Prevention of\
Mother-to-Child\
Transmission of HIV

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Generic Training Package

# Training Programme and Course Director Guide {#training-programme-and-course-director-guide .COVER-SH1}

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WHO Library Cataloguing-in-Publication Data

World Health Organization.

> Prevention of mother-to-child transmission of HIV generic training
> curriculum: training programme and course director guide.
>
> 1.Acquired immunodeficiency syndrome - therapy 2.HIV infections -
> therapy 3.Disease transmission, Vertical - prevention and control
> 4.Teaching materials I.Title.
>
> ISBN 92 4 159203 6 (NLM classification: WC 503.2)

**© World Health Organization 2004**

All rights reserved. Publications of the World Health Organization can
be obtained from Marketing and Dissemination, World Health Organization,
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The World Health Organization does not warrant that the information
contained in this publication is complete and correct and shall not be
liable for any damages incurred as a result of its use.

**Acknowledgment**

This package was prepared by the Department of HIV/AIDS, World Health
Organization (WHO) in collaboration with the United States Department of
Health and Human Services, Centers for Disease Control and Prevention
(HHS-CDC), Global AIDS Program (GAP), and is jointly published by WHO
and HHS-CDC. Tin Tin Sint (WHO) and Omotayo Bolu, Cristiane Costa,
Cheryl Mayo, and Andrea Swartzendruber (CDC) were the primary team
responsible for supervising the development and field testing of the
curriculum. René Ekpini and Isabelle de Zoysa (WHO) and Nathan Shaffer
(CDC) provided overall guidance and support for this project.

WHO and CDC would like to thank Matthew Chersich, Inam Chitsike, Halima
Dao, Ian Grubb, Peggy Henderson, Yvan Hutin, Rafael Lopezolarte, David
Miller, Nozighu Tatiana Ndondo, Kevin O\'Reilly, Constanza Vallenas and
Mayada Youssef Fox (WHO); George Bicego, Tracy Creek, Beth Dillon, Chris
Galavotti, Joan Kraft, Joel Kuritsky, Michelle McConnell, Dorothy
Mbori-Ngacha, Jan Moore, Serigne Ndiaye, Monica Nolan, Joseph Petraglia,
Rose Pray, RJ Simonds, Monica Smith (CDC); and Ellen Piwoz (AED) for
their review of draft materials. Acknowledgments are also due to Thurma
Goldman, from HHS-HRSA, and Estelle Quain (USAID) for their support and
to UNICEF and UNFPA for their technical contributions.

WHO and CDC would like to thank the Ministries of Health and the CDC/GAP
offices in Guyana, Ethiopia, Mozambique, and Cambodia for hosting the
field tests.

WHO and CDC would also like to acknowledge the significant contribution
of the François-Xavier Bagnoud (FXB) Center at the University of
Medicine and Dentistry of New Jersey, who led this project from initial
development through field tests and revisions along with JHPIEGO, an
affiliate of Johns Hopkins University, through the University Technical
Assistance Program (UTAP) with CDC. In addition to the curriculum
development role, the FXB Center provided essential support for overall
project coordination and final production of the training package. The
FXB Center group include Mary Boland, Virginia Allread, Karen Forgash,
Magaly Garcia, Nancy Lerner-Weiss, Nancy Paradis, Linda Podhurst, Anne
Reilly, Monica Reiss, Natalia Rivera, and Deborah Storm. JHPIEGO staff
who contributed to this project includes Jean Anderson, Linda Fogarty,
Emmanuel Otolorin, and Kai Spratt.

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Table of Contents

**Abbreviations and Acronyms** ii

**Introduction** 1

Section 1: Training Programme Guide

CHAPTER 1.1: The PMTCT National Training Plan 5

CHAPTER 1.2: Adapting the Generic Training Package 9

Section 2: Course Director Guide

CHAPTER 2.1: Logistical Planning 14

CHAPTER 2.2: Trainers & Panellists 17

CHAPTER 2.3: The Field Visit 21

CHAPTER 2.4: Conducting the Training Course 23

SECTION 3: Appendices 27

Appendix 1: Developing the national training plan

Appendix 2: Sample evaluation tools

Appendix 3: Generic training package adaptation process

Appendix 4: Adapting the Participant Manual

Appendix 5: Adapting the Trainer Manual

Appendix 6: Course Director checklists

Appendix 7: Sample documents

Appendix 8: Trainer preparation

Appendix 9: Field visit

**Acknowledgement**

Acknowledgement is given to the *HIV and Infant Feeding Counselling: A
Training Course.* (World Health Organization, UNAIDS, UNICEF, 2000) for
suggesting the breadth of topics to be included in this document. Where
appropriate, specific sections from the *HIV and Infant Feeding
Counselling: A Training Course.* *Director's Guide* have been
referenced.

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Abbreviations and Acronyms

**AIDS** Acquired immunodeficiency syndrome

**ANC** Antenatal care

**ARV** Antiretroviral

**ART** Antiretroviral therapy

**CDC** United States Centers for Disease Control and Prevention

**CMV** Cytomegalovirus

**ELISA** Enzyme-linked immunosorbent assay

**FAO** United Nations Food and Agricultural Organisation

**HAART** Highly active antiretroviral therapy

**HIV** Human immunodeficiency virus

**IMCI** Integrated management of childhood illness

**MAC** *Mycobacterium avium complex*

**MCH** Maternal and child health

**MTCT** Mother-to-child transmission of HIV

**NGO** Non-governmental organisation

**NVP** Nevirapine

**OI** Opportunistic infection

**PCP** *Pneumocystis carinii* pneumonia

**PEP** Post-exposure prophylaxis

**PLWHA** People living with HIV/AIDS

**PMTCT** Prevention of mother-to-child transmission of HIV

**RCHS** Reproductive and child health services

**STD/I** Sexually transmitted disease/infection

**UNAIDS** Joint United Nations Programme on HIV/AIDS

**UNFPA** United Nations Population Fund

**UNGASS** United Nations General Assembly Special Session

**UNICEF** United Nations Children\'s Fund

**USAID** U.S. Agency for International Development

**VCT** Voluntary Counselling and Testing

**WHO** World Health Organization

**ZDV** Zidovudine, the generic name for azidothymidine (AZT)

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Introduction

Of the 40 million people living with HIV/AIDS worldwide at the end of
2003, 2.5 million were children under 15 years of age. Last year alone,
700,000 children were newly infected with the AIDS virus. The most
significant source of HIV infection in children and infants is
transmission of HIV from mother-to-child during pregnancy, labour and
delivery, and breastfeeding.

**A comprehensive Prevention of Mother-to-Child Transmission of HIV
(PMTCT) programme can significantly reduce the number of infected
infants by providing treatment, care and support to women with HIV
infection and their families**. The rapidly growing HIV/AIDS pandemic
combined with the expansion of PMTCT services world-wide requires
efforts to maximise resources and human capacity development.

The WHO/CDC Prevention of Mother-to-Child Transmission of HIV Generic
Training Package is designed to provide 1) information and content for a
national PMTCT training effort and 2) healthcare workers with the
knowledge and introductory skills necessary to deliver PMTCT services in
an integrated manner.

Structure of the PMTCT Generic Training Package

The package is a comprehensive set of resource materials designed for
adaptation at the national level. It supports the review and development
of policies and protocols while providing the essential components
required for a PMTCT training effort. The Training Package will be
updated every six months to ensure that content reflects the most
current scientific developments and policy changes. The package
contains:

-   **Training Programme and Course Director Guide:**

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-   *Section 1 Training Programme Guide:* targeted to those with overall
    responsibility for developing the PMTCT National Training Plan,
    adapting the generic PMTCT package, and developing the plan to
    evaluate training efforts. This may be a team of individuals working
    for or under guidance of the National Ministry of Health, or one or
    more partner agencies*.*

-   *Section 2 Course Director Guide*: targeted to the individual or
    team responsible for organising and conducting the PMTCT training
    courses.

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-   **Participant Manual:** the main reference document for course
    participants. It includes an introduction; nine content modules,
    each with summary; clearly stated objectives; technical information;
    and exercises, as well as a **Glossary and Resources Guide.**

-   **Presentation Booklet:** summarises the main content areas within
    the Participant Manual.

-   **Trainer Manual:** outlines the package, describes the trainer role
    in course planning and offers the trainer directions to conduct each
    session.

-   **Pocket Guide:** provides clear, concise information to support the
    delivery of services and is a handy reference for healthcare
    workers. The **Wall Charts** can be posted in the health centre or
    facility and are a reference on key PMTCT content areas.

-   **CD-ROM:** contains the PMTCT Generic Training Package in
    Microsoft^®^ Word and Adobe Acrobat^®^ PDF files.

Using the PMTCT Generic Training Package

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Advantages of the PMTCT Generic Package

Users will find the documents and materials helpful at several points in
the PMTCT programme cycle, as shown in the figure above. The package
assists users to customise PMTCT training to reflect a range of
policies, programmes, and interventions. Advantages to using the Generic
Package include:

-   Evidence--based content with the most current scientific
    understanding of HIV transmission, MTCT, and HIV treatment

-   Access to a training package that is the result of research,
    field-testing, and extensive global review

-   A context to review and update existing country-specific PMTCT
    policies and guidelines

-   Nine stand-alone modules that can be used for training of beginning
    and advanced PMTCT healthcare workers

-   Adaptable support tools for trainers, healthcare workers, and
    facilities

PMTCT National Training Plan

Overall planning includes developing the PMTCT National Training
Plan[^1] and ensuring that the Generic Training Package supports the
national PMTCT strategy and the National Training Plan. Planning is
required to develop the Training Plan, to ensure that the package is
adapted to meet the training needs of the target population and that
national policies on PMTCT are integrated into and supported by the
training course. The group of stakeholders involved in developing the
PMTCT National Training Plan (Chapter 1.1) is similar to the
stakeholders involved in adapting the PMTCT package (Chapter 1.2). As
such, the Training Plan may be developed in parallel with the adaptation
of the package. Just as PMTCT programmes require funding, training
programmes require staffing and a budget. It is suggested that funding
for the PMTCT training programme be prioritised at a national level to
guarantee an adequate budget at the local level.

National versus Local Roles

While this Guide recognises roles and responsibilities will be shared,
there is no attempt to prescribe which responsibilities are to be
undertaken at the national versus local level.

Local planning is required in preparation for the implementation of the
course, and the training sessions have to be based on participant
learning needs. Before courses are implemented locally, the Course
Director must work closely with PMTCT facility supervisors and
participants to adapt the course and teaching methods to meet their
needs.

Summary

Developing and implementing a PMTCT programme---complete with strategies
for antiretroviral (ARV) treatment and prophylaxis, safer delivery
practices, and safer infant-feeding practices---is a complex process.
The PMTCT staff training can be integrated within the national PMTCT
strategy and considered a priority in the allocation of resources. The
effort invested in planning can save time and money and help to ensure
that resources are targeted, that the final PMTCT training product is
well accepted, and that it achieves its goals and objectives.

This PMTCT Generic Training Package provides an approach to addressing
training need in the context of a national and global effort. By
shortening the planning phase, it allows for a rapid implementation and
evaluation of the training effort.

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**Section 1**

Training Programme Guide

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**Chapter 1.1**

The PMTCT National Training Plan

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Once the national PMTCT strategy is finalised, the adaptation of the
National PMTCT Training Plan is an important component of the PMTCT
programme; it is a tool to make sure that training is targeted where it
is needed and linked closely to the delivery of services. The Plan
states who will be trained, the knowledge/skills to be transferred
during training, the training approach, and the evaluation process. It
addresses the training needs of all healthcare workers who will be
supporting the National PMTCT Programme.

As noted in the Introduction to this Guide, it is recognised that the
Generic Training Package may be implemented at a local level. The
Training Plan supports relevant national policies and provides direction
for and coordination with the PMTCT-related training of the implementing
agency. The Training Plan will be referred to as "national" but the
Guide recognises a country may adapt this plan for targeted settings.

What is a PMTCT National Training Plan?

Each setting requires the development of a unique mix of interventions
to address immediate gaps in service delivery as well as to sustain
improvements over time. A PMTCT National Training Plan identifies the
following:

-   Goals and objectives of training

-   Delineation of target audiences

-   Frequency, content, and length of training activities

-   Strategy for rollout, coverage, and sustainability

-   Responsible entity

-   Overview, timeline and budget for the plan

-   Process and timelines for monitoring, review, and revision of the
    plan

A well-designed National PMTCT Training Plan can evolve into a long-term
effort that supports the sustainability of training outcomes over time.
It recognises that training activities are sustainable when they fit
within the resource and time constraints faced by trainers, supervisors
and health systems. Such a strategy will include targets to build and
sustain human capacity and address additional factors that affect
service delivery including:

-   Pre-service PMTCT training focusing on nursing schools, medical
    schools and other health-related training institutions

-   In-service training systems including training-of-trainer
    approaches, the provision of supervision and support to trainers,
    and the development and distribution of effective training materials

-   Long-term retention of healthcare staff

-   Overall funding of health services including remuneration of
    healthcare workers

Steps in developing the plan

The PMTCT National Training Plan is the result of an active
collaboration of key stakeholders whose input is needed to ensure a
well-considered and coordinated plan. Additionally, the involvement of a
range of stakeholders can reduce duplication of training efforts and
widen the base of support for the plan. The process described in this
Guide is designed to be adapted to national circumstances and resources.

The agency authorised to develop the PMTCT National Training Plan
should, ideally, be the one that is ultimately responsible for all
national PMTCT services and targets. The person who heads this agency,
or his /her designee, is most likely to be responsible for the plan, for
example, the Director of Maternal and Child Health (MCH) Services, the
PMTCT Coordinator, the Minister of Health, or the Director of the
National AIDS Control Programme.

The National Training Plan Chairperson/Director has the following
responsibilities:

-   Chair the National Training Plan meetings

-   Approve the agenda, meeting goals and objectives, and all
    correspondences

-   Approve the participant list

-   Appropriate a budget for the meetings

-   Identify resources for the plan

-   Ensure the plan is feasible and achievable

-   Approve the draft plan and the final plan

-   Ensure deadlines are met

-   Monitor the implementation phase

-   Evaluate the outcome

Stakeholders

The individuals and organisations invited to participate in the
development process could include the following:

-   Director of MCH services

-   Director of AIDS/AIDS prevention and control services

-   National PMTCT coordinator

-   National laboratory coordinator

-   Key donor and technical agencies

-   Non-government organisations, AIDS service organisations, community-
    and faith-based organisations

-   Private sector providers including AIDS service organisations

-   PMTCT service director or supervisor

-   Health education/training specialist in HIV and/or PMTCT

-   Staff working in ANC and Labour and Delivery including at least one
    physician, nurse/nurse midwife, infant-feeding specialist, and HIV
    counsellor

-   Physician or nurse specialising in follow-up care of mothers and
    families with HIV and HIV treatment

-   AIDS advocate knowledgeable about the effects of stigma and
    discrimination on persons living with HIV/AIDS (PLWHA)

-   Individual/group charged with drafting the National HIV Training
    Plan

This list can be refined or expanded to meet local expectations,
objectives, and staffing patterns. A description of a sample process for
developing a PMTCT National Training Plan appears in Appendix 1.

Monitoring and evaluating training

This Guide recommends that an evaluation strategy for the training
effort be developed within the national training plan. Further, the
evaluation strategy and tools may be designed at the national level to
ensure standardisation of data collection across all training
activities. Sample course evaluation tools are included in Appendix 2.

**The evaluation effort can be designed to determine:**

-   If the training supported the delivery and uptake of PMTCT programme
    services

-   If the training programme was completed as designed and planned

-   If the training was offered to the people for whom it was intended

-   If the training met its goals and objectives

-   Changes in the training programme to better meet learning needs

-   Gaps in learning to assist with planning future courses

-   Guidance for refresher and/or advanced training

-   Guidance for skills-building clinical training

Types of evaluation

There are two complementary approaches to monitoring and evaluating
PMTCT training programmes: process (also called quality assurance)
evaluation and outcome evaluation. The evaluation strategy for a
training programme may be designed to include one or both approaches.

Process and quality assurance evaluation

Process evaluation and quality assurance focus on program monitoring to
provide feedback on the overall course, which sessions and exercises the
participants found useful, and which need to be changed. Feedback may
also be sought on the more practical aspects of the training, such as
the training site/facility and materials. Process data are collected
from the:

-   Participants

-   Trainers

-   PMTCT supervisors

Examples of process data include the following:

-   Number of training sessions conducted during the past year

-   Number of participants and areas of specialty

-   Number/percentage of participants who thought meeting facilities
    were adequate for the training

Outcome evaluation

Outcome evaluation determines whether the goals of the training were
met. Immediate outcome evaluation considers the degree to which training
goals were met as measured at the conclusion of the training activity.
For example:

-   Self-reported changes in perception of skill and ability before the
    course versus after the course

-   Self-reported assessment of anticipated changes in clinical practice

-   Change in knowledge as measured by comparing scores from pre- and
    post-test questionnaires

Long-term outcome evaluation examines whether the goals of the training
were reached once participants returned to the practice setting and
applied the information they learned during the training. Long-term
outcomes evaluation will assess whether participants were able to
implement PMTCT services specific to the following:

-   National policies on providing PMTCT services

-   Specific interventions for PMTCT

-   Strategies to overcome stigma and discrimination

-   Linkages with agencies that provide treatment, care, and support for
    mothers and families with HIV

-   Practices that facilitate a safe, healthy environment for healthcare
    workers

-   Management of occupational exposure to HIV including post-exposure
    prophylaxis

-   Data collection for programme monitoring

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**Chapter 1.2**

Adapting the Generic Training Package

Once the national PMTCT strategy has been finalised, the adaptation of
the Generic Training Package may begin. (This Training Programme and
Course Director Guide is designed to support the national training
effort and is the only component of the Generic Training Package that
does not require adaptation.)

Adapting all of the other components of the package may take place prior
to or parallel with the development of the National Training Plan. Where
resources are limited for adapting the Generic Training Package,
technical assistance may be available from a number of sources such as
in-country or international universities, domestic or international
consultancy firms, and international donor agencies.

**This Training Package is described as "generic" because it:**

-   Includes key international PMTCT guidelines and policies

-   Requires customisation to include country-specific policies and
    context

-   Presents key course elements to guide training

-   Provides the template for a full PMTCT training package

Adapting the Generic Training Package

Adaptation is the process of integrating the participant and trainer
materials in the PMTCT Generic Training Package into a training
programme that is consistent with national and local goals and policies
and existing MCH services-building a "national" training programme. The
adapted materials will include national protocols, guidelines,
algorithms, or descriptions, and reflect local epidemiology, cultures,
practices, language, and training needs.

Within each module is a box entitled "Relevant Policies for Inclusion in
National Curriculum" that identifies the important national policies,
guidance, or summary statements to be discussed in the module**.**

The Participant Manual is organised into nine modules reflecting a
comprehensive approach to PMTCT and the minimum knowledge set necessary
to function effectively in a PMTCT setting.

It is recommended that the course be designed to include each of the
modules. Although the adaptation process will reflect learning needs and
additional subjects may be added, the deletion of a module in its
entirety is discouraged**.**

A suggested approach to adapting the Generic Training Package is
described in Appendix 3. Step 1 in Appendix 3 is the most
work-intensive; it is the phase during which the following tasks are
undertaken:

-   Comparing existing PMTCT curricula with the new curriculum, and
    incorporating relevant information from the old programme into the
    new (or vice versa).

-   Incorporating summaries of national PMTCT-related policies into the
    relevant modules of the Generic Training Package. Some of these
    policies may be included in the national PMTCT plan or may be
    embedded in several documents. A comprehensive listing of these
    national policies appears in Appendix 4 of this Guide. Also, each
    module in the Participant Manual includes a listing of the national
    policies relevant to that particular module.

The following questions may help to identify which text will need
adapting:

-   Does the text support local policy?

-   Does the text reflect local epidemiology?

-   Are the language and wording appropriate?

-   Is the text appropriate for the knowledge level/training of local
    healthcare workers?

-   Is the text culturally sensitive/appropriate?

-   Does the text reflect local practices (personal, social or
    professional)?

After completing Step 1 (Appendix 3), the remainder of the adaptation
process focuses on reviewing, updating, and clarifying the content.
Because this phase includes consultation with stakeholders, it may be
time-consuming.

The stakeholders help to develop an accurate document that reads well
and can be implemented with minimal difficulty, and the consultation
helps ensure their support for the training efforts and the PMTCT
programme.

Approaches to involving stakeholders in the adaptation of the Generic
Training Package may include meeting in one large group or in a series
of smaller, topic-specific interest groups. The stakeholders' meeting
chairperson and participants mirror those who are important for the
PMTCT National Training Plan described in Chapter 1.1 of this document.
In many settings it will be the same group. In others, it may be a
subgroup of the national group.

