similarly health care workers in the field will need to be trained in skin testing and reading of test reactions.
The TWG and national programmes need to establish clear guidelines to define the priority groups for testing (and treating), the methods and techniques for the tests, interpretation of test results and next steps after testing. Educational material developed in the local language for health care personnel and patients is useful (59); examples are available online (44, 64).
For TB infection skin tests, training nurses for injection and reading of induration is crucial. Simple protocols for training (57), and using mobile technologies for training and QC of skin testing (45) may facilitate the widespread use of these tests, even in remote settings. Practical training material is available in several languages; for example, for injection (43) and reading of results (65).
As discussed in Area 8, close QC and quality assessment of human resource competency is necessary. Digital tools (as exemplified in Area 7) may indicate which areas of training need to be strengthened.
Step 4.2 – Sensitize health staff on the importance of a TPT programme
Sensitizing health care personnel on the importance of programmatic management of TPT in reducing TB mortality and morbidity is critical to enhance acceptance and promote uptake of tests for TB infection. Both TPT and testing for TB infection should be integral parts of training on the national guidelines (58, 59). In addition, engagement with professional associations for doctors and nurses, and organization of continuing medical education programmes may be required when testing intervention is introduced. Using e-learning modules may help with faster cascading of the training. Ongoing mentoring during review meetings and field visits of programme managers and field supervisors is also crucial to ensure quality of implementation of all activities across the cascade of care.
Step 4.3 – Assess and document the competence of staff
For TB infection skin tests, assessment of staff competency should be part of a cyclic process of QC and quality assessment. This can be in person or at distance (see Area 8). If the latter, training and QC can be achieved with the help of digital technologies (45) (see Area 8). Interventions should be undertaken when appropriate, with reassessment performed afterwards. For IGRAs, QC and quality assessment should follow standard laboratory procedures (see Area 8). However, the competence of staff to perform all steps of the cascade of care should be assessed and re-training should be offered when necessary.