**Module 1: Overview: Tuberculosis, the Global Emergency**

+----------------+-----------------------------------------------------+
| **Purpose**    | To provide participants with the basic terms and    |
|                | concepts related to tuberculosis infection and its  |
|                | diagnosis and control.                              |
+----------------+-----------------------------------------------------+
| **P            | None                                                |
| re-requisite** |                                                     |
|                |                                                     |
| **Modules**    |                                                     |
+----------------+-----------------------------------------------------+
| **Module       | 1 hour 20 minutes                                   |
| Time**         |                                                     |
+----------------+-----------------------------------------------------+
| **Learning     | At the end of this module, participants will be     |
| Objectives**   | able to                                             |
|                |                                                     |
|                | -   Explain the TB epidemic and global TB burden    |
|                |                                                     |
|                | -   Describe the forms of TB and how it is          |
|                |     transmitted                                     |
|                |                                                     |
|                | -   Define and compare various methods of TB        |
|                |     diagnosis noting where each is most effective   |
|                |                                                     |
|                | -   Explain the term NTP                            |
|                |                                                     |
|                | -   Describe the DOTS component of STOP TB strategy |
|                |                                                     |
|                | -   Explain the importance of AFB microscopy in the |
|                |     DOTS Program                                    |
|                |                                                     |
|                | -   Describe levels of TB laboratory services.      |
+----------------+-----------------------------------------------------+

**Module Overview**

+-----+-------+--------------+---------------------+-------------------+
| **  | **T   | **Activity/\ | **Content**         | **Resources\      |
| Ste | ime** | Method**     |                     | Needed**          |
| p** |       |              |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| 1   | 15    | >            | Introduction & TB   | Slides 1--9       |
|     | min   | Presentation | Overview            |                   |
+-----+-------+--------------+---------------------+-------------------+
| 2   | 15    | >            | TB Transmission and | Slides 10--12     |
|     | min   | Presentation | Risks               |                   |
|     |       | > and        |                     |                   |
|     |       | > D          |                     |                   |
|     |       | emonstration |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| 3   | 10    | >            | TB Diagnosis        | Slides 13--16     |
|     | min   | Presentation |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| 4   | 10    | >            | National TB Program | Slides 17--21     |
|     | min   | Presentation | & DOTS              |                   |
|     |       | > and        |                     |                   |
|     |       | > Discussion |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| 5   | 10    | >            | Role of AFB         | Slides 22--24     |
|     | min   | Presentation | Microscopy          |                   |
+-----+-------+--------------+---------------------+-------------------+
| 6   | 10    | >            | Lab Network: TB     | Slides 25--29     |
|     | min   | Presentation | Control Program     |                   |
+-----+-------+--------------+---------------------+-------------------+
| 7   | 10    | > Q&A        | Summary             | Slide 30          |
|     | min   |              |                     |                   |
+-----+-------+--------------+---------------------+-------------------+

**Material/Equipment Checklists**

-   PowerPoint slides or transparencies

-   Overhead projector or computer w/LCD projector

-   Flipchart

```{=html}
<!-- -->
```
-   \[OPTIONAL for Slide 10\] Spray bottle containing water and scented
    oil (e.g., Lavender)