Adapting the course syllabus

A course syllabus appears in the Introduction to the Trainer Manual. The
Course Director may adapt the course syllabus to meet training needs in
response to the following participant considerations:

-   Level of previous training in PMTCT

-   Previous experience in PMTCT settings

-   Responsibilities of staff

The course was developed to be 6 days long including an optional field
visit. The training may be expanded or shortened, depending on
priorities and resources. The amount of time for each module may vary
depending on needs and participants' PMTCT job functions.

Adapting the trainer materials

Once the stakeholders have approved the Participant Manual, begin the
process of adapting the Presentation Booklet, Pocket Guide, and Wall
Charts. The Trainer Manual includes the technical text from the
Participant Manual; as such it may require the same revisions as the
Participant Manual, including revisions in the training exercises.
Alternatively, consideration may be given to removing technical text in
the Trainer Manual. Thus, the Trainer Manual would include only guidance
on presenting the material and running the exercises.

It is suggested that the Course Director review the Trainer Manual,
noting the topics and training exercises that may prompt questions. When
meeting with PMTCT facility staff, the Course Director may take the
opportunity to discuss these. If the Course Director is not a clinician,
s/he may want to learn about the service, resource, and social issues
facing healthcare workers and patients.

A list of the revisions to be considered for the Trainer Manual is
included in Appendix 5. Revising the interactive exercises to ensure
they are culturally appropriate is discussed in Section 2: *Course
Director Guide*.

This first training course may be planned as a field test or pilot
course within the context of the national rollout. Review of the
evaluation information will suggest additional changes in both the
written materials and training methods. Regardless of how carefully the
materials were adapted, testing of the package helps to refine content,
particularly before multiple copies of the package are in circulation.

Updating the Generic Training Package

While adapting the package, stakeholders may develop the process for
assuring the package is updated regularly. Consider the following
questions in this discussion:

-   How often will the package need to be updated?

-   Will it be revised on a schedule or only when major policy changes
    occur?

-   Who will be responsible for the updates?

-   Who will review and approve the updates? (eg, will approval of all
    stakeholders be required or just the chairperson)?

-   Who will ensure that the updates are made in all components of the
    package?

-   How will revised editions be distinguished from previous editions?

-   How will the revised editions be distributed to the field?

Advanced and refresher courses

The need for additional training for PMTCT staff---and the subject areas
the training should address---will become evident from a number of
sources: the initial needs assessment; the results of the course
evaluation, knowledge pre- and post tests, long term outcome
evaluations; and informal discussions with participants, trainers, and
PMTCT facility supervisors. The subject areas should be considered as
topics for the refresher/advanced courses.

It may be helpful to validate the results of the evaluation with a
formal assessment of the follow-up training needs of staff working in
PMTCT settings. An example of a refresher course needs assessment may be
found in Appendix 2.

Refresher courses are important for keeping staff knowledge current and
for addressing skills development. Refresher courses may be clinical or
classroom-based (or a combination of both); they may be conducted in
groups, on a one-to-one basis, or even self-guided, depending on the
individual and the training need. Taking into consideration the training
budget and the urgency of the learning need, refresher courses may be
offered within weeks, a month, or even a year after the original PMTCT
training.

Translation

The Generic Training Package is expected to be available in both French
and Spanish by 2005. When translation into other languages is necessary,
several factors should be considered:

-   Timing: Should the Generic Participant Manual be translated into the
    local language immediately, or can the translation wait until after
    the Participant Manual is adapted?

-   Precedent: Has the generic or an adapted version been translated by
    another country? For example, Mozambique translated a draft of the
    Generic Training Package into Portuguese in late 2003. It is wise to
    start from the generic version, but even an adapted version of the
    package may help with translating key terms and ensuring
    standardisation of PMTCT-related terminology across countries in
    which people speak the same language.

The following may help ensure an accurately translated document:

-   Identify a person or team of translators who know(s) the PMTCT, HIV,
    or medical fields. The translators must be native speakers in the
    target language (the language they are translating into) as well as
    fluent in the language they are translating from. In addition,
    ensure that one translator is familiar with the norms, culture,
    traditions, and values of the country.

-   Review the Glossary in the Participant Manual for key terms and
    translate them. Two or more people should check and agree on the
    translation of the key words.

-   To ensure accuracy and to catch errors in style or content, engage a
    clinician with technical knowledge to review the key clinical terms
    and sections that have been translated.

-   Check that the formatting and style of the translated modules are
    consistent with the original documents.

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height="1.5798611111111112in"}

**Section 2**

Course Director Guide

![](media/image7.png){width="1.0277777777777777in"
height="1.5833333333333333in"}

**Chapter 2.1**

Logistical Planning

**Section 2:** The Course Director Guide is a resource document targeted
to the individual or team responsible for organising and conducting the
PMTCT training. This chapter focuses on the process of implementing a
PMTCT training course within the context of a national PMTCT training
effort. The training may need to be repeated two or more times in a
specific geographic area to train all staff without disrupting existing
ANC and Labour and Delivery services. Appendix 6: Course Director
Checklists support the information provided in this chapter.

Participants

The participants invited to attend the PMTCT training course will be
determined based on the National Training Plan. The plan will suggest
the sites and individuals that have priority, particularly in the
rollout phase.

In most cases, because PMTCT services will be integrated into existing
ANC and Labour and Delivery services, it is suggested that the following
people attend the PMTCT course:

-   All nursing, midwifery, and other healthcare workers

-   HIV counsellors

-   Infant-feeding counsellors

-   Social workers and outreach staff

-   Administrative staff

-   Physicians responsible for or working in the facility

Number of participants

This course is designed for up to 20 participants.

The learning environment

The Course Director needs to create a learning environment where all
participants feel comfortable and secure. The course uses interactive
learning strategies, which require that participants work in small and
large groups and participate in role playing.

The ideal mix of participants will include women and men from all
disciplines of the PMTCT team. A multidisciplinary group will enable
participants to start working as a team and lead to an exchange of
perspectives resulting in a holistic picture of patient care needs.

Per diem/sitting fees

Decide well in advance whether participants will be provided with a per
diem/sitting fee to attend the course and/or travel reimbursement or
allowance. The participant letter of invitation will indicate clearly
the fees to be provided to participants.

Course announcements

The announcement advertising the course may be sent to the PMTCT
facility supervisors as soon as the date, time, and venue for the course
are decided. To facilitate planning, announcements for subsequent phases
of the course also may be sent to the facilities supervisors. Appendix 7
contains an example of a course announcement and cover letter.

Participant invitations

It is advisable to send a letter of invitation/confirmation as
participants register for the course. The letter can be hand delivered,
sent by internal mail, standard mail or e-mailed (where available). See
Appendix 7 for an example of a participant letter of invitation and a
confirmation letter.

Logistics

Choosing a course site

The ideal venue is a classroom that is adjacent or near to a clinical
centre for the field visits. Ideally this course is residential, with
accommodation near to the classroom. If the course is not residential,
allow adequate time for travel between participants' homes and the
classroom.

The classroom will need to hold the number of participants in the
course, as well as three to five breakout groups. In choosing a
classroom, consideration is given to:

-   Easy access to PMTCT clinical setting.

-   Room organised with chairs positioned around three sides of a
    rectangular table to take notes and allow the trainers to see all
    participants. When possible, find a room large enough to set up
    additional chairs (for interactive exercises) in groups of five in
    each of the four corners of the room.

-   Good lighting to allow participants to read and take notes. If using
    projectors, curtains or blinds can be closed to darken the room.

Meals

Try to provide morning refreshments, midday meals, and afternoon
refreshments. Please consider the following:

-   Timing of the meals/refreshments to coincide with breaks in the
    agenda

-   Food/drink delivery and layout do not interfere with the classroom
    proceedings

Slides

The slides may be projected onto a screen or light-coloured wall using a
laptop computer and LCD projector, or photocopied onto transparencies
and viewed on an overhead projector.

Materials and supplies

The most important supplies for the course are the Participant Manual,
Presentation Booklet, Pocket Guide, and Wall Charts; every participant
will need a copy of each. All trainers need a copy of the Trainer
Manual, Presentation Booklet, Pocket Guide, and Wall Charts. In
addition, if the relevant PMTCT policies don't already appear in the
Participant Manuals, then copies should be made available for the
training. (A listing of the national policies, guidelines and protocols
that should appear in the Participant Manual appears in the column
entitled "Insert" in Appendix 4.)

Appendix 6 includes a comprehensive list of the equipment, materials,
and supplies needed to conduct the PMTCT training course. One week
before the training, ensure that everything on the equipment list is in
stock or reserved for loan. Additionally, a list of supplies needed
appears in the beginning of each module in the Trainer Manual.

Clerical and logistical support

The Course Director may need support staff before, during, and after the
training. Before the training, the Course Director may need assistance
with:

-   Contacting, inviting, and confirming participants

-   Contacting panellists

-   Organising the field visit

-   Arranging the Trainer Preparation Days

-   Arranging for the venue and food

-   Fielding questions from participants

-   Photocopying course materials, including evaluation questionnaires

-   Securing equipment, materials and supplies

-   Preparing name tags and certificates

On the day of the training, assistance may be required to:

-   Register participants

-   Take care of any last minute room details

-   Be aware of difficulties with accommodations or other logistics

After the training, assistance may be required to:

-   Write and mail thank you notes

-   Input the evaluation data

-   Produce and distribute the Course Evaluation Report

![](media/image7.png){width="1.0277777777777777in"
height="1.5833333333333333in"}

**Chapter 2.2**

Trainers & Panellists

Trainers

It is important that trainers be chosen with care, that each has the
required skill set, and that they interact well to form a dynamic
multidisciplinary training team. For this training course, which is
designed for 20 participants, the suggested ratio, if possible, is one
trainer for every six participants.

Responsibilities of the trainers include:

-   Attending and participating in the Trainer Preparation Days

-   Attending the complete PMTCT Training Course

-   Fully preparing and presenting the material for specific modules

-   Assisting with participant learning by facilitating the exercises

-   Supporting small group work during all exercises

-   Attending the Daily Trainer Meetings after each training day

-   Giving the Course Director input on progress toward meeting goals
    and objectives

-   Offering suggestions for improving the course

Each trainer will lead the training for 2 or 3 modules and assist with
the training of another 2 or 3 modules. Each module has two trainers:
one primary and one secondary trainer. The following is a description of
the primary versus secondary trainer roles:

-   Primary Trainer---takes the lead on teaching a specific module. S/he
    will need to be competent with the material as well as the teaching
    methods.

-   Secondary Trainer---assists and supports the primary trainer as
    necessary, including:

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```
-   Observing the training to anticipate a need of the primary trainer

-   Taking notes on flipchart or the black- or whiteboard where required

-   Assisting in facilitating group work and exercises

-   Supporting dialogue with the participants

Levels of trainers

In addition to the Course Director, each training session requires at
least one Expert Trainer and two to three Faculty Trainers; co-trainers
are optional. The trainer levels are:

-   Expert (Master) Trainers have a complete understanding of clinical
    content and possess advanced training skills. Expert Trainers are
    likely to be employed as trainers instead of being clinicians or
    managers who have been asked to do a lecture; the Expert Trainers
    may be responsible for training in one or more localities. In most
    settings, these trainers differ from teachers. The Expert Trainer
    may or may not be the same person as the Course Director.

-   Faculty Trainers have a thorough understanding of the clinical
    content. They also have basic training skills to effectively convey
    the clinical content to the participants.

-   Co-trainers have an understanding of clinical content and training
    skills but their primary function is to assist the Expert Trainer. A
    Co-trainer is unlikely to take the lead facilitating any of the
    modules but may assist with interactive exercises.

Potential trainers for the PMTCT course include:

-   Trainers working in health-related education efforts, particularly
    HIV or MCH

-   Trainers employed by the health authority or local government

-   Healthcare workers in related fields: the HIV clinic, the HIV
    counselling and testing centre, or the ANC clinic

Setting the date for the course

Choose dates to avoid national holidays and scheduled national or
regional conferences or meetings. In general, the final dates are set
pending confirmation of the trainers availability.

Inviting trainers

The Course Director invites each of the trainers to join the training
team, discusses the terms of reference and answers any questions. A
sample trainer invitation letter is included in Appendix 7.

Panel discussions

The PMTCT Training Course includes two panel discussions:

-   A panel of people living with HIV/AIDS (PLWHA) for *Module 5 Stigma
    and Discrimination Related to MTCT*

-   A panel of healthcare workers discussing strategies for supportive
    care for the caregiver for *Module 8 Safety and Supportive Care in
    the Work Environment*

PLWHA panel

The purpose of the PLWHA panel is to offer insight into living with the
social and physical effects of HIV infection. Information on choosing a
panel moderator and panellists, as well as tips on how to prepare for
the panel presentation and conduct the panel discussion is in the
Trainer Manual, Appendix 5-B.

Supportive care for the caregiver panel

The purpose of this panel is to examine factors that contribute to
burnout syndrome and develop creative solutions to prevent compassion
fatigue. Other participants should feel free to contribute to the
discussion. The Course Director will recruit 3 or 4 experienced and
articulate participants experienced in the HIV field but not necessarily
PMTCT. He/she will discuss the panel presentation with these individuals
during the weeks before the training begins and provide panellists with
a copy of Exercise 8.4 "Questions for panellists" from the Trainer
Manual.

Guest speakers

Guest speakers may have extensive expertise in technical subject areas
but a limited background in interactive training. For example, a guest
speaker may be chosen to present a particular session, such as the
demonstration of the rapid HIV antibody test. When inviting the guest
speaker, include a discussion of the following:

-   An overview of the commitment they are making in the context of the
    course objectives

-   An overview of the participants, their jobs, and level of knowledge

-   The exact time allotted for the presentation

A sample guest speaker letter of invitation/confirmation is included in
Appendix 7.

Trainer Preparation Days

The preparation of trainers takes place over three days in the week or
month before the PMTCT Training Course. Successive sessions may be
shorter if some of the trainers are experienced.

Along with discussing how the training course fits into the overall
national PMTCT strategy, and how the course is managed, implemented,
monitored, and evaluated, the objectives of the Trainer Preparation Days
are to:

-   Thoroughly review technical content.

-   Use the course materials competently.

-   Practise the exercises in the Trainer Manual.

-   Explore strategies to maximise interactive participation.

Planning the Trainer Preparation Days

Appendix 8 includes a checklist to assist with planning the Trainer
Preparation Days, as well as a tool for assigning primary and secondary
trainers for each module.

Agenda for Trainer Preparation Days

Day 1 includes time for an overview of the PMTCT training, the opening
ceremony/introduction and a description of the training course
participants. The majority of the three days will be spent reviewing the
training course starting with the introduction, going though all nine
modules and ending with the closing exercise and discussion of field
visit.

Discussing modules

The discussion of each of the modules could proceed as follows:

-   The Course Director briefly introduces the primary and secondary
    trainer and the module.

-   The Course Director introduces any new learning strategies and gives
    tips on the exercises.

-   Each primary trainer presents her/his module in turn. Trainers may
    summarise the lecture, but take the time to practise the interactive
    exercises.

-   Each secondary trainer functions as s/he will do on the day of the
    actual training eg, by taking notes on flipchart, assisting with
    visual aids, or moderating discussion.

Introducing the "Checklist of Training Skills"

The Course Director introduces the "Checklist of Training Skills" found
in Appendix 8. S/he may go through each of the general categories, such
as "movements" and "speech", and explain what they mean.

Giving feedback

Giving individual feedback is not an easy technique to learn. The Course
Director can model this technique during the module feedback sessions.

**Giving feedback to trainers**

-   Did the trainer's movements and speech help the presentation?

-   Did the trainer involve the class in discussion and answer questions
    clearly?

-   Did the trainer explain the content clearly using the visual aids as
    needed?

-   Did the trainer use the Trainer's Manual and other materials
    accurately?

-   Did the trainer include all of the important content?

-   Did the trainer stay on schedule?

**Always provide feedback on the strengths of the presentation first\
and then suggest areas to be modified.** [^2]

![](media/image7.png){width="1.0277777777777777in"
height="1.5833333333333333in"}

**Chapter 2.3**

The Field Visit

The goal of the field visit is to reinforce the classroom learning by
providing participants with an observation experience in a PMTCT
facility setting, such as an ANC clinic, Labour and Delivery facility,
or follow-up treatment centre.

Timing of field visit

The field visit may take place any time after Module 6: HIV Testing and
Counselling for PMTCT. If necessary, the field visit may take place the
week after the training. The timing of the visit and the people with
whom trainees will meet will be based on the learning objectives.

The objectives may include any of the following:

-   To observe an HIV information provision session

-   To observe an HIV counselling session

-   To observe rapid testing

-   To observe the provision of advice and support around ARV
    treatment/prophylaxis

-   To observe the provision of infant-feeding counselling and support

-   To observe the use of universal precautions in the Labour and
    Delivery setting

-   To gain an understanding of the management of occupational exposure
    to HIV including post-exposure prophylaxis

-   To discuss PMTCT course monitoring

-   To observe the provision of support to an patient who is HIV
    infected

-   To observe referral and follow-up of patients to treatment, care and
    support services

Small versus large groups

Depending on the number of trainees, the size of the facility, and the
availability of clinic staff to host the training group, the
participants may stay together as a large group or visit in smaller
groups. Consideration may be given to dividing participants into
interest groups related to work responsibilities and settings. Examples
are as follows:

-   HIV testing and counselling

-   Infant feeding

-   Facility management

-   ANC and HIV clinical services

-   Labour and Delivery

Organising the site visit

The ideal setting for the site visit is a clinical centre of excellence
for PMTCT. Where possible, meet with the manager and clinical staff
prior to the visit to discuss:

-   The objectives of the visit

-   The number of participants

-   The best day or days for the visit

-   The staff who will be available to meet with participants

-   The potential to observe activities with patients

Additional information about the field visit, including tips for
organising the visit and an interview guide for participants can be
found in Appendix 9.

![](media/image7.png){width="1.0277777777777777in"
height="1.5833333333333333in"}

**Chapter 2.4**

Conducting the Training Course

The Course Director is present throughout the entire PMTCT Training
Course to help ensure that it runs according to agenda, to support the
trainers, to conduct the Daily Trainer Meetings, and to collect
evaluation information.

Course Director responsibilities during the PMTCT Training Course

The Course Director may be actively involved in training; other times
s/he will be the supervisor of the training team. Specific
responsibilities during the course include:

-   Facilitating the opening and closing ceremonies

-   Introducing the trainers, speakers, and panellists

-   Introducing the materials

-   Supervising and supporting trainers

-   Ensuring trainers have all the equipment and materials needed for
    their presentations

-   Facilitating daily trainer meetings

-   Modelling supportive teaching, gentle supervision, and
    confidence-building in all interactions with trainers and
    participants

-   Ensuring that the trainer(s) follow the agenda

-   Being responsible for any last minute decision or changes to the
    agenda

-   Ensuring that participants return from breaks in a timely manner

The Course Director arrives at the training site an hour before the
course to prepare for each day's training.

-   On the first day, places welcome and directional signs near the
    entrance and on the way to the training room.

-   Ensures that the room is open and that the temperature and
    environment are comfortable.

-   Ensures the registration table is staffed, participant materials are
    organised, and equipment is set up and in operating order and chairs
    are set up for the first interactive session of the day.

-   Ensures that materials are available for each of the interactive
    exercises that are on the agenda for the day.

Opening Ceremony and Course Introduction

The Opening Ceremony and Course Introduction are the formal start of the
training course and serve to welcome course participants, place PMTCT
and PMTCT training into a national context, create enthusiasm for the
course, and introduce the PMTCT National Training Curriculum. This will
be the participants' first experience with the course, the time when
their impressions and expectations will be set.

A two- to four-hour session may be scheduled as the "Opening Ceremony
and Course Introduction". A Ministry of Health representative, local
dignitary, key PMTCT professional, or the Course Director may chair the
session.

Objectives of the Opening Ceremony are as follows:

-   Formally open the course with a presentation from an outside
    speaker(s). It is important to involve at least one individual from
    local, district/state/provincial or national government, or from a
    key institution/organisation to showcase support from that agency
    for PMTCT services.

-   Provide participants with an overview of the importance of PMTCT
    services

-   Provide participants with an overview of how this training fits into
    the National Training Plan and PMTCT strategy, as well as the
    importance of training

-   Build energy and enthusiasm for the course

Objectives of the Course Introduction include:

-   Introduce trainers

-   Introduce the curriculum, training, and training methods

-   Discuss participants' responsibilities including ground rules

-   Provide an opportunity to begin participant networking

-   Provide an overview of course evaluation

Participants need to know that evaluation data provide information to
improve future courses. Explain that there are (may be) two types of
evaluation forms for this course:

-   (Optional) The Pre- and Post-test Knowledge Questionnaire will
    measure changes in knowledge from the beginning of the course to the
    end of the course. This questionnaire is administered during the
    Course Introduction and just before the closing session.

-   The Overall Evaluation gives the Course Director a sense of whether
    participants thought the course met its goals and asks for feedback
    on the facilities. The Overall Evaluation form is administered just
    before the Closing Session.

Just before the participants leave the Opening Ceremony and Course
Introduction, remind them to:

-   Bring their Participant Manuals and Presentation Booklets with them
    every day of the course

-   Encourage them to read the content in the Participant Manual or
    Presentation Booklet each evening to introduce them to the content
    for the next day

-   Wear their name tags each day

Daily trainer meetings

The Course Director conducts short trainer meetings at the end of the
day to debrief and discuss impressions of the training.

**Agenda for the daily trainer meeting**

-   Review of each of the modules presented by the trainer.

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-   Discuss the strength of the presentation.

-   State one wish about the presentation (area for improvement).

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-   Talk about the progress of specific groups and individual
    participants.

-   Discuss how to manage concerns.

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-   What concerns came up during the day?

-   What suggestions do the other trainers have for managing them?

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-   Plan for the following day(s), including preparations and practise
    if necessary.

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-   Make sure tasks are assigned.

-   Verify that trainers have all needed materials and equipment.

-   Verify arrangements and assignments for the first day of the course.

-   Adjust schedule when necessary.

The agenda for the daily trainer meeting on the final day includes the
above and solicits the trainers' impressions of the course. Additional
questions that are important to ask at this time are:

-   Did the course meet its objectives?

-   Which two aspects of the training do you think the participants
    found most useful?

-   Which two aspects do you think they enjoyed the most?

-   What single topic was most difficult for participants to grasp?

-   How could the training could be improved?

The Course Director may prepare a short summary of the meetings to
document the discussion and contribute to the course evaluation process.

Closing session

The Closing Session---the formal ending of the course---includes time
for completing the course evaluations, as well as for emphasising how
the course supports the national PMTCT Training Programme. This is also
an opportunity for the Course Director to thank the trainers,
participants, visitors, and panellists for their time, commitment, and
hard work. The Closing Session offers the opportunity to accomplish
several important objectives:

-   Complete evaluation forms

-   Bring closure to the training experience

-   Reinforce the importance of PMTCT and beginning the transition back
    to the workplace

-   Present participants with their certificates (An example of a
    Certificate of Course Completion is included in Appendix 7.)

Agenda for the closing session

Allow the first 30 minutes for participants to complete the evaluation
forms:

-   (Optional) Post-Test Knowledge Questionnaire

-   Course Evaluation

The course evaluation is generally followed by an address to the
participants and the conferring of course certificates. The appropriate
person to give participants their course certificates may include any of
the following: Course Director, Course Director's supervisor, a local
dignitary or MOH officer. By the closing session, the participants
typically feel as if they know each other quite well, and their shared
experiences over the previous days create a bond between them regarding
their common task and how they will contribute to the success of the
PMTCT Programme. The Closing Session acknowledges that bond and starts
preparing participants to use the knowledge gained in the course when
they return to the workplace.

Thank you letters

Thank you letters are sent to the people who helped to make the PMTCT
Training Course a success:

-   Opening Ceremony presenter(s)

-   PLWHA panellists

-   Trainers

-   Individuals that participated in the PLWHA and policymakers and/or
    healthcare provider panel

-   Guest speakers

-   Closing Session presenter(s)

Sample thank you letters are included in Appendix 7: Sample Documents.

Evaluation

A range of evaluation information is available from the daily trainer
meetings, informal participant feedback, and course evaluation forms.

The evaluation data for each PMTCT course may be summarised into a brief
report that could:

-   Ease the data collection, compilation, and analysis for reporting

-   Provide a progress report to the Ministry of Health

-   Provide direction for course revision

-   Provide a record to assist planning for the next course

![](media/image7.png){width="1.0263888888888888in"
height="1.5798611111111112in"}

**Section 3**

Appendices

Appendix 1 Developing the national training plan

+---------+------------------------------------------------------------+
| **First |                                                            |
| me      |                                                            |
| eting** |                                                            |
+---------+------------------------------------------------------------+
| *       | -   Agree on meeting goal and objectives.                  |
| *Prepar |                                                            |
| ation** | -   Decide who will chair the meeting.                     |
|         |                                                            |
|         | -   Develop agenda.                                        |
|         |                                                            |
|         | -   Agree on participant list.                             |
|         |                                                            |
|         | -   Set dates according to participants' schedules.        |
|         |                                                            |
|         | -   Agree how suggestions from meeting will be             |
|         |     incorporated into the final document.                  |
|         |                                                            |
|         | -   Decide how proceedings of meeting will be recorded.    |
|         |                                                            |
|         | -   Choose meeting site.                                   |
|         |                                                            |
|         | -   Send out invitations with agenda.                      |
+---------+------------------------------------------------------------+
| *       | **Title of meeting---Date/Time/Location**                  |
| *Sample |                                                            |
| Meeting | -   Welcome and introductions                              |
| A       |                                                            |
| genda** | -   Overview of the goal to develop the National Training  |
|         |     Plan for PMTCT services                                |
|         |                                                            |
|         | -   Presentation on PMTCT                                  |
|         |                                                            |
|         | ```{=html}                                                 |
|         | <!-- -->                                                   |
|         | ```                                                        |
|         | -   Overview and rationale of PMTCT                        |
|         |                                                            |
|         | -   Overview of PMTCT services                             |
|         |                                                            |
|         | -   Funding                                                |
|         |                                                            |
|         | -   National Goals for PMTCT training                      |
|         |                                                            |
|         | ```{=html}                                                 |
|         | <!-- -->                                                   |
|         | ```                                                        |
|         | -   Presentation on PMTCT training                         |
|         |                                                            |
|         | ```{=html}                                                 |
|         | <!-- -->                                                   |
|         | ```                                                        |
|         | -   Current status of training (numbers trained, numbers   |
|         |     needing training)                                      |
|         |                                                            |
|         | -   Introduce the PMTCT Generic Training Package.          |
|         |                                                            |
|         | ```{=html}                                                 |
|         | <!-- -->                                                   |
|         | ```                                                        |
|         | -   Discussion of National PMTCT Training Plan             |
|         |                                                            |
|         | ```{=html}                                                 |
|         | <!-- -->                                                   |
|         | ```                                                        |
|         | -   Target audience                                        |
|         |                                                            |
|         | -   Number of participants                                 |
|         |                                                            |
|         | -   Learning needs/training content/topics                 |
|         |                                                            |
|         | -   Length of training                                     |
|         |                                                            |
|         | -   Responsible entity                                     |
|         |                                                            |
|         | -   Training infrastructure                                |
|         |                                                            |
|         | -   Timeline, budget and funding source                    |
|         |                                                            |
|         | -   Overview and timeline for the evaluation plan          |
|         |                                                            |
|         | -   Process and timeline to review and update plan         |
|         |                                                            |
|         | ```{=html}                                                 |
|         | <!-- -->                                                   |
|         | ```                                                        |
|         | -   Next steps                                             |
|         |                                                            |
|         | -   Discussion of process of adaptation of Generic         |
|         |     Training Package                                       |
|         |                                                            |
|         | -   Date/time/site of next meeting to review draft plan    |
|         |     and draft of adaptation of package                     |
+---------+------------------------------------------------------------+

+---------+------------------------------------------------------------+
| *       |                                                            |
| *Second |                                                            |
| p       |                                                            |
| lanning |                                                            |
| me      |                                                            |
| eting** |                                                            |
+---------+------------------------------------------------------------+
| *       | -   Draft agenda for Chair's approval.                     |
| *Prepar |                                                            |
| ation** | -   Send out minutes from previous meeting, draft of       |
|         |     national plan, and reminder of date, time and location |
|         |     of the next meeting.                                   |
+---------+------------------------------------------------------------+
| *       | **Title of meeting---Date/Time/Location**                  |
| *Sample |                                                            |
| Meeting | -   Welcome and overview of objectives                     |
| A       |                                                            |
| genda** | -   Summary of work since the first meeting                |
|         |                                                            |
|         | -   Presentation of draft National Training Plan           |
|         |                                                            |
|         | -   Discussion of document                                 |
|         |                                                            |
|         | -   Action on approval                                     |
|         |                                                            |
|         | -   Review of adaptation of Generic Training Package       |
|         |                                                            |
|         | -   Action on approval                                     |
|         |                                                            |
|         | -   Next steps                                             |
+---------+------------------------------------------------------------+

Appendix 2 Sample evaluation tools

Course Evaluation Form

+-----------------------------------------------------------------------+
| Course Evaluation                                                     |
|                                                                       |
| PMTCT Training Course --- (Insert) Dates/Location                     |
+-----------------------------------------------------------------------+

What is your discipline?

  ----------------- ----------------- ------------------------------------- -----------------
   Physician        Nurse            Midwife                              Social Worker

   Outreach Worker  Counsellor       Other (please state:                
                                      \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)   
  ----------------- ----------------- ------------------------------------- -----------------

Please place a check in the box that best describes your level of
understanding or ability for each of the following items (with "1" being
the lowest level and "5" being the highest):

+---------------------------------+--------------+---------------------+
|                                 |              | Low High            |
|                                 |              |                     |
|                                 |              | 1 2 3 4 5           |
+---------------------------------+--------------+---------------------+
| 1.  Understanding of PMTCT in   | Before       |                |
|     the context of an antenatal | Training     |                     |
|     setting                     |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 2.  Ability to provide HIV      | Before       |                |
|     testing and counselling in  | Training     |                     |
|     line with national policy   |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 3.  Ability to advise and       | Before       |                |
|     support women on ARV        | Training     |                     |
|     treatment/prophylaxis       |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 4.  Ability to provide women    | Before       |                |
|     who are HIV infected with   | Training     |                     |
|     information, counselling    |              |                     |
|     and support around infant   |              |                     |
|     feeding                     |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 5.  Understanding of Universal  | Before       |                |
|     Precautions as it applies   | Training     |                     |
|     to your work setting        |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 6.  Understanding of the        | Before       |                |
|     management of occupational  | Training     |                     |
|     exposure to HIV (including  |              |                     |
|     post-exposure prophylaxis)  |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 7.  Understanding of PMTCT      | Before       |                |
|     programme monitoring and    | Training     |                     |
|     the role you have to play   |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+
| 8.  Ability to implement the    | Before       |                |
|     PMTCT programme as          | Training     |                     |
|     described in national       |              |                     |
|     policy                      |              |                     |
+---------------------------------+--------------+---------------------+
|                                 | After        |                |
|                                 | Training     |                     |
+---------------------------------+--------------+---------------------+

1.  What is the most important information you learned at this training
    course?

2\. What did you like least about this training course?

3\. What did you like most about this training course?

4.  What information/topics should be included in future trainings?

5\. Will you change your practice after attending this activity?  Yes 
No

> If you answered "YES", please indicate what you will change in your
> practice.
>
> If you answered "NO", please indicate why you do not expect to change
> your practice.

Please rate the following aspects of the training course.

+--------------------------------+--------+--------+--------+--------+
|                                | **St   | **A    | **Disa | **St   |
|                                | rongly | gree** | gree** | rongly |
|                                | A      |        |        | Disa   |
|                                | gree** |        |        | gree** |
+--------------------------------+--------+--------+--------+--------+
| 1.  Meeting facilities were    |        |        |        |        |
|     adequate for this training |        |        |        |        |
+--------------------------------+--------+--------+--------+--------+
| 2.  Participant Manual and     |        |        |        |        |
|     other handouts were        |        |        |        |        |
|     helpful                    |        |        |        |        |
+--------------------------------+--------+--------+--------+--------+
| 3.  There was enough time to   |        |        |        |        |
|     cover all material         |        |        |        |        |
+--------------------------------+--------+--------+--------+--------+
| 4.  Ideas were communicated    |        |        |        |        |
|     clearly                    |        |        |        |        |
+--------------------------------+--------+--------+--------+--------+
| 5.  Presenters gave personal   |        |        |        |        |
|     attention to participants  |        |        |        |        |
|     when necessary             |        |        |        |        |
+--------------------------------+--------+--------+--------+--------+
| 6.  Questions were answered to |        |        |        |        |
|     my satisfaction            |        |        |        |        |
+--------------------------------+--------+--------+--------+--------+

**Additional Comments:**

***Thank you for your time!***

Appendix 2 Sample evaluation tools

Sample Pre- and Post-Test Knowledge Questionnaire

***Note to Course Director:***

This Knowledge Questionnaire contains content taught within each of the
nine modules in the Participant Manual. You may select questions that
apply to the these nine modules and simplify or substitute language
depending upon participant experience with multiple choice testing. The
question stem and correct choice may be redesigned into a true and false
format.

+-----------------------------------------------------------------------+
| PMTCT Training Course                                                 |
|                                                                       |
| Sample Knowledge Questionnaire                                        |
+-----------------------------------------------------------------------+

***Directions**: Please read each question carefully and circle the
letter\
of the **most accurate** response to the question.*

+----+-----------------------------------------------------------------+
| 1  | > What is the most common route of HIV transmission worldwide?  |
| \. |                                                                 |
|    | a)  Blood transfusions                                          |
|    |                                                                 |
|    | b)  Heterosexual contact                                        |
|    |                                                                 |
|    | c)  Intravenous drug use                                        |
|    |                                                                 |
|    | d)  Mother-to-child transmission                                |
+----+-----------------------------------------------------------------+
| 2  | According to the adult WHO Staging System of HIV infection, a   |
| \. | clinical symptom\                                               |
|    | of Stage II is                                                  |
|    |                                                                 |
|    | a)  Chronic diarrhoea lasting more than one month               |
|    |                                                                 |
|    | b)  Normal activity level without symptoms                      |
|    |                                                                 |
|    | c)  Recurrent upper respiratory tract infections                |
|    |                                                                 |
|    | d)  Kaposi's sarcoma                                            |
+----+-----------------------------------------------------------------+
| 3  | The risk of mother-to-child transmission of HIV infection       |
| \. | increases when                                                  |
|    |                                                                 |
|    | a)  Breastfeeding is continued over time                        |
|    |                                                                 |
|    | b)  Non-invasive delivery procedures are used                   |
|    |                                                                 |
|    | c)  Maternal viral load is low                                  |
|    |                                                                 |
|    | d)  Sexually transmitted infections are treated early           |
+----+-----------------------------------------------------------------+
| 4  | Primary prevention of HIV infection includes all of these,      |
| \. | ***except***                                                    |
|    |                                                                 |
|    | a)  Correct and consistent use of condoms                       |
|    |                                                                 |
|    | b)  Excluding male partners from HIV education programs         |
|    |                                                                 |
|    | c)  Delaying the age of first sexual intercourse                |
|    |                                                                 |
|    | d)  Being faithful to one uninfected partner who is faithful as |
|    |     well                                                        |
+----+-----------------------------------------------------------------+
| 5  | Screening and treatment for tuberculosis (TB) should be         |
| \. | available to                                                    |
|    |                                                                 |
|    | a)  Women who are HIV-infected who are not receiving            |
|    |     antiretroviral treatment                                    |
|    |                                                                 |
|    | b)  All women presenting for ANC services with a cough of more  |
|    |     than 2 weeks                                                |
|    |                                                                 |
|    | c)  Women who are HIV-infected with recent exposure to          |
|    |     tuberculosis                                                |
|    |                                                                 |
|    | d)  All the above                                               |
+----+-----------------------------------------------------------------+
| 6  | > The ***first choice*** WHO-recommended mother-infant regimen  |
| \. | > for antiretroviral prophylaxis in PMTCT is                    |
|    |                                                                 |
|    | a)  Single dose nevirapine                                      |
|    |                                                                 |
|    | b)  Zidovudine (ZDV) and nevirapine (NVP)                       |
|    |                                                                 |
|    | c)  Zidovudine (ZDV) and lamivudine (3TC)                       |
|    |                                                                 |
|    | d)  Zidovudine (ZDV), lamivudine (3TC) and saquinavir/ritonavir |
|    |     (SQV/r)                                                     |
+----+-----------------------------------------------------------------+

Appendix 2 Sample evaluation tools *continued*

+----+-----------------------------------------------------------------+
| 7  | > What is one advantage of using commercial infant-feeding      |
| \. | > formula?                                                      |
|    |                                                                 |
|    | a)  It provides all the nutrients and antibodies a baby may     |
|    |     need                                                        |
|    |                                                                 |
|    | b)  It is always available                                      |
|    |                                                                 |
|    | c)  Other family members can help feed the baby                 |
|    |                                                                 |
|    | d)  It carries very little risk of causing diarrhoea or         |
|    |     bacterial infections                                        |
+----+-----------------------------------------------------------------+
| 8  | When exclusive breastfeeding with early cessation is the chosen |
| \. | infant-feeding option, at what age should cessation take place? |
|    |                                                                 |
|    | a)  Eight months                                                |
|    |                                                                 |
|    | b)  Within four months                                          |
|    |                                                                 |
|    | c)  As soon as safely possible given local circumstances        |
|    |                                                                 |
|    | d)  Twelve months                                               |
+----+-----------------------------------------------------------------+
| 9  | Postnatal infant-feeding counselling and follow-up are required |
| \. |                                                                 |
|    | a)  Mainly during the first few months of breastfeeding         |
|    |                                                                 |
|    | b)  When replacement feeding is the chosen option               |
|    |                                                                 |
|    | c)  Whenever a mother decides to change her feeding practice    |
|    |                                                                 |
|    | d)  At selected intervals based on clinic protocols             |
+----+-----------------------------------------------------------------+
| 10 | > International human rights declarations include the rights of |
| \. | > persons living with HIV/AIDS (PLWHA) to                       |
|    |                                                                 |
|    | a)  Reduce the number of working hours                          |
|    |                                                                 |
|    | b)  Socially isolate themselves within their communities        |
|    |                                                                 |
|    | c)  Access antiretroviral treatment and be free from HIV/AIDS   |
|    |     related discrimination                                      |
|    |                                                                 |
|    | d)  Disclose their diagnosis within a specified period of time  |
|    |     to employers                                                |
+----+-----------------------------------------------------------------+
| 11 | > Before HIV testing, pre-test information may include the      |
| \. | > following                                                     |
|    |                                                                 |
|    | a)  Confidentiality                                             |
|    |                                                                 |
|    | b)  Benefits of partner testing                                 |
|    |                                                                 |
|    | c)  Safer sex practices                                         |
|    |                                                                 |
|    | d)  All of the above                                            |
+----+-----------------------------------------------------------------+
| 12 | How do the HIV rapid tests measure HIV serostatus?              |
| \. |                                                                 |
|    | a)  Detecting the presence of HIV antigen                       |
|    |                                                                 |
|    | b)  Detecting the presence of HIV antibody                      |
|    |                                                                 |
|    | c)  Determining the quantity of HIV                             |
|    |                                                                 |
|    | d)  Detecting the presence of viral DNA                         |
+----+-----------------------------------------------------------------+
| 13 | Standard diagnosis of HIV infection in infants according to WHO |
| \. | guidelines occurs                                               |
|    |                                                                 |
|    | a)  Within 48 hours of birth using HIV-DNA PCR testing          |
|    |                                                                 |
|    | b)  At 12 months using the Western Blot                         |
|    |                                                                 |
|    | c)  At 18 months using antibody testing                         |
|    |                                                                 |
|    | d)  At 12 months using the ELISA                                |
+----+-----------------------------------------------------------------+
| 14 | Prophylaxis for *Pneumocystis Carinii* Pneumonia (PCP) with     |
| \. | cotrimoxazole is recommended for                                |
|    |                                                                 |
|    | a)  Persons with symptomatic HIV                                |
|    |                                                                 |
|    | b)  Adults/adolescents with CD4 cell counts less than 500/mm^3^ |
|    |                                                                 |
|    | c)  All HIV-exposed infants until HIV infection is ruled out    |
|    |                                                                 |
|    | d)  All of the above                                            |
+----+-----------------------------------------------------------------+
| 15 | > PLWHA have a 40% lifetime risk of becoming co-infected with   |
| \. |                                                                 |
|    | a)  Malaria                                                     |
|    |                                                                 |
|    | b)  Helminth infection                                          |
|    |                                                                 |
|    | c)  Tuberculosis                                                |
|    |                                                                 |
|    | d)  Cytomegalovirus                                             |
+----+-----------------------------------------------------------------+

Appendix 2 Sample evaluation tools *continued*

+----+-----------------------------------------------------------------+
| 16 | > The first step in making contaminated instruments and         |
| \. | > equipment safe to handle is                                   |
|    |                                                                 |
|    | a)  Cleaning with soap and hot running water                    |
|    |                                                                 |
|    | b)  Sterilisation using heat or steam                           |
|    |                                                                 |
|    | c)  Boiling for 20 minutes                                      |
|    |                                                                 |
|    | d)  Decontamination by soaking in a bleach solution for 10      |
|    |     minutes                                                     |
+----+-----------------------------------------------------------------+
| 17 | > Protocols for managing occupational exposure to HIV infection |
| \. | > include antiretroviral prophylaxis administered to the worker |
|    |                                                                 |
|    | a)  As soon as rapid testing confirms HIV diagnosis of the      |
|    |     source                                                      |
|    |                                                                 |
|    | b)  Within 2 hours after the exposure                           |
|    |                                                                 |
|    | c)  Once clearance from the medical supervisor is obtained      |
|    |                                                                 |
|    | d)  Within 24 hours after the exposure                          |
+----+-----------------------------------------------------------------+
| 18 | > Which of the following describes the routine assessment of    |
| \. | > ongoing activities through record keeping and regular         |
|    | > reporting?                                                    |
|    |                                                                 |
|    | a)  Situation assessment                                        |
|    |                                                                 |
|    | b)  Implementation                                              |
|    |                                                                 |
|    | c)  Monitoring                                                  |
|    |                                                                 |
|    | d)  Evaluation                                                  |
+----+-----------------------------------------------------------------+
| 19 | > Which of the following represents a health facility indicator |
| \. | > that can be monitored to determine programme activity?        |
|    |                                                                 |
|    | a)  Percentage of orphans linked to mothers who are             |
|    |     HIV-infected in Asia                                        |
|    |                                                                 |
|    | b)  Nationwide statistics on HIV prevalence in pregnant women   |
|    |     between 15 and 25 years or age                              |
|    |                                                                 |
|    | c)  Percentage of women receiving pre-test information in ANC   |
|    |     clinic who are tested for HIV                               |
|    |                                                                 |
|    | d)  Number of PLWHA who are co-infected with tuberculosis       |
|    |     worldwide                                                   |
+----+-----------------------------------------------------------------+
| 20 | > Collection of usable data in programme management requires    |
| \. |                                                                 |
|    | a)  Understanding the data to be collected                      |
|    |                                                                 |
|    | b)  Standardising collection tools and terms used               |
|    |                                                                 |
|    | c)  Recording the data each time in the same way                |
|    |                                                                 |
|    | d)  All of the above                                            |
+----+-----------------------------------------------------------------+

Correct answers: 1(b), 2 (c), 3(a), 4(b), 5(d), 6(b), 7(c), 8(c), 9(c),
10(c), 11(d), 12(b), 13(c), 14(c), 15(c), 16(d), 17(b), 18(c), 19(c),
20(d)

Appendix 2 Sample evaluation tools

+-----------------------------------------------------------------------+
| Participant Long-term Outcome Interview Guide                         |
|                                                                       |
| PMTCT Training Course                                                 |
+-----------------------------------------------------------------------+

Thank you for agreeing to participate in this interview. We are talking
with those who attended the PMTCT Training Course to improve future
courses. Your responses will be anonymous. Findings of the survey will
be reported as aggregate (as a group) only; there will be no way anyone
can trace back a particular response to you.

1.  Date

2.  What is your discipline?

  ----------------- ------------------ --------------------------------------------------------------------------- ----------------
   Physician        Nurse             Midwife                                                                    Social Worker

   Outreach Worker  Counsellor        Other (please state:                                                      
                                       \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)   
  ----------------- ------------------ --------------------------------------------------------------------------- ----------------

3.  When did you attend the PMTCT training course?

4.  Are you currently working in a setting that provides PMTCT services?

+----------------------------------+-------+---+-----+-----+---+--------+
|                                  | **Not | * |     | *   |   | **Ext  |
|                                  | at    | * |     | *So |   | remely |
|                                  | all   | N |     | mew |   | valu   |
|                                  | valua | o |     | hat |   | able** |
|                                  | ble** | t |     | v   |   |        |
|                                  |       | v |     | alu |   |        |
|                                  |       | e |     | abl |   |        |
|                                  |       | r |     | e** |   |        |
|                                  |       | y |     |     |   |        |
|                                  |       | v |     |     |   |        |
|                                  |       | a |     |     |   |        |
|                                  |       | l |     |     |   |        |
|                                  |       | u |     |     |   |        |
|                                  |       | a |     |     |   |        |
|                                  |       | b |     |     |   |        |
|                                  |       | l |     |     |   |        |
|                                  |       | e |     |     |   |        |
|                                  |       | * |     |     |   |        |
|                                  |       | * |     |     |   |        |
+----------------------------------+-------+---+-----+-----+---+--------+
| 5.  How valuable did you find    |       |   |     |     |   |        |
|     the PMTCT training course?   |       |   |     |     |   |        |
+----------------------------------+-------+---+-----+-----+---+--------+
|                                  | *     |   | **M |     | * |        |
|                                  | *No** |   | ayb |     | * |        |
|                                  |       |   | e** |     | Y |        |
|                                  |       |   |     |     | e |        |
|                                  |       |   |     |     | s |        |
|                                  |       |   |     |     | * |        |
|                                  |       |   |     |     | * |        |
+----------------------------------+-------+---+-----+-----+---+--------+
| 6.  Would you recommend (or have |       |   |     |     |   |        |
|     you recommended) this        |       |   |     |     |   |        |
|     training to others?          |       |   |     |     |   |        |
+----------------------------------+-------+---+-----+-----+---+--------+

7.  How did the training influence the way you provide the following
    services:

a\. HIV testing and counselling

b\. Helping patients who are HIV-infected deal with stigma and
discrimination

c\. Infant-feeding counselling and support

> d\. ARV treatment and prophylaxis

e\. Caring for women who are HIV-infected during labour and delivery

> f\. Answering questions and referring patients to local agencies that
> provide treatment, care, and support for mothers and families with HIV
>
> g\. Providing or ensuring follow-up care and HIV testing of infants

8\. In thinking back to the course, which part was the most valuable to
your work?

9\. Which was least valuable?

10\. What suggestions do you have for improving the course?

11\. In what areas related to PMTCT do you feel you would like
additional training?

12\. What other comments or suggestions do you have about the training?

***Thank you for your time!***

Appendix 2 Sample evaluation tools

+-----------------------------------------------------------------------+
| Facility Supervisor Long-term Outcome Interview Guide                 |
|                                                                       |
| PMTCT Training Course                                                 |
+-----------------------------------------------------------------------+

Thank you for agreeing to participate in this interview. We are talking
with the supervisors of those who attended the PMTCT Training Course to
improve future courses. Your responses will be anonymous. Findings of
the survey will be reported as aggregate (as a group) only; there will
be no way anyone can trace back a particular response to you.

Date

1.  What is your job title?

2.  What are the names of the facilities (PMTCT) for which you have
    responsibility?

3.  When did your staff attend the PMTCT training?

4\. How did the training affect the way staff provide the following
services:

a\. HIV testing and counselling

b\. Helping patients who are HIV-infected deal with stigma and
discrimination

c\. Infant-feeding counselling and support

d\. ARV treatment/prophylaxis

e\. Care to women who are HIV-infected during labour and delivery

f\. Refer women to local agencies that provide treatment, care and
support for\
mothers and families with HIV

g\. Follow-up care and HIV testing of infants

5\. What were the strengths of the training?

6\. What were the weaknesses of the training?

7\. What suggestions do you have for improving the course?

8\. What are the additional PMTCT-related training needs of staff that
attended the course?

9.  What other comments or suggestions do you have about the training?

***Thank you for your time!***

Appendix 2 Sample evaluation tools

+-----------------------------------------------------------------------+
| PMTCT Refresher Course                                                |
|                                                                       |
| Course Needs Assessment                                               |
+-----------------------------------------------------------------------+

A training workshop is being planned for providers at all PMTCT sites.
Your input will help to design a training that meets educational needs.
Please complete the following survey and return it

to \<person\> [by \<date\>]{.underline}

Date

1\. What is your discipline?

  ------------------ ---------------- --------------------------------- -----------------
   Physician         Nurse           Midwife                          Social Worker

   Outreach Worker   Counsellor      Other (please state:            
                                      \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)   
  ------------------ ---------------- --------------------------------- -----------------

2\. Did you attend a PMTCT training course? No\_\_\_\_\_\_\_ If yes,
when and where?

I would like to know more about:

+----------------------+---------+---------+-------+--------+---------+
| Please circle one    | **1**   | **2**   | **3** | **4**  | **5**   |
| choice:              |         |         |       |        |         |
|                      | **Very  | **Im    | **Uns | **Pr   | **Does  |
|                      | im      | portant | ure** | obably | NOT     |
|                      | portant | to\     |       | not    | need to |
|                      | to      | in      | *     | neces  | be      |
|                      | in      | clude** | *if** | sary** | inc     |
|                      | clude** |         |       |        | luded** |
|                      |         |         | **Nee |        |         |
|                      |         |         | ded** |        |         |
+----------------------+---------+---------+-------+--------+---------+
| E                    | 1       | 2       | 3     | 4      | 5       |
| ducating/counselling |         |         |       |        |         |
| pregnant women about |         |         |       |        |         |
| HIV testing          |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Giving pregnant      | 1       | 2       | 3     | 4      | 5       |
| women HIV test       |         |         |       |        |         |
| results              |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Referring women who  | 1       | 2       | 3     | 4      | 5       |
| are HIV-infected for |         |         |       |        |         |
| specialty medical    |         |         |       |        |         |
| care                 |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Assessing symptoms   | 1       | 2       | 3     | 4      | 5       |
| in women who are     |         |         |       |        |         |
| HIV-infected         |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Laboratory follow-up | 1       | 2       | 3     | 4      | 5       |
| of women who are     |         |         |       |        |         |
| HIV-infected         |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Family planning for  | 1       | 2       | 3     | 4      | 5       |
| women who are        |         |         |       |        |         |
| HIV-infected         |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Patient/family       | 1       | 2       | 3     | 4      | 5       |
| education for        |         |         |       |        |         |
| families affected by |         |         |       |        |         |
| HIV                  |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Nutritional          | 1       | 2       | 3     | 4      | 5       |
| assessment of women  |         |         |       |        |         |
| who are HIV-infected |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Caring for women who | 1       | 2       | 3     | 4      | 5       |
| are HIV-infected     |         |         |       |        |         |
| during labour and    |         |         |       |        |         |
| delivery             |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| ARV treatment and    | 1       | 2       | 3     | 4      | 5       |
| prophylaxis to PMTCT |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+
| Infant-feeding       | 1       | 2       | 3     | 4      | 5       |
| counselling and      |         |         |       |        |         |
| support              |         |         |       |        |         |
+----------------------+---------+---------+-------+--------+---------+

Appendix 2: Sample evaluation tools *continued*

+---------------------+---------+---------+---+-------+---+---------+---+---------+
| *Continued from\    | **1**   | **2**   |   | **3** |   | **4**   |   | **5**   |
| previous page*      |         |         |   |       |   |         |   |         |
|                     | **Very  | **Im    |   | **Uns |   | **P     |   | **Does  |
|                     | im      | portant |   | ure** |   | robably |   | NOT     |
|                     | portant | to\     |   |       |   | not     |   | need to |
|                     | to      | in      |   | *     |   | nece    |   | be      |
|                     | in      | clude** |   | *If** |   | ssary** |   | inc     |
|                     | clude** |         |   |       |   |         |   | luded** |
|                     |         |         |   | **Nee |   |         |   |         |
|                     |         |         |   | ded** |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Infant feeding for  | 1       | 2       | 3 |       | 4 |         | 5 |         |
| infants who are     |         |         |   |       |   |         |   |         |
| HIV-exposed         |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Diagnosis of        | 1       | 2       | 3 |       | 4 |         | 5 |         |
| infants born to     |         |         |   |       |   |         |   |         |
| mothers who are     |         |         |   |       |   |         |   |         |
| HIV-infected        |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Counselling parents | 1       | 2       | 3 |       | 4 |         | 5 |         |
| about HIV testing   |         |         |   |       |   |         |   |         |
| of infants who are  |         |         |   |       |   |         |   |         |
| HIV-exposed         |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Immunisation        | 1       | 2       |   | 3     |   | 4       |   | 5       |
| schedule for        |         |         |   |       |   |         |   |         |
| infants who are     |         |         |   |       |   |         |   |         |
| HIV-exposed         |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Assessing symptoms  | 1       | 2       |   | 3     |   | 4       |   | 5       |
| in infants who are  |         |         |   |       |   |         |   |         |
| HIV-exposed         |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Psychosocial        | 1       | 2       |   | 3     |   | 4       |   | 5       |
| assessment of       |         |         |   |       |   |         |   |         |
| families affected   |         |         |   |       |   |         |   |         |
| by HIV              |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Psychosocial        | 1       | 2       |   | 3     |   | 4       |   | 5       |
| support for         |         |         |   |       |   |         |   |         |
| families living     |         |         |   |       |   |         |   |         |
| with HIV infection  |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Helping families    | 1       | 2       |   | 3     |   | 4       |   | 5       |
| cope with grief and |         |         |   |       |   |         |   |         |
| loss                |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Helping families    | 1       | 2       |   | 3     |   | 4       |   | 5       |
| cope with chronic   |         |         |   |       |   |         |   |         |
| illness             |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Disclosure of HIV   | 1       | 2       |   | 3     |   | 4       |   | 5       |
| status to family    |         |         |   |       |   |         |   |         |
| and others          |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Community agencies  | 1       | 2       |   | 3     |   | 4       |   | 5       |
| for support         |         |         |   |       |   |         |   |         |
| services            |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Support for         | 1       | 2       |   | 3     |   | 4       |   | 5       |
| healthcare          |         |         |   |       |   |         |   |         |
| providers caring    |         |         |   |       |   |         |   |         |
| for families        |         |         |   |       |   |         |   |         |
| affected by HIV     |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Stigma and          | 1       | 2       |   | 3     |   | 4       |   | 5       |
| discrimination      |         |         |   |       |   |         |   |         |
| related to HIV/AIDS |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| Infection control   | 1       | 2       |   | 3     |   | 4       |   | 5       |
| in the workplace    |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+
| PMTCT programme     | 1       | 2       |   | 3     |   | 4       |   | 5       |
| monitoring          |         |         |   |       |   |         |   |         |
+---------------------+---------+---------+---+-------+---+---------+---+---------+

What are the three areas in which you **most** want training?\
*(Choose from the list above or add your own topics)*

1\.

2\.

3\.

***Thank you for your time!***

**Appendix 3 Generic training package adaptation process**

+--------------------+-------------------------------------------------+
| **Step**           | **Description**                                 |
+--------------------+-------------------------------------------------+
| **Step 1:** Adapt  | -   See Appendix 4 for a listing of the         |
| Generic            |     policies to be added and text that should   |
| Participant        |     be considered for adaptation.               |
| Manual, consult    |                                                 |
| with               | -   Develop policy summaries, if appropriate.   |
| stakeholders.[^3]  |                                                 |
|                    | -   Modify the text of the Participant Manual   |
|                    |     where necessary.                            |
|                    |                                                 |
|                    | -   Consult with stakeholders on the initial    |
|                    |     draft of the adaptation.                    |
+--------------------+-------------------------------------------------+
| **Step 2:** Revise | -   Make the revisions to Participant Manual as |
| adaptation.        |     suggested by the stakeholders.              |
+--------------------+-------------------------------------------------+
| **Step 3:**        | -   Obtain final approval of the Participant    |
| Approve            |     Manual.                                     |
| Participant        |                                                 |
| Manual.            |                                                 |
+--------------------+-------------------------------------------------+
| **Step 4:** Adapt  | -   Adapt the Presentation Booklet, Pocket      |
| clinician support  |     Guide, and Wall Charts. Follow process of   |
| materials.         |     approval as agreed at stakeholders meeting. |
+--------------------+-------------------------------------------------+
| **Step 5:** Adapt  | -   See Appendix 5 for guidance on adapting the |
| Trainer Manual.    |     Trainer Manual.                             |
+--------------------+-------------------------------------------------+
| **Step 6:** Plan   | -   This process can be started while working   |
| initial training   |     on Steps 3--5.                              |
|                    |                                                 |
| course.            |                                                 |
+--------------------+-------------------------------------------------+
| **Step 7:**        | -   Develop the plan to monitor and evaluate    |
| Develop evaluation |     the training effort. This process can be    |
| plan.              |     started while working on Steps 1--6.        |
+--------------------+-------------------------------------------------+
| **Step 8:**        | -   Organise and implement the initial training |
| Implement initial  |     course.                                     |
| training course.   |                                                 |
+--------------------+-------------------------------------------------+
| **Step 9:** Revise | -   Revise as suggested by the evaluation of    |
| national training  |     the initial course.                         |
| curriculum.        |                                                 |
+--------------------+-------------------------------------------------+
| **Step 10:**       | -   Proceed with training strategy on           |
| Implement revised  |     district/state and local level using the    |
| national PMTCT     |     new PMTCT national training curriculum.     |
| curriculum         |                                                 |
|                    | -   Monitor and evaluate training activities.   |
+--------------------+-------------------------------------------------+
| **Step 11:**       | -   Revise the curriculum to include updates in |
| Review training    |     the generic product, lessons learned in the |
| curriculum         |     field, and modifications in national        |
| annually           |     policy.                                     |
+--------------------+-------------------------------------------------+

Appendix 4 Adapting the Participant Manual

The middle column (\"Insert\") is a listing of the national policies
that are recommended for inclusion in a national curriculum. The column
entitled \"Adapt/Revise\" lists the sections of the Generic Participant
Manual that may be considered for editing to ensure the module text
supports national policy.

+-----------------+---------------------------+------------------------+
| **Module**      | **Insert**                | **Adapt/Revise**       |
+-----------------+---------------------------+------------------------+
| **              |                           | After Module 1-9 are   |
| Introduction:** |                           | revised, update the    |
| **Prevention    |                           | following:             |
| of\             |                           |                        |
| Mother-to-Child |                           | -   Table of Contents  |
| Transmission of |                           |                        |
| HIV**           |                           | -   "Abbreviations and |
|                 |                           |     Acronyms" to       |
|                 |                           |     include any        |
|                 |                           |     local/national     |
|                 |                           |     abbreviations;     |
|                 |                           |     delete any that    |
|                 |                           |     were deleted from  |
|                 |                           |     the text           |
|                 |                           |                        |
|                 |                           | -   "Course syllabus   |
|                 |                           |     for PMTCT Generic  |
|                 |                           |     Training Package"  |
+-----------------+---------------------------+------------------------+
| 1: Introduction | **Session 1**             | **Session 2**          |
| to HIV/AIDS     |                           |                        |
|                 | -   Brief summary of      | -   "Natural history   |
|                 |                           |     (or course) of HIV |
|                 |   local/national/regional |     infection"         |
|                 |     epidemiology of HIV   |     section: ensure    |
|                 |                           |     technical          |
|                 | -   If available, a graph |     information in     |
|                 |     illustrating HIV      |     "Seroconversion"   |
|                 |     prevalence among      |     corresponds with   |
|                 |     pregnant women at     |     information in     |
|                 |     antenatal clinics (a  |     national           |
|                 |     local variation on    |     policies/guidance  |
|                 |     Figure 1.2)           |                        |
|                 |                           | -   "Staging systems   |
|                 |                           |     for HIV" note      |
|                 |                           |     which of the two   |
|                 |                           |     (WHO or CDC) is    |
|                 |                           |     used more often    |
+-----------------+---------------------------+------------------------+
| 2: Overview of  | **Session 3**             | Session 3              |
| HIV Prevention  |                           |                        |
| in Mothers,     | -   Element 3: Prevention | -   "Element 4:        |
| Infants, and    |     of HIV transmission   |     Provision of       |
| Young Children  |     from women infected   |     treatment, care,   |
|                 |     with HIV to their     |     and support to     |
|                 |     infants               |     women infected     |
|                 |                           |     with HIV, their    |
|                 | ```{=html}                |     infants, and their |
|                 | <!-- -->                  |     families"          |
|                 | ```                       |                        |
|                 | -                         | ```{=html}             |
|                 |   Local/national/regional | <!-- -->               |
|                 |     summary of            | ```                    |
|                 |     epidemiology of MTCT  | -   Summary of         |
|                 |                           |     services available |
|                 | -   Brief introduction to |     locally            |
|                 |     local/national PMTCT  |                        |
|                 |     policy and programme  |                        |
|                 |     including PMTCT       |                        |
|                 |     targets               |                        |
|                 |                           |                        |
|                 | ```{=html}                |                        |
|                 | <!-- -->                  |                        |
|                 | ```                       |                        |
|                 | -   Element 4: Provision  |                        |
|                 |     of treatment, care,   |                        |
|                 |     and support to women  |                        |
|                 |     infected with HIV,    |                        |
|                 |     their infants, and    |                        |
|                 |     their families        |                        |
|                 |                           |                        |
|                 | ```{=html}                |                        |
|                 | <!-- -->                  |                        |
|                 | ```                       |                        |
|                 | -   Local/national        |                        |
|                 |     PMTCT-Plus targets    |                        |
|                 |                           |                        |
|                 |     **Appendices**        |                        |
|                 |                           |                        |
|                 | ```{=html}                |                        |
|                 | <!-- -->                  |                        |
|                 | ```                       |                        |
|                 | -   Appendices: copies of |                        |
|                 |     patient brochures on  |                        |
|                 |     personal risk         |                        |
|                 |     reduction strategies  |                        |
|                 |     (if available)        |                        |
+-----------------+---------------------------+------------------------+

*Appendix 4 Adapting the Participant Manual* continued

+----------------+--------------------------+--------------------------+
| **Module**     | **Insert**               | **Adapt/Revise**         |
+----------------+--------------------------+--------------------------+
| 3: Specific    | Session 1                | Session 1                |
| Interventions  |                          |                          |
| to Prevent     | -   National             | -   Review entire        |
| MTCT           |     policy/guidelines on |     session to ensure    |
|                |     antiretroviral       |     compatibility with   |
|                |     treatment and        |     national             |
|                |     prophylaxis for the  |     policy/guidance      |
|                |     prevention of MTCT   |                          |
|                |     (PMTCT)              | Session 2                |
|                |                          |                          |
|                | Session 2                | -   "Preventing          |
|                |                          |     opportunistic        |
|                | -   National guidelines  |     infections" add any  |
|                |     on ANC               |     common opportunistic |
|                |     care/management of   |     infections that      |
|                |     HIV-infected women   |     cause adverse        |
|                |     and women with       |     outcomes in pregnant |
|                |     unknown status       |     women                |
|                |                          |                          |
|                | -   ANC/PMTCT            | -   "Recurrent or        |
|                |     confidentiality      |     chronic infection"   |
|                |     policy, policy on    |     add any other common |
|                |     recording HIV status |     infections that are  |
|                |     in patient's medical |     not already included |
|                |     record (if not in    |     in the listing of    |
|                |     above)               |     examples             |
|                |                          |                          |
|                | Session 3                | -   Table 3.1 "Essential |
|                |                          |     Package of           |
|                | -   National policy on   |     Integrated Antenatal |
|                |     management of labour |     Care Services" to    |
|                |     and delivery of      |     reflect the ideal    |
|                |     women infected with  |     package of care for  |
|                |     HIV and women with   |     ANC patients         |
|                |     unknown HIV status   |                          |
|                |                          | Session 3                |
|                | -   National policy on   |                          |
|                |     testing and          | -   "Considerations      |
|                |     counselling in       |     Regarding Mode of    |
|                |     labour               |     Delivery" to reflect |
|                |                          |     national policy on   |
|                | Session 4                |     vaginal delivery     |
|                |                          |     versus elective      |
|                | -   National guidelines  |     cesarean section     |
|                |     on immediate         |                          |
|                |     postpartum care of   | -   "Strategies to       |
|                |     women who are        |     reduce MTCT risk in  |
|                |     HIV-infected and     |     women with unknown   |
|                |     women with unknown   |     HIV status"          |
|                |     HIV status           |     including "Testing   |
|                |                          |     and counselling      |
|                | Session 5                |     during labour" and   |
|                |                          |     "Providing ARV       |
|                | -   National guidelines  |     prophylaxis without  |
|                |     on immediate newborn |     testing" to reflect  |
|                |     care of infants who  |     national policies    |
|                |     are HIV-exposed and  |                          |
|                |     infants with unknown |                          |
|                |     HIV status           |                          |
+----------------+--------------------------+--------------------------+
| 4: Infant      | Session 2                | Session 2                |
| Feeding in the |                          |                          |
| Context of HIV | -   National HIV         | -   "Feeding Options     |
| Infection      |     infant-feeding       |     During the First 6   |
|                |     policy and           |     Months" Revise this  |
|                |     recommendations      |     entire session to    |
|                |                          |     reflect the          |
|                | Session 3                |     infant-feeding       |
|                |                          |     options covered in   |
|                | -   National guidelines  |     national policy      |
|                |     on infant-feeding    |     (delete options that |
|                |     counselling and      |     are not appropriate  |
|                |     support              |     or practised)        |
|                |                          |                          |
|                |                          | -   "Table 4.1           |
|                |                          |     Commercial infant    |
|                |                          |     formula" cost of     |
|                |                          |     Commercial Infant    |
|                |                          |     Formula (if          |
|                |                          |     applicable)          |
|                |                          |                          |
|                |                          | -   "Option2:            |
|                |                          |     Home-modified animal |
|                |                          |     milk" cost of        |
|                |                          |     micronutrient        |
|                |                          |     supplements and      |
|                |                          |     sugar (if            |
|                |                          |     applicable)          |
|                |                          |                          |
|                |                          | Appendices               |
|                |                          |                          |
|                |                          | -   "Appendix 4-C        |
|                |                          |     Complementary        |
|                |                          |     feeding from 6--24   |
|                |                          |     months" to reflect   |
|                |                          |     local guidelines,    |
|                |                          |     customs and foods    |
+----------------+--------------------------+--------------------------+

Appendix 4 Adapting the Participant Manual *continued*

+----------------+--------------------------+-------------------------+
| **Module**     | **Insert**               | **Adapt/Revise**        |
+================+==========================+=========================+
| 5: Stigma and  | Session 1                | Session 2               |
| Discrimination |                          |                         |
| Related to     | -   National policies on | -   "Examples of        |
| MTCT           |     discrimination,      |     stigmatisation and  |
|                |     equal rights, and    |     discrimination" to  |
|                |     human rights         |     include local       |
|                |     relevant to people   |     examples            |
|                |     with HIV             |                         |
|                |                          | Session 3               |
|                | -   Local or national    |                         |
|                |     policies regarding   | -   "Dealing with       |
|                |     patient rights       |     Stigma and          |
|                |     within PMTCT and ANC |     Discrimination in   |
|                |     services             |     Healthcare Settings |
|                |                          |     and Communities"    |
|                |                          |     (entire session) to |
|                |                          |     include relevant    |
|                |                          |     national, local,    |
|                |                          |     site-specific or    |
|                |                          |     individual          |
|                |                          |     interventions to    |
|                |                          |     address             |
|                |                          |     HIV/AIDS-related    |
|                |                          |     stigma              |
+----------------+--------------------------+-------------------------+
| 6: HIV Testing | Session 1                | Session 2               |
| & Counselling  |                          |                         |
| for PMTCT      | -   National HIV testing | -   "HIV Testing"       |
|                |     policy               |     (entire session) to |
|                |                          |     reflect the tests   |
|                | -   National             |     used                |
|                |     confidentiality      |                         |
|                |     policy               | -   "All testing        |
|                |                          |     follows the same    |
|                | -   National policy on   |     basic steps:"       |
|                |     opt-in vs. opt-out,  |     (under "Overview of |
|                |     informed consent &   |     HIV testing") to    |
|                |     disclosure           |     ensure that the     |
|                |     recommendations (if  |     guidance on "window |
|                |     not included in      |     period" agrees with |
|                |     above)               |     national local      |
|                |                          |     guidance.           |
|                | Session 2                |                         |
|                |                          | Session 3               |
|                | -   Algorithm for HIV    |                         |
|                |     testing (eg, rapid   | -   "Pre-Test           |
|                |     test and/or ELISA)   |     Information and     |
|                |                          |     Counselling"        |
|                | -   Policy on diagnostic |     (entire session) to |
|                |     testing of the       |     reflect national    |
|                |     infant exposed to    |     guidelines          |
|                |     HIV, including HIV   |                         |
|                |     antibody or viral    | Session 4               |
|                |     testing              |                         |
|                |                          | -   "Post-Test          |
|                | -   Algorithm(s) for     |     Information and     |
|                |     diagnosing HIV       |     Counselling"        |
|                |     infection in an      |     (entire session) to |
|                |     infant born to a     |     reflect national    |
|                |     mother with HIV      |     guidelines          |
|                |                          |                         |
|                | Session 3                | Appendices              |
|                |                          |                         |
|                | -   National pre-test    | -   "Appendix 6-E       |
|                |     Information and      |     Post-test           |
|                |     counselling policies |     counselling         |
|                |     or guidance          |     checklist,          |
|                |                          |     HIV-negative        |
|                | Session 4                |     result" to reflect  |
|                |                          |     national guidelines |
|                | -   National post-test   |                         |
|                |     counselling policies | -   "Appendix 6-F       |
|                |     or guidance for both |     Post-test           |
|                |     women who test       |     counselling         |
|                |     HIV-positive and     |     checklist,          |
|                |     women who test       |     HIV-positive        |
|                |     HIV-negative         |     result" to reflect  |
|                |                          |     national guidelines |
+----------------+--------------------------+-------------------------+

Appendix 4 Adapting the Participant Manual *continued*

+----------------+--------------------------+-------------------------+
| **Module**     | **Insert**               | **Adapt/Revise**        |
+----------------+--------------------------+-------------------------+
| 7: Linkages to | Session 1                | Session 2               |
| Treatment,     |                          |                         |
| Care, and      | -   Listing of local     | -   "Treatment, Care,   |
| Support for    |     agencies providing   |     and Support of the  |
| Mothers and    |     clinical and social  |     Mother with HIV     |
| Families with  |     support services for |     Infection" (entire  |
| HIV Infection  |     mothers and families |     Session) to reflect |
|                |     with HIV             |     local/national      |
|                |                          |     follow-up           |
|                | Session 2                |     guidelines and      |
|                |                          |     services for the    |
|                | -   Guidelines on        |     mother with HIV     |
|                |     postpartum care of   |                         |
|                |     the mother with HIV  | Session 3               |
|                |     Infection            |                         |
|                |                          | -   "Treatment, Care,   |
|                | -   Guidelines on        |     and Support of the  |
|                |     prevention and       |     Infant and Young    |
|                |     treatment of         |     Child Exposed to    |
|                |     opportunistic        |     HIV" (entire        |
|                |     infections such as   |     session) to reflect |
|                |     PCP and TB           |     national guidelines |
|                |                          |     and services for    |
|                | -   National guidelines  |     infants and young   |
|                |     on HIV care and      |     children            |
|                |     treatment for        |                         |
|                |     adults, including    | Appendices              |
|                |     ARV treatment        |                         |
|                |                          | -   Appendix 7-A        |
|                | -   Any other national   |     "Tuberculosis (TB)" |
|                |     guidelines on        |     with local          |
|                |     treatment of         |     recommen-dations    |
|                |     symptoms and         |     for prevention and  |
|                |     palliative care,     |     treatment of TB     |
|                |     nutritional support, |                         |
|                |     and social and       | -   Appendix 7-C        |
|                |     psychosocial support |     "*Pneumocystis      |
|                |     (if not included in  |     carinii* pneumonia  |
|                |     above)               |     prophylaxis in      |
|                |                          |     adults and infants" |
|                | Session 3                |     with national       |
|                |                          |     guidelines for PCP  |
|                | -   Guidelines for       |     prophylaxis in      |
|                |     follow-up visits and |     adults and infants  |
|                |     immunisation         |                         |
|                |     schedule for the     | -   Appendix 7-D        |
|                |     infant/child exposed |     "Suggestions to     |
|                |     to HIV               |     maximise food       |
|                |                          |     intake" review the  |
|                | -   Clinical guidelines  |     "Suggested          |
|                |     on the care and      |     Strategies" to      |
|                |     treatment, including |     ensure they reflect |
|                |     ARV treatment, of    |     locally available   |
|                |     infants/children who |     and acceptable      |
|                |     are HIV-exposed or   |     foods               |
|                |     HIV-infected         |                         |
+----------------+--------------------------+-------------------------+
| 8: Safety and  | Session 1                | Session 1               |
| Supportive     |                          |                         |
| Care in the    | -   National guidelines, | -   "Universal          |
| Work           |     policies, standards  |     precautions" to     |
| Environment    |     of procedure on      |     reflect national    |
|                |     Universal            |     guidel              |
|                |     Precautions in       | ines/policies/standards |
|                |     MCH/ANC settings     |     of procedure        |
|                |                          |                         |
|                | Session 2                | Session 2               |
|                |                          |                         |
|                | -   National guidelines, | -   "When it is         |
|                |     policies, standards  |     necessary to recap, |
|                |     of procedure on      |     use the             |
|                |     handling and         |     single-handed       |
|                |     decontamination of   |     scooping method:"   |
|                |     equipment and        |     and "One-handed     |
|                |     materials if not     |     recap method:"      |
|                |     included previously  |     delete these        |
|                |     in Session 1         |     sections including  |
|                |                          |     diagrams if         |
|                | -   National policy on   |     recapping is NEVER  |
|                |     risk reduction in    |     practised           |
|                |     the obstetric        |                         |
|                |     setting              | -   "Sharps containers" |
|                |                          |     to reflect national |
|                |                          |     guidelines/         |
|                |                          |     policies/standards  |
+----------------+--------------------------+-------------------------+

+----------------+-----------------------+----------------------------+
| Appendix 4     |                       |                            |
| Adapting the   |                       |                            |
| Participant    |                       |                            |
| Manual         |                       |                            |
| *continued*    |                       |                            |
+----------------+-----------------------+----------------------------+
| Module         | Insert                | Adapt/Revise               |
+----------------+-----------------------+----------------------------+
| 8: Safety and  |                       | Session 2 *continued*      |
| Supportive     |                       |                            |
| Care in the    |                       | -   "Personal protective   |
| Work           |                       |     equipment",            |
| Environment\   |                       |     "Decontamination of    |
| *continued*    |                       |     equipment", "Safe work |
|                |                       |     practices" and "Risk   |
|                |                       |     reduction in the       |
|                |                       |     obstetric setting" to  |
|                |                       |     reflect national       |
|                |                       |     guidelines and         |
|                |                       |     practices              |
|                |                       |                            |
|                |                       | Session 3                  |
|                |                       |                            |
|                |                       | -   "Post-exposure         |
|                |                       |     prophylaxis" and       |
|                |                       |     "Guidelines for        |
|                |                       |     providing PEP" to      |
|                |                       |     reflect local/national |
|                |                       |     policy. If a PEP       |
|                |                       |     policy does not exist  |
|                |                       |     either locally or      |
|                |                       |     nationally, consider   |
|                |                       |     deleting or revising   |
|                |                       |     this session.          |
|                |                       |                            |
|                |                       | Session 4                  |
|                |                       |                            |
|                |                       | -   "Signs & symptoms of   |
|                |                       |     burnout" and "Tips for |
|                |                       |     managing burnout" to   |
|                |                       |     reflect local risks    |
|                |                       |     and local tips to      |
|                |                       |     prevent burnout        |
|                |                       |                            |
|                |                       | Appendices                 |
|                |                       |                            |
|                |                       | -   "Appendix 8-A          |
|                |                       |     Guidelines for         |
|                |                       |     cleaning,              |
|                |                       |     sterilisation, and     |
|                |                       |     disposal of infectious |
|                |                       |     waste materials" to    |
|                |                       |     reflect local/national |
|                |                       |     policy                 |
|                |                       |                            |
|                |                       | -   "Appendix 8-B Managing |
|                |                       |     occupational exposure  |
|                |                       |     to HIV" to reflect     |
|                |                       |     local/national policy  |
+----------------+-----------------------+----------------------------+
| 9: PMTCT       | Session 2             | Session 3                  |
| Programme      |                       |                            |
| Monitoring     | -   National          | -   Table 9.1 "Flow of     |
|                |     indicators for    |     Record Keeping Data"   |
|                |     PMTCT programmes  |     to reflect national    |
|                |                       |     flow of data           |
|                | -   Health Facility   |                            |
|                |     indicators for    | Appendices                 |
|                |     PMTCT programmes  |                            |
|                |                       | -   Replace or revise      |
|                | Appendices            |     Appendix 9-B "Sample   |
|                |                       |     PMTCT Columns to Add   |
|                | -   Full set of forms |     to Standard ANC and    |
|                |     used in the PMTCT |     Maternity Ward         |
|                |     programme         |     Registers" to reflect  |
|                |                       |     local forms            |
+----------------+-----------------------+----------------------------+
| Field Visit    |                       | -   "Timing and objectives |
|                |                       |     of field visit" to     |
|                |                       |     reflect                |
|                |                       |     locally/nationally     |
|                |                       |     agreed objectives      |
|                |                       |                            |
|                |                       | -   "Field visit interview |
|                |                       |     guide" to reflect      |
|                |                       |     locally/nationally     |
|                |                       |     agreed objectives      |
+----------------+-----------------------+----------------------------+
| Glossary       | -   Any key           | -   Revise definitions or  |
|                |     terminology added |     spelling as            |
|                |     to text           |     appropriate            |
+----------------+-----------------------+----------------------------+
| Resources      | -   National/local    | -   Add national/local     |
|                |     resources         |     resources as           |
|                |                       |     appropriate            |
+----------------+-----------------------+----------------------------+

Appendix 5 Adapting the Trainer Manual

Include all the insertions, adaptations, revisions from the Participant
Manual. In addition, consider the cultural relevance and appropriateness
of the following exercises.

+-----------------+----------------------------------------------------+
| **Module**      | **Adapt/Revise**                                   |
+=================+====================================================+
| Course Overview | **Introduction Exercise 2 Determining the ground   |
| and             | rules for the course**                             |
| Introduction    |                                                    |
|                 | -   Consider any other ground rules that may be    |
|                 |     necessary                                      |
+-----------------+----------------------------------------------------+
| 1: Introduction | **Exercise 1.2 HIV 1, 2, 3 Knowledge interactive   |
| to HIV/AIDS     | game**                                             |
|                 |                                                    |
|                 | -   Review for difficulty level and adjust         |
|                 |     questions if necessary                         |
+-----------------+----------------------------------------------------+
| 2: Overview of  | **Exercise 2.2 Local terminology: interactive      |
| HIV Prevention  | discussion**                                       |
| in Mothers,     |                                                    |
| Infants, and    | -   Ask colleagues working in the HIV prevention   |
| Young Children  |     and care field to tell you the local terms and |
|                 |     phrases used to discuss sex, STIs, HIV         |
|                 |     disease, or condoms.                           |
+-----------------+----------------------------------------------------+
| 3: Specific     | **Exercise 3.1 Antenatal care: case studies**      |
| Interventions   |                                                    |
| to Prevent MTCT | **Exercise 3.2 Labour and delivery ARV             |
|                 | prophylaxis: case studies**                        |
|                 |                                                    |
|                 | **Exercise 3.3 Immediate postpartum care of women  |
|                 | who are\                                           |
|                 | HIV-infected and women with unknown HIV status:    |
|                 | case studies**                                     |
|                 |                                                    |
|                 | **Exercise 3.4 Immediate postnatal care of infants |
|                 | who are\                                           |
|                 | HIV-exposed: case studies**                        |
|                 |                                                    |
|                 | -   Discuss all case studies with local            |
|                 |     clinicians. Adapt the circumstances, names and |
|                 |     ages of the characters and debriefing          |
|                 |     questions to reflect local situations and      |
|                 |     issues. Add or drop scenarios to make them     |
|                 |     more locally appropriate.                      |
+-----------------+----------------------------------------------------+
| 4: Infant       | **Exercise 4.2 National and local policies on      |
| Feeding in the  | infant feeding: large group discussion**           |
| Context of HIV  |                                                    |
| Infection       | -   Discuss with local PMTCT staff the degree to   |
|                 |     which national infant-feeding policies or      |
|                 |     protocols are reflected in current feeding     |
|                 |     practices.                                     |
|                 |                                                    |
|                 |     **Exercise 4.3 Infant-feeding counselling and  |
|                 |     support: role play**                           |
|                 |                                                    |
|                 | -   Discuss all role plays with local clinicians.  |
|                 |     Adapt the circumstances and names to reflect   |
|                 |     local situations and issues. Add or drop roles |
|                 |     to make them more locally appropriate.         |
+-----------------+----------------------------------------------------+
| 5: Stigma and   | **Exercise 5.1 Labels: interactive game**          |
| Discrimination  |                                                    |
| Related to MTCT | -   Consider the "Labels" as listed in the         |
|                 |     "Advance Preparation" section for Session 1;   |
|                 |     modify as appropriate. Choose labels of groups |
|                 |     that are subject to HIV-related stigma and     |
|                 |     discrimination.                                |
|                 |                                                    |
|                 |     **Exercise 5.2 Examples of stigma and          |
|                 |     discrimination: large-group discussion**       |
|                 |                                                    |
|                 | -   Ask local PLWHA for examples of stigma and     |
|                 |     discrimination that they have heard or         |
|                 |     witnessed. Find out from local PMTCT facility  |
|                 |     managers the policies and procedures that are  |
|                 |     in place to protect staff and patients from    |
|                 |     discrimination.                                |
|                 |                                                    |
|                 |     **Alternative Exercise 5.3 Stigma and          |
|                 |     discrimination: case study**                   |
|                 |                                                    |
|                 | -   Similar to the case studies in Module 3, if    |
|                 |     using the alternative Exercise 5.3, review the |
|                 |     case with local clinicians. Adapt the          |
|                 |     circumstances, names and ages of the           |
|                 |     characters and debriefing questions to reflect |
|                 |     local situations and issues. Add or drop       |
|                 |     scenarios to make them more locally            |
|                 |     appropriate.                                   |
+-----------------+----------------------------------------------------+

Appendix 5 Adapting the Trainer Manual *continued*

+-----------------+----------------------------------------------------+
| **Module**      | **Adapt/Revise**                                   |
+=================+====================================================+
| 6: HIV Testing  | **Exercise 6.1 Confidentiality role play**         |
| and Counselling |                                                    |
| for PMTCT       | -   Ask clinicians for ideas to make the role-play |
|                 |     appropriate and find out about adherence to    |
|                 |     local confidentiality policies. Adapt the      |
|                 |     situation and names to make it relevant to     |
|                 |     participants.                                  |
|                 |                                                    |
|                 |     **Exercise 6.4 Post-test counselling: small    |
|                 |     group role play**                              |
|                 |                                                    |
|                 | -   Ask clinicians to ensure that the scenarios    |
|                 |     for HIV-negative and HIV-positive test results |
|                 |     are typical of your area; edit the situations, |
|                 |     names and ages or add/drop scenarios as        |
|                 |     necessary.                                     |
+-----------------+----------------------------------------------------+
| 7: Linkages to  | **Exercise 7.2 Postpartum case study**             |
| Treatment,      |                                                    |
| Care, and       | -   Ask clinicians to ensure the scenarios are     |
| Support for     |     typical of your area. Adapt the scenario, name |
| Mothers and     |     and age of the main character as well as the   |
| Families with   |     debriefing questions to reflect local          |
| HIV Infection   |     situations and issues.                         |
|                 |                                                    |
|                 |     **Exercise 7.3 Clinical presentation of HIV in |
|                 |     infants**                                      |
|                 |                                                    |
|                 | -   Ask paediatric HIV clinicians about the common |
|                 |     presentation of HIV in infants and young       |
|                 |     children.                                      |
+-----------------+----------------------------------------------------+
| 8: Safety and   | **Exercise 8.1 Reducing HIV transmission risk in   |
| Supportive Care | MCH settings: case study**                         |
| in the Work     |                                                    |
| Environment     | -   Edit the scenario, name and description of     |
|                 |     care provided to reflect local situations and  |
|                 |     guidelines.                                    |
|                 |                                                    |
|                 |     **Exercise 8.2 Promoting a safe work           |
|                 |     environment resource list: group discussion**  |
|                 |                                                    |
|                 | -   Liaise with a local control of infection nurse |
|                 |     to find out if the resource list is            |
|                 |     appropriate; find out safe ways to be flexible |
|                 |     in the extraordinary situations or in          |
|                 |     situations where some equipment or materials   |
|                 |     are not available.                             |
|                 |                                                    |
|                 |     **Exercise 8.3 PEP case study: small-group     |
|                 |     discussion**                                   |
|                 |                                                    |
|                 | -   Ask clinicians to ensure scenario is typical   |
|                 |     of your area. Adapt the scenario, name and the |
|                 |     debriefing questions.                          |
|                 |                                                    |
|                 |     **Exercise 8.4 Compassion fatigue/burnout in   |
|                 |     PMTCT programmes: large group discussion**     |
|                 |                                                    |
|                 | -   Discuss compassion fatigue/burnout with local  |
|                 |     clinicians working in the HIV field. If they   |
|                 |     don't recognize it, then describe the symptoms |
|                 |     and enquire if they have seen these            |
|                 |     signs/symptoms in themselves, staff or         |
|                 |     colleagues. Find out a bit more about how      |
|                 |     compassion fatigue presents and how it is      |
|                 |     being managed.                                 |
+-----------------+----------------------------------------------------+
| 9: PMTCT        | **Exercise 9.1 Understanding indicator             |
| Programme       | requirements: small group discussion**             |
| Monitoring      |                                                    |
|                 | -   Ask a PMTCT facility supervisor if the         |
|                 |     scenario is typical. Adapt the scenario, name  |
|                 |     and the debriefing questions to reflect local  |
|                 |     and national monitoring requirements and       |
|                 |     practices.                                     |
|                 |                                                    |
|                 |     **Exercise 9.2 Using indicators: small group   |
|                 |     discussion**                                   |
|                 |                                                    |
|                 | -   Talk with national PMTCT Coordinator to obtain |
|                 |     information on the number and percentage of    |
|                 |     pregnant women receiving ARV                   |
|                 |     treatment/prophylaxis. If the information on   |
|                 |     treatment/prophylaxis is available, choose an  |
|                 |     indicator targeted for reporting/improvement   |
|                 |     and change the scenario accordingly.           |
|                 |                                                    |
|                 |     **Exercise 9.3 Completing local PMTCT forms    |
|                 |     (optional)**                                   |
|                 |                                                    |
|                 | -   Have available local PMTCT Forms to present to |
|                 |     trainees. Consider inviting PMTCT coordinator  |
|                 |     to discuss how the forms are completed.        |
+-----------------+----------------------------------------------------+

Appendix 6 Course Director checklists

Activity Checklist

+--------+---+-------------------------------------------------------------+
| Ac     |   |                                                             |
| tivity |   |                                                             |
| chec   |   |                                                             |
| klist: |   |                                                             |
| Course |   |                                                             |
| Di     |   |                                                             |
| rector |   |                                                             |
| orien  |   |                                                             |
| tation |   |                                                             |
| (      |   |                                                             |
| before |   |                                                             |
| the    |   |                                                             |
| first  |   |                                                             |
| c      |   |                                                             |
| ourse) |   |                                                             |
+--------+---+-------------------------------------------------------------+
|  when |   | **Activity**                                                |
| co     |   |                                                             |
| mplete |   |                                                             |
+--------+---+-------------------------------------------------------------+
|        |   | Familiarise yourself with national PMTCT Strategy.          |
+--------+---+-------------------------------------------------------------+
|        |   | Familiarise yourself with national PMTCT//HIV Training      |
|        |   | Plan.                                                       |
+--------+---+-------------------------------------------------------------+
|        |   | Familiarise yourself with the PMTCT generic training        |
|        |   | package and all of its components.                          |
+--------+---+-------------------------------------------------------------+
|        |   | Familiarise yourself with the Evaluation Plan and           |
|        |   | materials.                                                  |
+--------+---+-------------------------------------------------------------+
|        |   | Participate in local activities around package adaptation.  |
+--------+---+-------------------------------------------------------------+
|        |   | Assess if Participant Manual is expected to be adapted      |
|        |   | locally or if the adaptation process was completed at a     |
|        |   | national level.                                             |
+--------+---+-------------------------------------------------------------+
|        |   | Liaise with local PMTCT clinicians, HIV providers, PLWHA    |
|        |   | and others to make any necessary adaptations to the         |
|        |   | exercises in the Trainer Manual.                            |
+--------+---+-------------------------------------------------------------+
|        |   | Liaise with local PMTCT clinic managers/supervisors to      |
|        |   | promote training and ensure that your training supports     |
|        |   | their clinical work.                                        |
+--------+---+-------------------------------------------------------------+
|        |   | Verify local training budget.                               |
+--------+---+-------------------------------------------------------------+
| ####   |   |                                                             |
|  Activ |   |                                                             |
| ity ch |   |                                                             |
| ecklis |   |                                                             |
| t: bef |   |                                                             |
| ore ea |   |                                                             |
| ch tra |   |                                                             |
| ining  |   |                                                             |
| course |   |                                                             |
+--------+---+-------------------------------------------------------------+
|  when | # |                                                             |
| co     | # |                                                             |
| mplete | # |                                                             |
|        | # |                                                             |
|        | # |                                                             |
|        | # |                                                             |
|        | # |                                                             |
|        | # |                                                             |
|        | # |                                                             |
|        |   |                                                             |
|        | A |                                                             |
|        | c |                                                             |
|        | t |                                                             |
|        | i |                                                             |
|        | v |                                                             |
|        | i |                                                             |
|        | t |                                                             |
|        | y |                                                             |
+--------+---+-------------------------------------------------------------+
|        | V |                                                             |
|        | e |                                                             |
|        | r |                                                             |
|        | i |                                                             |
|        | f |                                                             |
|        | y |                                                             |
|        | b |                                                             |
|        | u |                                                             |
|        | d |                                                             |
|        | g |                                                             |
|        | e |                                                             |
|        | t |                                                             |
|        | f |                                                             |
|        | o |                                                             |
|        | r |                                                             |
|        | t |                                                             |
|        | h |                                                             |
|        | i |                                                             |
|        | s |                                                             |
|        | t |                                                             |
|        | r |                                                             |
|        | a |                                                             |
|        | i |                                                             |
|        | n |                                                             |
|        | i |                                                             |
|        | n |                                                             |
|        | g |                                                             |
|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
|        | F |                                                             |
|        | i |                                                             |
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|        | l |                                                             |
|        | i |                                                             |
|        | s |                                                             |
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|        | b |                                                             |
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|        | s |                                                             |
|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
|        | F |                                                             |
|        | i |                                                             |
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|        | l |                                                             |
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|        | m |                                                             |
|        | e |                                                             |
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|        | s |                                                             |
|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
|        | F |                                                             |
|        | i |                                                             |
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|        | l |                                                             |
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|        | s |                                                             |
|        | t |                                                             |
|        | s |                                                             |
|        | / |                                                             |
|        | g |                                                             |
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|        | s |                                                             |
|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
|        | I |                                                             |
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|        | s |                                                             |
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|        | s |                                                             |
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|        | c |                                                             |
|        | h |                                                             |
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|        | c |                                                             |
|        | k |                                                             |
|        | l |                                                             |
|        | i |                                                             |
|        | s |                                                             |
|        | t |                                                             |
|        | . |                                                             |
|        | ) |                                                             |
+--------+---+-------------------------------------------------------------+
|        | I |                                                             |
|        | f |                                                             |
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|        | o |                                                             |
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|        | r |                                                             |
|        | s |                                                             |
|        | e |                                                             |
|        | i |                                                             |
|        | s |                                                             |
|        | r |                                                             |
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
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|        | a |                                                             |
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+--------+---+-------------------------------------------------------------+
|        | S |                                                             |
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|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
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|        | a |                                                             |
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|        | d |                                                             |
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+--------+---+-------------------------------------------------------------+
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+--------+---+-------------------------------------------------------------+
|        | S |                                                             |
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|        | b |                                                             |
|        | a |                                                             |
|        | s |                                                             |
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|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
|        | C |                                                             |
|        | o |                                                             |
|        | n |                                                             |
|        | f |                                                             |
|        | i |                                                             |
|        | r |                                                             |
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|        | T |                                                             |
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|        | a |                                                             |
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|        | r |                                                             |
|        | P |                                                             |
|        | r |                                                             |
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|        | p |                                                             |
|        | a |                                                             |
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|        | a |                                                             |
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|        | o |                                                             |
|        | n |                                                             |
|        | D |                                                             |
|        | a |                                                             |
|        | y |                                                             |
|        | s |                                                             |
|        | . |                                                             |
+--------+---+-------------------------------------------------------------+
|        | A |                                                             |
|        | r |                                                             |
|        | r |                                                             |
|        | a |                                                             |
|        | n |                                                             |
|        | g |                                                             |
|        | e |                                                             |
|        | f |                                                             |
|        | o |                                                             |
|        | r |                                                             |
|        | f |                                                             |
|        | o |                                                             |
|        | o |                                                             |
|        | d |                                                             |
|        | f |                                                             |
|        | o |                                                             |
|        | r |                                                             |
|        | t |                                                             |
|        | r |                                                             |
|        | a |                                                             |
|        | i |                                                             |
|        | n |                                                             |
|        | i |                                                             |
|        | n |                                                             |
|        | g |                                                             |
|        | a |                                                             |
|        | n |                                                             |
|        | d |                                                             |
|        | T |                                                             |
|        | r |                                                             |
|        | a |                                                             |
|        | i |                                                             |
|        | n |                                                             |
|        | e |                                                             |
|        | r |                                                             |
|        | P |                                                             |
|        | r |                                                             |
|        | e |                                                             |
|        | p |                                                             |
|        | a |                                                             |
|        | r |                                                             |
|        | a |                                                             |
|        | t |                                                             |
|        | i |                                                             |
|        | o |                                                             |
|        | n |                                                             |
|        | D |                                                             |
|        | a |                                                             |
|        | y |                                                             |
|        | s |                                                             |
|        | . |                                                             |
+--------+---+-------------------------------------------------------------+

Appendix 6 Course Director checklists *continued*

  ------------ -------------------------------------------------------------
  **Activity   
  checklist:   
  before each  
  training     
  course**     

   when       **Activity**
  complete     

               Conduct Trainer Preparation Days.

               Identify and confirm availability of equipment for training
               (projector, extension cords/leads and flipchart and/or
               white/black board).

               Purchase or identify materials for training, see "Equipment
               and Supplies Checklist" below for a comprehensive list.

               Ensure copies of evaluation materials are ready.

               Prepare certificates of course completion.

               Make name tags (optional, alternatively have participants
               write out their own name tags at the beginning of the opening
               ceremony).

               Identify staff to check-in participants on first day of
               training.

               A day or two before the training, check on training room,
               ensure room will be appropriately set up for the Opening
               Ceremony.
  ------------ -------------------------------------------------------------

+--------+-------------------------------------------------------------+
| **Ac   |                                                             |
| tivity |                                                             |
| chec   |                                                             |
| klist: |                                                             |
| site   |                                                             |
| pl     |                                                             |
| anning |                                                             |
| check  |                                                             |
| list** |                                                             |
+--------+-------------------------------------------------------------+
| **    | **Activity**                                                |
| when   |                                                             |
| comp   |                                                             |
| lete** |                                                             |
+--------+-------------------------------------------------------------+
|        | Identify sites for both the Training Preparation Days and   |
|        | the PMTCT Training Course, confirm dates of availability.   |
+--------+-------------------------------------------------------------+
|        | Obtain written directions for those walking, driving or     |
|        | taking public transportation to training site.              |
+--------+-------------------------------------------------------------+
|        | Enquire about car parking, including cost.                  |
+--------+-------------------------------------------------------------+
|        | Enquire about access for disabled participants.             |
+--------+-------------------------------------------------------------+
|        | Obtain cost estimates for food/refreshments.                |
|        |                                                             |
|        | -   Menu and cost of breakfast/lunch                        |
|        |                                                             |
|        | -   Refreshments (mid-morning or mid-afternoon snack,       |
|        |     coffee/tea, water)                                      |
|        |                                                             |
|        | -   How cost of food will be billed                         |
|        |                                                             |
|        | -   If outside catering can be brought into site            |
+--------+-------------------------------------------------------------+
|        | Choose a vendor for food and refreshments.                  |
+--------+-------------------------------------------------------------+
|        | Obtain extra table to register participants on first day.   |
+--------+-------------------------------------------------------------+
|        | Obtain cost estimates for renting training equipment such   |
|        | as projector and flipchart and whether equipment can be     |
|        | brought in for the training days.                           |
+--------+-------------------------------------------------------------+
|        | Finalise arrangements for equipment.                        |
+--------+-------------------------------------------------------------+
|        | Obtain names and phone number of on-site contact people:    |
|        |                                                             |
|        | -   Technical person affiliated with the site (in case of   |
|        |     difficulty such as temperature of room)                 |
|        |                                                             |
|        | -   Logistical person affiliated with the site (in case     |
|        |     refreshments are late)                                  |
|        |                                                             |
|        | -   Audiovisual person, if equipment is rented              |
+--------+-------------------------------------------------------------+
|        | In the training room, enquire about:                        |
|        |                                                             |
|        | -   Unlocking the door in the morning and afternoon?        |
|        |                                                             |
|        | -   How to turn on/off the lights?                          |
|        |                                                             |
|        | -   Is there a projection screen?                           |
|        |                                                             |
|        | -   Are there blinds/curtains to darken the room?           |
|        |                                                             |
|        | -   Are there enough table/chairs and space to set up for   |
|        |     break-out groups (so that chairs do not have to be      |
|        |     re-arranged each time)?                                 |
|        |                                                             |
|        | -   Is placement of electrical outlets adequate and whether |
|        |     extension cords/leads will be necessary?                |
|        |                                                             |
|        | -   Is the lighting adequate?                               |
|        |                                                             |
|        | -   Check temperature and how to adjust it if needed        |
+--------+-------------------------------------------------------------+

Appendix 6 Course Director checklists *continued*

+--------+-------------------------------------------------------------+
| **Ac   |                                                             |
| tivity |                                                             |
| chec   |                                                             |
| klist: |                                                             |
| after  |                                                             |
| each   |                                                             |
| tr     |                                                             |
| aining |                                                             |
| co     |                                                             |
| urse** |                                                             |
+--------+-------------------------------------------------------------+
| **    | ######### Activity                                          |
| when   |                                                             |
| comp   |                                                             |
| lete** |                                                             |
+--------+-------------------------------------------------------------+
|        | Draft and send out thank you letters to guest speakers,     |
|        | panellists and presenters (for opening ceremony and closing |
|        | session).                                                   |
+--------+-------------------------------------------------------------+
|        | Document observations and evaluation results that require   |
|        | action when planning for the next training course.          |
+--------+-------------------------------------------------------------+
|        | Update check lists and planning list for the next training  |
|        | course.                                                     |
+--------+-------------------------------------------------------------+
|        | Compile summary of evaluation data; submit evaluation data  |
|        | if requested.                                               |
+--------+-------------------------------------------------------------+
|        | Set date to meet with PMTCT Clinic Mangers and trainers a   |
|        | couple of weeks after the training to get their feedback.   |
+--------+-------------------------------------------------------------+
|        | Ensure that all fees and reimbursements have been processed |
|        | and paid.                                                   |
+--------+-------------------------------------------------------------+
|        | Prepare report of the training course for submission to     |
|        | supervisor or manager.                                      |
+--------+-------------------------------------------------------------+

Equipment and Supply Checklist

  ---------------------- -------------- ------------------------------------------------
  **Equipment/supplies                  
  checklist:\                           
  equipment/supplies                    
  needed every day of                   
  the training**                        

   when complete        **Quantity**   **Equipment**

                         1              Flipchart and/or Whiteboard and/or Blackboard

                         2 or 3         Pads of flipchart paper (only if using
                                        Flipchart)

                         2--10          Flipchart markers and/or Whiteboard markers
                                        and/or chalk

                         1 roll/pack    Tape or blue tack to hold flipchart paper on
                                        wall\
                                        (eg, masking tape) and for Labels Game (Module
                                        5)

                         1              LCD Projector and laptop computer OR Overhead
                                        Projector, if available

                         1              Extension cord/lead

                         One (1) per    Participant Manual
                         participant    

                                        Copies of national PMTCT policies, if not
                                        already in Participant Manual

                                        Presentation Booklet

                                        Pocket Guide

                                        Wall Charts

                                        Copies of Course evaluation form (for the last
                                        day)

                                        Pens

                         One (1) per    Name tags for participants, trainers, observers,
                         person present guest speakers, presenters and other present

                         Two (2) per    Copies of Pre-test and Post-test (optional)\
                         participant    (for Opening Ceremony/Course Introduction and
                                        last day)

                         \~ 200 sheets  Paper (8.5" x 11" or A4)

                         20--100        Small prizes, such as sweets or condoms, to give
                                        to small groups that have performed well

                         1              Large envelope (to fit the sheet of paper or
                                        card unfolded) or bowl for the Anonymous
                                        Question Exercise bag, box, or basket
  ---------------------- -------------- ------------------------------------------------

Appendix 6 Course Director checklists *continued*

+--------+---+----------+---+-----------------------------------------------+
| **     |   |          |   |                                               |
| Equipm |   |          |   |                                               |
| ent/su |   |          |   |                                               |
| pplies |   |          |   |                                               |
| chec   |   |          |   |                                               |
| klist: |   |          |   |                                               |
| Course |   |          |   |                                               |
| Ov     |   |          |   |                                               |
| erview |   |          |   |                                               |
| and    |   |          |   |                                               |
| Module |   |          |   |                                               |
| 1**    |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|  when |   | **Qu     | # |                                               |
| co     |   | antity** | # |                                               |
| mplete |   |          | # |                                               |
|        |   |          | # |                                               |
|        |   |          | # |                                               |
|        |   |          | # |                                               |
|        |   |          | # |                                               |
|        |   |          | # |                                               |
|        |   |          | # |                                               |
|        |   |          |   |                                               |
|        |   |          | S |                                               |
|        |   |          | u |                                               |
|        |   |          | p |                                               |
|        |   |          | p |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | / |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | e |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | s |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per    | 1 |                                               |
|        |   | par      | 2 |                                               |
|        |   | ticipant | x |                                               |
|        |   |          | 2 |                                               |
|        |   |          | 0 |                                               |
|        |   |          | c |                                               |
|        |   |          | m |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | d |                                               |
|        |   |          | s |                                               |
|        |   |          | ( |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | p |                                               |
|        |   |          | l |                                               |
|        |   |          | a |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | p |                                               |
|        |   |          | e |                                               |
|        |   |          | r |                                               |
|        |   |          | ) |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
| **     |   |          |   |                                               |
| Equipm |   |          |   |                                               |
| ent/su |   |          |   |                                               |
| pplies |   |          |   |                                               |
| chec   |   |          |   |                                               |
| klist: |   |          |   |                                               |
| Module |   |          |   |                                               |
| 2**    |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|  when |   | ##       | * |                                               |
| co     |   | #######  | * |                                               |
| mplete |   | Quantity | S |                                               |
|        |   |          | u |                                               |
|        |   |          | p |                                               |
|        |   |          | p |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | / |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | e |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | s |                                               |
|        |   |          | * |                                               |
|        |   |          | * |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 2 per    | S |                                               |
|        |   | par      | t |                                               |
|        |   | ticipant | r |                                               |
|        |   |          | i |                                               |
|        |   |          | p |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | p |                                               |
|        |   |          | e |                                               |
|        |   |          | r |                                               |
|        |   |          | a |                                               |
|        |   |          | p |                                               |
|        |   |          | p |                                               |
|        |   |          | r |                                               |
|        |   |          | o |                                               |
|        |   |          | x |                                               |
|        |   |          | i |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | e |                                               |
|        |   |          | l |                                               |
|        |   |          | y |                                               |
|        |   |          | 5 |                                               |
|        |   |          | x |                                               |
|        |   |          | 8 |                                               |
|        |   |          | c |                                               |
|        |   |          | m |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | k |                                               |
|        |   |          | e |                                               |
|        |   |          | d |                                               |
|        |   |          | a |                                               |
|        |   |          | s |                                               |
|        |   |          | d |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | c |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | b |                                               |
|        |   |          | e |                                               |
|        |   |          | d |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | S |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | s |                                               |
|        |   |          | i |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | 3 |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1        | B |                                               |
|        |   |          | a |                                               |
|        |   |          | g |                                               |
|        |   |          | , |                                               |
|        |   |          | b |                                               |
|        |   |          | o |                                               |
|        |   |          | x |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | b |                                               |
|        |   |          | a |                                               |
|        |   |          | s |                                               |
|        |   |          | k |                                               |
|        |   |          | e |                                               |
|        |   |          | t |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
| ##     |   |          |   |                                               |
| ### Eq |   |          |   |                                               |
| uipmen |   |          |   |                                               |
| t/supp |   |          |   |                                               |
| lies c |   |          |   |                                               |
| heckli |   |          |   |                                               |
| st: Mo |   |          |   |                                               |
| dule 3 |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|  when |   | **Qu     | * |                                               |
| co     |   | antity** | * |                                               |
| mplete |   |          | S |                                               |
|        |   |          | u |                                               |
|        |   |          | p |                                               |
|        |   |          | p |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | / |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | e |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | s |                                               |
|        |   |          | * |                                               |
|        |   |          | * |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per    | C |                                               |
|        |   | par      | o |                                               |
|        |   | ticipant | p |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | s |                                               |
|        |   |          | u |                                               |
|        |   |          | m |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | p |                                               |
|        |   |          | o |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | e |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | ( |                                               |
|        |   |          | A |                                               |
|        |   |          | N |                                               |
|        |   |          | C |                                               |
|        |   |          | ) |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | d |                                               |
|        |   |          | P |                                               |
|        |   |          | M |                                               |
|        |   |          | T |                                               |
|        |   |          | C |                                               |
|        |   |          | T |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | H |                                               |
|        |   |          | I |                                               |
|        |   |          | V |                                               |
|        |   |          | , |                                               |
|        |   |          | i |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | o |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | a |                                               |
|        |   |          | d |                                               |
|        |   |          | y |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | P |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | u |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per    | C |                                               |
|        |   | par      | o |                                               |
|        |   | ticipant | p |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | s |                                               |
|        |   |          | u |                                               |
|        |   |          | m |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | p |                                               |
|        |   |          | o |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | g |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | d |                                               |
|        |   |          | c |                                               |
|        |   |          | o |                                               |
|        |   |          | u |                                               |
|        |   |          | n |                                               |
|        |   |          | s |                                               |
|        |   |          | e |                                               |
|        |   |          | l |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | g |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | l |                                               |
|        |   |          | a |                                               |
|        |   |          | b |                                               |
|        |   |          | o |                                               |
|        |   |          | u |                                               |
|        |   |          | r |                                               |
|        |   |          | , |                                               |
|        |   |          | i |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | o |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | a |                                               |
|        |   |          | d |                                               |
|        |   |          | y |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | P |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | u |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per    | C |                                               |
|        |   | par      | o |                                               |
|        |   | ticipant | p |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | s |                                               |
|        |   |          | u |                                               |
|        |   |          | m |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | p |                                               |
|        |   |          | o |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | A |                                               |
|        |   |          | R |                                               |
|        |   |          | V |                                               |
|        |   |          | p |                                               |
|        |   |          | r |                                               |
|        |   |          | o |                                               |
|        |   |          | p |                                               |
|        |   |          | h |                                               |
|        |   |          | y |                                               |
|        |   |          | l |                                               |
|        |   |          | a |                                               |
|        |   |          | x |                                               |
|        |   |          | i |                                               |
|        |   |          | s |                                               |
|        |   |          | p |                                               |
|        |   |          | r |                                               |
|        |   |          | o |                                               |
|        |   |          | t |                                               |
|        |   |          | o |                                               |
|        |   |          | c |                                               |
|        |   |          | o |                                               |
|        |   |          | l |                                               |
|        |   |          | f |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | P |                                               |
|        |   |          | M |                                               |
|        |   |          | T |                                               |
|        |   |          | C |                                               |
|        |   |          | T |                                               |
|        |   |          | , |                                               |
|        |   |          | i |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | o |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | a |                                               |
|        |   |          | d |                                               |
|        |   |          | y |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | P |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | u |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per    | C |                                               |
|        |   | par      | o |                                               |
|        |   | ticipant | p |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | s |                                               |
|        |   |          | u |                                               |
|        |   |          | m |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | o |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | A |                                               |
|        |   |          | R |                                               |
|        |   |          | V |                                               |
|        |   |          | t |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | m |                                               |
|        |   |          | e |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | g |                                               |
|        |   |          | u |                                               |
|        |   |          | i |                                               |
|        |   |          | d |                                               |
|        |   |          | e |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | f |                                               |
|        |   |          | o |                                               |
|        |   |          | r |                                               |
|        |   |          | p |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | g |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | w |                                               |
|        |   |          | o |                                               |
|        |   |          | m |                                               |
|        |   |          | e |                                               |
|        |   |          | n |                                               |
|        |   |          | , |                                               |
|        |   |          | i |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | o |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | a |                                               |
|        |   |          | d |                                               |
|        |   |          | y |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | P |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | u |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per    | C |                                               |
|        |   | par      | o |                                               |
|        |   | ticipant | p |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | s |                                               |
|        |   |          | u |                                               |
|        |   |          | m |                                               |
|        |   |          | m |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | o |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
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|        |   |          | n |                                               |
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|        |   |          | r |                                               |
|        |   |          | l |                                               |
|        |   |          | o |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | p |                                               |
|        |   |          | o |                                               |
|        |   |          | s |                                               |
|        |   |          | t |                                               |
|        |   |          | n |                                               |
|        |   |          | a |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | c |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | p |                                               |
|        |   |          | o |                                               |
|        |   |          | l |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | e |                                               |
|        |   |          | s |                                               |
|        |   |          | , |                                               |
|        |   |          | i |                                               |
|        |   |          | f |                                               |
|        |   |          | n |                                               |
|        |   |          | o |                                               |
|        |   |          | t |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
|        |   |          | r |                                               |
|        |   |          | e |                                               |
|        |   |          | a |                                               |
|        |   |          | d |                                               |
|        |   |          | y |                                               |
|        |   |          | i |                                               |
|        |   |          | n |                                               |
|        |   |          | P |                                               |
|        |   |          | a |                                               |
|        |   |          | r |                                               |
|        |   |          | t |                                               |
|        |   |          | i |                                               |
|        |   |          | c |                                               |
|        |   |          | i |                                               |
|        |   |          | p |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | t |                                               |
|        |   |          | M |                                               |
|        |   |          | a |                                               |
|        |   |          | n |                                               |
|        |   |          | u |                                               |
|        |   |          | a |                                               |
|        |   |          | l |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
| **     |   |          |   |                                               |
| Equipm |   |          |   |                                               |
| ent/su |   |          |   |                                               |
| pplies |   |          |   |                                               |
| chec   |   |          |   |                                               |
| klist: |   |          |   |                                               |
| Module |   |          |   |                                               |
| 4**    |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|  when |   | **Qu     |   | ######### Supplies/Materials                  |
| co     |   | antity** |   |                                               |
| mplete |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 per\   |   | Copies of summaries of national or local      |
|        |   | par      |   | infant-feeding policy or protocol, if not     |
|        |   | ticipant |   | already in Participant Manual                 |
+--------+---+----------+---+-----------------------------------------------+
|        |   | N/A      |   | Information about local cost of the           |
|        |   |          |   | following:                                    |
|        |   |          |   |                                               |
|        |   |          |   | -   Commercial infant formulas                |
|        |   |          |   |                                               |
|        |   |          |   | -   Sugar (for home-prepared formulas)        |
|        |   |          |   |                                               |
|        |   |          |   | -   Multivitamin syrups or powders used to    |
|        |   |          |   |     supplement home-prepared formulas         |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1        |   | Tin of commercially prepared infant formula   |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 2 or 3   |   | Measuring spoons                              |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 2 or 3   |   | Feeding cups                                  |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1 set    |   | Equipment to correctly make home-prepared     |
|        |   |          |   | infant formula (if used in your area)         |
+--------+---+----------+---+-----------------------------------------------+
|        |   | 1        |   | If available, model of a breast to            |
|        |   |          |   | demonstrate correct position during           |
|        |   |          |   | breastfeeding                                 |
+--------+---+----------+---+-----------------------------------------------+
|        |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
| ##     |   |          |   |                                               |
| ### Eq |   |          |   |                                               |
| uipmen |   |          |   |                                               |
| t/supp |   |          |   |                                               |
| lies c |   |          |   |                                               |
| heckli |   |          |   |                                               |
| st: Mo |   |          |   |                                               |
| dule 5 |   |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|  when | * |          |   | **Supplies/Materials**                        |
| co     | * |          |   |                                               |
| mplete | Q |          |   |                                               |
|        | u |          |   |                                               |
|        | a |          |   |                                               |
|        | n |          |   |                                               |
|        | t |          |   |                                               |
|        | i |          |   |                                               |
|        | t |          |   |                                               |
|        | y |          |   |                                               |
|        | * |          |   |                                               |
|        | * |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+
|        | 1 |          |   | Sheets of paper (8.5 x 11" or A4) for Labels  |
|        | p |          |   | game                                          |
|        | e |          |   |                                               |
|        | r |          |   |                                               |
|        | p |          |   |                                               |
|        | a |          |   |                                               |
|        | r |          |   |                                               |
|        | t |          |   |                                               |
|        | i |          |   |                                               |
|        | c |          |   |                                               |
|        | i |          |   |                                               |
|        | p |          |   |                                               |
|        | a |          |   |                                               |
|        | n |          |   |                                               |
|        | t |          |   |                                               |
+--------+---+----------+---+-----------------------------------------------+

Appendix 6 Course Director checklists *continued*

  ---------------------- ----------------- -------------- ------------------------ -----------------------------------------------
  **Equipment/supplies                                                             
  checklist: Module 6**                                                            

   when complete        **Quantity**                     **Supplies/Materials**   

                         1 per participant                Copies of summaries of   
                                                          national or local HIV    
                                                          testing and counselling  
                                                          policies, if not already 
                                                          in Participant Manual    

                         1                                Rapid HIV test kit and   
                                                          supplies including       
                                                          gloves, alcohol wipes,   
                                                          lancets, test materials, 
                                                          and adhesive bandages    

                                                                                   

  **Equipment/supplies                                                             
  checklist: Module 7**                                                            

   when complete        **Quantity**                     **Supplies/Materials**   

                                                          No additional equipment  
                                                          or supplies are required 
                                                          for Module 7             

                                                                                   

  **Equipment/supplies                                                             
  checklist: Module 8**                                                            

   when complete                          **Quantity**                            **Supplies/Materials**

                                                                                   No additional equipment or supplies are
                                                                                   required for Module 8

                                                                                   

  **Equipment/supplies                                                             
  checklist: Module 9**                                                            

   when complete        **Quantity**                     **Supplies/Materials**   

                         1 set/participant                Full sets of national    
                                                          and local PMTCT forms    

                         1 set                            (Optional) Copies of     
                                                          PMTCT forms photocopied  
                                                          onto overhead            
                                                          transparencies (assuming 
                                                          an Overhead Projector is 
                                                          available)               

                         1 per participant                Small pieces of paper or 
                                                          index cards              

                         1                                Basket or envelope       

                                                                                   

  **Equipment/supplies                                                             
  checklist: Field                                                                 
  Visit**                                                                          

   when complete        **Quantity**                     **Supplies/Materials**   

                                                          No additional equipment  
                                                          or supplies are required 
                                                          for the field visit      
  ---------------------- ----------------- -------------- ------------------------ -----------------------------------------------

Appendix 7 Sample documents

Course announcement and covering letter

\<Date\>

\<Name, PMTCT Facility Supervisor\>

\<Address\>

\<Address\>

Dear \<Name\>,

The \<sponsoring agency\> is sponsoring a training course for the
Prevention of Mother-to-Child Transmission of HIV Infection (PTMCT). You
and your staff are invited to attend the PMTCT Training Course, which
will be held from \<dates\> at the \<site and address\>. This course is
targeted to doctors, nurses, midwives, social workers, counsellors and
outreach workers.

The goals of the PMTCT course are to:

-   Provide healthcare workers with the knowledge and skills to deliver
    core PMTCT services.

-   Provide an overview of the fundamental principles of a sustainable
    PMTCT programme.

The course syllabus is attached for your information. Also attached are
flyers advertising the course; please post and distribute these notices
to assist in informing staff of the upcoming course.

The course is residential. The Health Authority will reimburse
participants for travel and accommodation expenses. Breakfast and lunch
will be provided from the \<dates\>, but there will be no participant
per diem. Registration forms are also attached: please encourage your
staff to sign-up before \<deadline date for registration\>.

Do not hesitate to contact me if you have any questions; my phone number
is: \<phone number\>. Again, thank you for this opportunity to work with
you. I look forward to you and your staff's participation on the
upcoming PMTCT course.

Yours truly,

\<Name\>

\<Job Title\>

Attachments: Course syllabus

Flyers advertising course

Registration forms

Appendix 7 Sample documents

Course announcement

**\
**![](media/image7.png){width="1.0277777777777777in"
height="1.5833333333333333in"}**Prevention of Mother-to-Child\
Transmission of HIV**

**Course\
\
**

**When:** \<Start date and time\> to \<Course completion date and time\>

**Where:** \<Site and address\>, (Residential Course)

**For Whom:** PMTCT Clinic staff, including: Doctors, Nurses, Midwives,
Social workers, Counsellors and Outreach workers

+---------+------------------------------------------------------------+
| Goals:  | -   Provide healthcare workers with the knowledge and      |
|         |     skills to deliver core PMTCT services                  |
|         |                                                            |
|         | -   Provide an overview of the fundamental principles of a |
|         |     sustainable PMTCT programme.                           |
+---------+------------------------------------------------------------+

**Topics:** Introduction to HIV/AIDS; Overview of HIV prevention in
mothers, infants and young children; Specific interventions to prevent
mother-to-child transmission of HIV; Infant feeding; Stigma and
discrimination; HIV testing and counselling; Linkages to treatment,
care, and social support; Safety and supportive care in the work
environment including universal precautions and post-exposure
prophylaxis; Supportive care for the caregiver; and PMTCT programme
monitoring.

Travel and accommodation expenses will be reimbursed.

Breakfast and Lunch will be provided from \<dates\>.

For more information, see your supervisor or call \<phone number\>.

Sponsored by the \<name of sponsor\>

Appendix 7 Sample documents

Covering letter

######## ![](media/image7.png){width="1.0277777777777777in" height="1.5833333333333333in"}Registration

####### PMTCT Training Course

**When:** \<Date and time\> to \<Date and time\>

**Where:** \<Site and address\>

+-----------------------------------------------------------------------+
| **Mail, fax or e-mail completed form to:**                            |
|                                                                       |
| \<Name and title\>, \<address\>                                       |
|                                                                       |
| Tel/Fax: \<phone, fax numbers\> Email: [\<e-mail                      |
| address\>@address.org](mailto:TrainingCoordinator@bha.org)            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| Surname:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_    |
| First Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   |
|                                                                       |
| Credenti                                                              |
| als:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Institution Affiliation and Department                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\                                           |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Work mailing address:                                                 |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Postal Code \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phone        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_      |
|                                                                       |
| E-mail \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_             |
| Fa                                                                    |
| x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

What is your discipline?

  ----------------- ------------------ --------------------------------------- ----------------
   Physician        Nurse             Midwife                                Social Worker

   Outreach Worker  Counsellor        Other (Please state:                  
                                       \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_)   
  ----------------- ------------------ --------------------------------------- ----------------

Do you now work in a PMTCT service?  Yes  No If "YES" since when?
\_\_\_\_\_\_\_\_\_\_\_\_\_

+-----------------------------------------------------------------------+
| If you prefer that course confirmation and communication be directed  |
| to your home address, please write your address below:                |
|                                                                       |
| Home mailing address:                                                 |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_                                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Postal Code \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phone        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_      |
|                                                                       |
| Home E-mail                                                           |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

Appendix 7 Sample documents

Participant letter of confirmation

\<Date\>

\<Name, Title\>

\<Address\>

Dear \<Name\>,

I am pleased to confirm that you are registered for the Prevention of
Mother-to-Child Transmission of HIV Course, which will take place
\<date\> at \<site, address and phone number\>. Directions to the \<name
of site\> are attached.

The goals of the PMTCT course are to:

-   Provide healthcare workers with the knowledge and skills to deliver
    core PMTCT services

-   Provide an overview of the fundamental principles of a sustainable
    PMTCT programme.

You should check into the \<name of site\> by \<time\> on the morning of
the \<date\> so that you have time to settle into your room before the
Opening Ceremony and Course Introduction. The Course Syllabus is
attached and course times are as follows:

-   \<List day, date and time of opening ceremony and course
    introduction\>

-   \<List days, dates of the rest of the course\>

-   \<If appropriate also list day, dates of field visit and closing
    session\>

    \<Insert information regarding fees and reimbursements\>. Breakfast
    and lunch will be provided from the \<dates\>, but there will be no
    participant per diem. Do not hesitate to contact me if you have any
    questions; my phone number is: \<list phone number\>. Again, thank
    you for your interest in the PMTCT Course; I am looking forward to
    your participation.

Yours truly,

\<Name\>

\<Job Title\>

Attachment: Course Syllabus

Directions to \<name of training site\>

Appendix 7: Sample documents

Trainer invitation/confirmation

\<Name, Title\>

\<Address\>

Dear \<Name\>,

Thank you in advance for your participation in the upcoming PMTCT
training course. The PMTCT training course supports the national
training strategy and the national scale-up of PMTCT services through
training of Maternal-Child Health and Antenatal Care staff in this area.

The goals of the PMTCT course are to:

-   Provide healthcare workers with the knowledge and skills to deliver
    core PMTCT services

-   Provide an overview of the fundamental principles of a sustainable
    PMTCT programme.

We expect a total of 20 attendees, more than half will be midwives or
nurses, the remaining attendees are outreach workers and counsellors.
All of them are from the Antenatal clinics in \<name of geographic
area/health district\>.

As a trainer, you will be expected to attend the three Trainer
Preparation days and the entire PMTCT course. Date, times and sites of
both are as follows:

+-----------------------+-----------------------+----------------------+
|                       | **Date/times**        | **Site**             |
+-----------------------+-----------------------+----------------------+
| Trainer Preparation   | \<list times and      | \<name of site\>     |
| Days                  | dates\>               |                      |
|                       |                       | \<name of training   |
|                       |                       | room\>               |
|                       |                       |                      |
|                       |                       | \<address\>          |
|                       |                       |                      |
|                       |                       | \<phone number\>     |
+-----------------------+-----------------------+----------------------+
| PMTCT Training        | \<list times and      | \<name of site\>     |
|                       | dates\>               |                      |
|                       |                       | \<name of training   |
|                       |                       | room\>               |
|                       |                       |                      |
|                       |                       | \<address\>          |
|                       |                       |                      |
|                       |                       | \<phone number\>     |
+-----------------------+-----------------------+----------------------+

Directions to either of the above sites are available on request. You
will be reimbursed for mileage or other travel and hotel expenses. You
will also be provided with a per diem and honorarium as per \<name of
sponsoring agency\> policy.

Appendix 7 Sample documents

Trainer invitation/confirmation continued

Your responsibilities as a trainer are to:

-   Attend and participate in all of the Trainer Preparation Days and
    the entire PMTCT training course.

-   Fully prepare and present the material for assigned modules.

-   Assist participant learning by facilitating the exercises
    accompanying their modules, answering questions, getting back to
    participants on questions that cannot be answered during the
    training.

-   Help to support small group work during all modules, not just those
    you will teach.

-   Attend the Daily Trainer Meetings, which are scheduled every evening
    after each PMTCT Course training day, including the last day of
    training.

-   Feedback to the Course Director on how well the training met its
    goals and objectives; and how the training, Trainer Preparation Days
    and training materials (such as the Participant Manual) can be
    improved.

The objectives of the Trainer Preparation days are to:

-   Thoroughly review technical content.

-   Learn how to use the course materials.

-   Practise the exercises in the Trainer Manual.

-   Explore strategies that will maximise interactive participation.

-   Discuss the course, how the course fits into the overall national
    PMTCT strategy and how the course is managed, implemented, monitored
    and evaluated on the local levels.

Your module assignments are:

-   \<list module number and name\>

-   \<list module number and name\>

-   \<list module number and name\>

Please refer to the Trainer Manual that was mailed to you last week for
technical support, training exercises and teaching guidance and be
prepared to present these three modules on the Trainer Preparation days.
Please do not hesitate to contact us with any questions at \<list phone
number\>.

We very much look forward to working with you in the coming month. Thank
you again for your commitment to the PMTCT programme.

Yours truly,

\<Name, Title\>

Course Director

Appendix 7: Sample documents

Guest speaker letter of invitation/confirmation

\<Date\>

\<Name, Title\>

\<Address\>

Dear \<Name\>,

I would like to thank you in advance for your participation as a guest
speaker in the PMTCT training course. As you know from our conversation
you will be presenting \<list name of presentation and any important
points that should be included\> from \<time\> to \<time\> on \<day and
date\>. Attached you will find an outline of the presentation and a copy
of the entire module of which your presentation is a part. Please note
that your presentation should be about 40 minutes long. As our agenda is
very tight, my timekeeper may gently remind you to conclude your
presentation as your time ends.

The PMTCT training course supports the national training strategy and
the national scale-up of PMTCT services through training of
Maternal-Child Health staff in this area. The goals of the PMTCT course
are to:

-   Provide healthcare workers with the knowledge and skills to deliver
    core PMTCT services

-   Provide an overview of the fundamental principles of a sustainable
    PMTCT programme.

The course syllabus is attached so that you can see the breadth of
topics included on the course. We expect a total of 20 attendees, more
than half will be midwives or nurses, the remaining attendees are
outreach workers and counsellors. All of them are from \<name of
geographic area/health district\>.

Directions to the training site are included. You will be reimbursed for
\<insert mileage or other travel expenses\>. I very much look forward to
your presentation; do not hesitate to contact me if you have any
questions. Thank you again for your commitment to the PMTCT programme.

Yours truly,

\<Name, Title\>

Course Director

\<Contact Info\>

Attachments: Draft presentation outline

> Copy of Module X \<list number and name of relevant module\>
>
> Course Syllabus
>
> Direction
>
> Course Announcement

Appendix 7: Sample documents

Thank you letter to presenters

\<Date\>

\<Name, Title\>

\<Address\>

\<Address\>

Dear \<Name\>,

I would like to express our gratitude for the presentation you gave at
the Opening Ceremony of the Prevention of Mother-to-Child Transmission
of HIV Training Course on the \<date\>. Your contribution to the course,
particularly your depth of knowledge around mother-to-child transmission
of HIV in this country, was greatly appreciated. The discussion that you
facilitated was a thought-provoking start to the training.

Again, thank you for your time and willingness to share your expertise
and knowledge at the PMTCT training course. Your input was essential to
the success of the opening day and important to the overall effort to
provide healthcare workers with the knowledge and skills to deliver core
PMTCT services.

Yours truly,

\<Name\>

\<Job Title\>

Appendix 7: Sample documents

Thank you letter to PLWHA panellist

\<Date\>

\<Name, Title\>

\<Address\>

\<Address\>

Dear \<Name\>,

I would like to sincerely express our gratitude for your participation
on the PLWHA panel at the training on the \<date\>. Your contribution to
the Prevention of Mother-to-Child Transmission of HIV Training Course
was not only greatly appreciated but it was also memorable and thought
provoking.

Again, thank you for your time and willingness to share your experiences
and perspectives. You have provided those of us at the training a
perspective on living with HIV that we didn't have prior to hearing your
talk. Your input was essential to the success of the PMTCT course and to
the overall effort to provide healthcare workers with the knowledge and
skills to sensitively deliver PMTCT services.

Yours truly,

\<Name\>

\<Job Title\>

Appendix 7: Sample documents

Course completion certificate

![](media/image10.png){width="1.0270833333333333in"
height="1.582638888888889in"}

**(Sponsor)**

**PMTCT Training Group**

*This is to certify that*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*successfully completed the*

**Prevention of Mother-to-Child\
Transmission of HIV Training Course**

*\<Country\> National PMTCT Training Programme*

*\<Course dates\>*

*\<Course site\>*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Course Director***

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Director of (sponsor)***

Appendix 8: Trainer preparation

Trainer Preparation Days planning checklist

+--------+-------------------------------------------------------------+
| **T    |                                                             |
| rainer |                                                             |
| Prepa  |                                                             |
| ration |                                                             |
| Days** |                                                             |
+--------+-------------------------------------------------------------+
|  when | ###### Activity                                             |
| co     |                                                             |
| mplete |                                                             |
+--------+-------------------------------------------------------------+
|        | Assign a primary and secondary trainer to each module       |
|        | according to expertise and experience. Note that trainers   |
|        | with nursing/medical experience are recommended to teach    |
|        | the clinical modules:                                       |
|        |                                                             |
|        | -   Module 3: Specific Interventions to Prevent MTCT of HIV |
|        |                                                             |
|        | -   Module 4: Infant Feeding in the Context of HIV          |
|        |     Infection                                               |
|        |                                                             |
|        | -   Module 6: HIV Testing & Counselling for PMTCT           |
|        |                                                             |
|        | -   Module 7: Linkages to Treatment, Care, and Support for  |
|        |     Mothers and Families with HIV Infection and             |
|        |                                                             |
|        | -   Module 8: Safety and Supportive Care in the Work        |
|        |     Environment                                             |
+--------+-------------------------------------------------------------+
|        | Send trainers their confirmation as previously described\   |
|        | (see also Appendix 7).                                      |
+--------+-------------------------------------------------------------+
|        | Distribute copies of the following materials to each of the |
|        | trainers at least a week before the first Trainer           |
|        | Preparation Day:                                            |
|        |                                                             |
|        | -   Trainer Manual                                          |
|        |                                                             |
|        | -   Participant Manual                                      |
|        |                                                             |
|        | -   Presentation Booklet                                    |
|        |                                                             |
|        | -   Training Programme and Course Director Guide            |
|        |                                                             |
|        | -   PMTCT Course Syllabus (if not already in the Trainer    |
|        |     Manual)                                                 |
|        |                                                             |
|        | -   Training assignments (including a copy of the completed |
|        |     Table 3.1)                                              |
|        |                                                             |
|        | -   Agenda for the Trainer Preparation Days                 |
+--------+-------------------------------------------------------------+
|        | Request that each trainer read through their modules and    |
|        | come prepared to discuss how they would conduct the         |
|        | training given the guidance in the Trainer Manual.          |
+--------+-------------------------------------------------------------+
|        | Confirm the site for the Trainer Preparation Days.          |
+--------+-------------------------------------------------------------+
|        | Ensure training equipment and materials as described in the |
|        | course are available.                                       |
+--------+-------------------------------------------------------------+

Appendix 8: Trainer preparation *continued*

+-----------+----------------------------------------------------------+
| **        |                                                          |
| Checklist |                                                          |
| of        |                                                          |
| training  |                                                          |
| ski       |                                                          |
| lls**[^4] |                                                          |
+-----------+----------------------------------------------------------+
| ######    | -   Take centre stage -- do not get stuck in a corner or |
| Movements |     behind a desk                                        |
|           |                                                          |
|           | -   Face the audience -- do not face the board or screen |
|           |     when speaking                                        |
|           |                                                          |
|           | -   Make eye contact with people in all sections of the  |
|           |     audience                                             |
|           |                                                          |
|           | -   Use natural gestures and facial expression -- (but   |
|           |     try to avoid mannerisms)                             |
|           |                                                          |
|           | -   Move around the room -- approach people to get their |
|           |     attention & response                                 |
|           |                                                          |
|           | -   Avoid blocking the audience's view -- watch for      |
|           |     craning necks                                        |
+-----------+----------------------------------------------------------+
| *         | -   Slow and clear and loud enough for everyone to hear  |
| *Speech** |                                                          |
|           | -   Natural and lively -- varied                         |
|           |                                                          |
|           | -   Write difficult new words on the board or flipchart, |
|           |     pronounce and explain them                           |
+-----------+----------------------------------------------------------+
| **Inte    | -   Try to interact with all participants -- use names   |
| raction** |     as appropriate                                       |
|           |                                                          |
|           | -   Ask the questions suggested in the text -- ask       |
|           |     different participants                               |
|           |                                                          |
|           | -   Allow time for the participant to answer -- don't    |
|           |     give the answer too quickly\                         |
|           |     -- drop hints                                        |
|           |                                                          |
|           | -   Respond encouragingly and positively to all answers  |
|           |     -- correct errors gently                             |
|           |                                                          |
|           | -   Involve all participants -- include quiet ones --    |
|           |     control talkative ones                               |
|           |                                                          |
|           | -   Avoid discussions which are off the point or         |
|           |     distracting                                          |
|           |                                                          |
|           | -   Try to give satisfactory answers to questions from   |
|           |     participants                                         |
+-----------+----------------------------------------------------------+
| **Visual  | -   Have the required aids and equipment ready -- check  |
| aids**    |     and arrange them before the session                  |
|           |                                                          |
|           | -   Make sure that everyone can see clearly -- arrange   |
|           |     the room so that they can                            |
|           |                                                          |
|           | -   Point to what you are talking about on the projector |
|           |     or on the screen                                     |
|           |                                                          |
|           | -   Cover, turn off, or remove aids that are not in use  |
|           |                                                          |
|           | -   Let people handle aids used for demonstrations       |
|           |                                                          |
|           | -   Write large and clearly on the board -- arrange      |
|           |     words carefully so that there is enough room         |
|           |                                                          |
|           | -   Put slides and overheads away at end of session      |
+-----------+----------------------------------------------------------+
| **Use of  | -   Prepare thoroughly -- read the text and obtain any   |
| ma        |     aids that you need before                            |
| terials** |                                                          |
|           | -   Prepare your helpers (eg, for role-play) before the  |
|           |     session -- practise if possible                      |
|           |                                                          |
|           | -   Follow the session plan accurately and completely -- |
|           |     use your Trainer Manual                              |
|           |                                                          |
|           | -   Do not learn the session by heart -- follow the      |
|           |     Manual but talk in your own style                    |
|           |                                                          |
|           | -   Emphasise important and key points -- do not leave   |
|           |     important points out                                 |
|           |                                                          |
|           | -   Do not introduce too much extra material -- but give |
|           |     a few local examples                                 |
|           |                                                          |
|           | -   Try to avoid repetition unless really useful         |
|           |                                                          |
|           | -   If you find it necessary to read from the Manual,    |
|           |     look at the audience occasionally                    |
+-----------+----------------------------------------------------------+
| **Time    | -   Keep to time -- not too fast or too slow; don't take |
| man       |     too long with the early part of a session            |
| agement** |                                                          |
|           | -   Don't lose time between sessions (eg, going to       |
|           |     Clinical Practice) -- explain clearly what to do     |
+-----------+----------------------------------------------------------+

Appendix 8: Trainer preparation *continued*

Sample trainer assignment

  ---------------- -------------------------------- -------------- -------------
  **Day**          **Module**                       **Primary\     **Secondary
                                                    Trainer**      Trainer**

  **Pre-Training   Introduction, course overview,   Course         N/A
  Day**            ice breakers, ground rules       Director       

  **Day 1**        1: Introduction to HIV/AIDS                     

                   2: Overview of HIV Prevention in                
                   Mothers, Infants and Young                      
                   Children                                        

  **Day 2**        3: Specific Interventions to                    
                   Prevent MTCT                                    

                   4: Infant Feeding in the Context                
                   of HIV Infection                                

  **Day 3**        5: Stigma and Discrimination                    
                   Related to MTCT                                 

                   6: HIV Testing and Counselling                  
                   for PMTCT                                       

  **Day 4**        7: Linkages to Treatment, Care,                 
                   and Support for Mothers and                     
                   Families with HIV Infection                     

                   8: Safety and Supportive Care in                
                   the Work Environment                            

  **Day 5**        9: PMTCT Programme Monitoring                   

                   Closing Exercises                Course         N/A
                                                    Director       

  **Day 6**        Field Trip                                      
  ---------------- -------------------------------- -------------- -------------

Appendix 9: Field visit

Field Visit Planning Guide

The goal of the field visit is to provide participants with an
experience in a PMTCT setting to reinforce the classroom learning.

+------------+---------------------------------------------------------+
| ##         |                                                         |
| ## Plannin |                                                         |
| g and Cond |                                                         |
| ucting a F |                                                         |
| ield Visit |                                                         |
+------------+---------------------------------------------------------+
| **1-- 4    |                                                         |
| weeks      |                                                         |
| before the |                                                         |
| training** |                                                         |
+------------+---------------------------------------------------------+
| **Organise | Contact one or more local health centres to gain        |
| the visit  | permission for participants to visit and meet with      |
| or visits  | several members of staff. The staff with whom           |
| to a local | participants will meet can be determined by the field   |
| PMTCT      | visit objectives. If there are a number of PMTCT        |
| site**     | services near to the training site, the participants    |
|            | may be divided into special interest groups and visit   |
|            | different sites. If necessary, the visits could be      |
|            | staggered over the course of a day.                     |
+------------+---------------------------------------------------------+
| **Write    | Once you have commitments from staff at the PMTCT       |
| and send   | facility, follow up with a letter confirming the date   |
| co         | and timing of the visit and the visit objectives. It    |
| nfirmation | may be a good idea to also include the following in the |
| letter**   | letter:                                                 |
|            |                                                         |
|            | -   Brief description of the training; you may want to  |
|            |     attach a copy of the overall PMTCT training agenda, |
|            |     goals/objectives                                    |
|            |                                                         |
|            | -   Information on length of the visit.                 |
+------------+---------------------------------------------------------+

  ------------- ---------------------------------------------------------
  **1-- 4 weeks 
  before the    
  training**    

  **Develop     Finalise the visit guide for participants. See the sample
  Observation   guide below.
  Guide**       
  ------------- ---------------------------------------------------------

  ------------- ---------------------------------------------------------
  **1, 2, or 3  
  days before   
  the           
  training**    

  **Confirm the Telephone (or send another letter to) the people with
  meetings**    whom the participants will be meeting to reconfirm.
                Provide the healthcare workers with the final number of
                visitors.
  ------------- ---------------------------------------------------------

+------------+---------------------------------------------------------+
| **On the   |                                                         |
| morning of |                                                         |
| the Field  |                                                         |
| Visit**    |                                                         |
+------------+---------------------------------------------------------+
| **Team     | Ensure that at least one trainer will accompany each    |
| Leader,    | group of participants.                                  |
| name tags  |                                                         |
| and time   | Ask the participants to return to the training room at  |
| for        | the designated time for debriefing.                     |
| debrief**  |                                                         |
+------------+---------------------------------------------------------+

Appendix 9: Field visit *continued*

  ------------- ---------------------------------------------------------
  At the Site   

  **The         Once participants arrive at the PMTCT service/clinic, the
  meeting**     Trainer should ask for the healthcare worker scheduled
                for the first meeting.

  **Thank the   Thank each healthcare worker upon conclusion of each
  healthcare    observation or meeting.
  workers**     
  ------------- ---------------------------------------------------------

+------------+---------------------------------------------------------+
| At the end |                                                         |
| of the     |                                                         |
| Field      |                                                         |
| Visit      |                                                         |
+------------+---------------------------------------------------------+
| *          | -   When everyone has returned, allow approximately 30  |
| *Debrief** |     minutes for debriefing.                             |
|            |                                                         |
|            | -   The following questions may be helpful in directing |
|            |     group response:                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   How did their observations compare with what they   |
|            |     had learned in a given area? What was the same?     |
|            |     What made it different?                             |
|            |                                                         |
|            | -   Did the visit meet their expectations?              |
|            |                                                         |
|            | -   Is there something that could have made the visit   |
|            |     more beneficial?                                    |
|            |                                                         |
|            | -   Did they observe any practice that they felt could  |
|            |     be improved?                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Ask each participant to summarise their experience  |
|            |     in a sentence or two.                               |
+------------+---------------------------------------------------------+

  ------------- ---------------------------------------------------------
  **Within a    
  week after    
  the Field     
  Visit**       

  **Send out    Follow up with thank you notes to the clinical facilities
  thank you     staff that took time to meet with the participants.
  notes**       
  ------------- ---------------------------------------------------------

Document Order Form

**\
**![](media/image7.png){width="1.0277777777777777in"
height="1.5833333333333333in"}**WHO/CDC**

Prevention of\
Mother-to-Child

**Transmission of HIV (PMTCT)**

**Generic Training Package**

The World Health Organization (WHO) and the United States Centers for
Disease Control and Prevention (CDC) have collaborated to develop the
*Prevention of Mother-to-Child Transmission of HIV (PMTCT) Generic
Training Package*. The package is a comprehensive, evidence-based
generic PMTCT training course that was field tested in Guyana, Ethiopia,
Cambodia, and Mozambique. It is intended to be adapted to include the
policies, guidelines, and realities of the specific country setting.

**Document order form:**

Name

Address

City

Country

Telephone

Email

Number of copies: Quantity

**Training Programme and Course Director Guide**

**Trainer Manual**

**Participant Manual and Presentation Booklet**

**Pocket Guide**

**Wall Chart**

**CD-ROM** containing all components listed above in Microsoft^®^ Word
and Adobe^®^ Acrobat PDF files.........

**Complete PMTCT Generic Training Package**

![](media/image2.jpeg){width="0.75in"
height="0.7166666666666667in"}**World Health Organization**

**Department of HIV/AIDS**

> 20, Avenue Appia, CH-1211 Geneva 27
>
> Switzerland\
> E-mail: <hiv-aids@who.int>

<http://www.who.int/hiv/en>

**For further information, please contact:**

**World Health Organization**\
Department of HIV/AIDS\
20, Avenue Appia, CH-1211 Geneva 27, Switzerland\
E-mail: <hiv-aids@who.int>\
<http://www.who.int/hiv/en>

ISBN 92 4 159203 6

![](media/image11.png){width="2.0694444444444446in"
height="1.1534722222222222in"}

[^1]: This document refers to the PMTCT Training Plan as national while
    acknowledging that the PMTCT Training Programme may be managed by a
    partner organisation.

[^2]: World Health Organization, UNAIDS, UNICEF. 2000. *HIV and Infant
    Feeding Counselling: A Training Course, Director's Guide.* pg 21.

[^3]: The Participant Manual should be translated either before Step 1
    (ie, if the generic document is to be translated) or after Step 3:
    "Final Approval of Participant Manual" (ie, if the adapted version
    will be translated). The remaining components of the package may be
    translated after the Participant Manual has been adapted, translated
    and approved.

[^4]: Adapted from: *Breastfeeding Counselling: A Training Course,
    Trainer's Guide*, Part Four, Sessions 31-34, World Health
    Organization CDD Programme, UNICEF, (WHO/CDR/93.4; UNICEF/NUT/93.2),
    Pages 32-33. Available online:
    http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/Breastfeeding/Trainers_Guide_Part4.pdf