**Teaching Guide**

+-----------------+-----------------------------------------------------+
| **Slide         | **Teaching Points**                                 |
| Number**        |                                                     |
+=================+=====================================================+
| 1.              | **[Module 1: Overview: TB, The Global               |
|                 | Emergency]{.underline}**                            |
|                 |                                                     |
|                 | DISPLAY this slide before you begin the module.     |
|                 | Make sure participants are aware of the transition  |
|                 | into a new module.                                  |
+-----------------+-----------------------------------------------------+
| 2.              | **[Learning Objectives]{.underline}**               |
|                 |                                                     |
|                 | STATE the objectives on the slide                   |
+-----------------+-----------------------------------------------------+
| 3.              | **[Content Overview]{.underline}**                  |
|   **Flipchart** |                                                     |
|                 | (Suggested technique for presentation)              |
| > ![](m         |                                                     |
| edia/image1.wmf | WRITE the content outline before beginning this     |
| ){width="0.8423 | session.                                            |
| 611111111111in" |                                                     |
| >               | REFER to flipchart frequently to orient             |
| height="0.84236 | participants to where they are in the module.       |
| 11111111111in"} |                                                     |
|                 | EXPLAIN that these are the topics that will be      |
|                 | covered in this module.                             |
+-----------------+-----------------------------------------------------+
| 4.              | **[Global Emergency]{.underline}**                  |
|                 |                                                     |
|                 | STATE the message on the slide.                     |
+-----------------+-----------------------------------------------------+
| 5.              | **[Disturbing Statistics]{.underline}**             |
|                 |                                                     |
|                 | STATE the message on the slide                      |
|                 |                                                     |
|                 | EMPHASIZE that TB is the major killer among young   |
|                 | people.                                             |
+-----------------+-----------------------------------------------------+
| 6.  ![](me      | **[Country specific TB burden]{.underline}**        |
| dia/image2.wmf) |                                                     |
| {width="0.75in" | CUSTOMIZE                                           |
|                 |                                                     |
| height="0.67361 | Link to HIV/AIDS where appropriate                  |
| 11111111112in"} |                                                     |
+-----------------+-----------------------------------------------------+
| 7.              | **[What is TB?]{.underline}**                       |
|                 |                                                     |
|                 | STATE the message on the slide                      |
+-----------------+-----------------------------------------------------+
| 8.              | **[The Cause of TB]{.underline}**                   |
|                 |                                                     |
|                 | EXPLAIN that TB is predominantly caused by          |
|                 | *Mycobacterium tuberculosis* and occasionally       |
|                 | *Mycobacterium bovis*                               |
|                 |                                                     |
|                 | -   These bacteria are also known as tubercule      |
|                 |     bacilli because they produce characteristic     |
|                 |     lesions called tubercules in the lungs.         |
+-----------------+-----------------------------------------------------+
| 9.              | **[Staining Characteristics]{.underline}**          |
|                 |                                                     |
|                 | STATE the message on the slide                      |
|                 |                                                     |
|                 | -   HIGHLIGHT the features of the sputum smear      |
|                 |     stained by the Ziehl-Neelsen stain. The         |
|                 |     organisms appear red on a blue background. The  |
|                 |     blue color is from the counterstain called      |
|                 |     methylene blue.                                 |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   There is good contrast between the TB bacilli   |
|                 |     and background                                  |
|                 |                                                     |
|                 | POINT OUT the organisms can be found single, in     |
|                 | clumps, or in clusters. The organisms can be small, |
|                 | coco-bacilli, beaded, or long in morphology         |
+-----------------+-----------------------------------------------------+
| 10. ![](me      | **[TB Transmission]{.underline}**                   |
| dia/image2.wmf) |                                                     |
| {width="0.75in" | EXPLAIN the transmission of TB                      |
|                 |                                                     |
| height="0.67361 | STATE that transmission of bacilli (infection) from |
| 11111111112in"} | person-person occurs ALMOST exclusively by airborne |
|                 | transmission                                        |
|                 |                                                     |
|                 | -   The primary source of transmission is the       |
|                 |     patient with PTB who coughs                     |
|                 |                                                     |
|                 | -   Coughing produces micro-aerosols known as       |
|                 |     droplet nuclei that can remain suspended in the |
|                 |     air for least 30 minutes                        |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Transmission of TB occurs in poorly ventilated  |
|                 |     and enclosed areas                              |
|                 |                                                     |
|                 | \[OPTIONAL DEMONSTRATION: using a spray bottle      |
|                 | containing water and scented oil (e.g., Lavender)\] |
|                 |                                                     |
|                 | GENERATE a gentle mist into the classroom.          |
|                 |                                                     |
|                 | ASK participants if they can smell the scent of the |
|                 | oil. Smelling the scent means that participants     |
|                 | have inhaled droplet nuclei.                        |
+-----------------+-----------------------------------------------------+
| 11.             | **[Risk Factors for Infection]{.underline}**        |
|                 |                                                     |
|                 | STATE the risk factors on the slide.                |
|                 |                                                     |
|                 | EXPLAIN that a susceptible person has a higher risk |
|                 | of infection where there is continuous and          |
|                 | prolonged exposure to an AFB smear positive PTB     |
|                 | case in a confined space.                           |
|                 |                                                     |
|                 | EXPLAIN that the higher the number of infectious    |
|                 | sources spreading bacilli within a community, the   |
|                 | greater the transmission                            |
|                 |                                                     |
|                 | EXPLAIN that the risk of the infection from a smear |
|                 | negative PTB case is lower                          |
+-----------------+-----------------------------------------------------+
| 12.             | **[Risk Factors for Disease]{.underline}**          |
|                 |                                                     |
|                 | EMPHASIZE that few people infected with tubercle    |
|                 | bacilli become sick with TB. Many more become sick  |
|                 | when co-infected with HIV.                          |
+-----------------+-----------------------------------------------------+
| 13.             | **[Diagnosis of TB]{.underline}**                   |
|                 |                                                     |
|                 | DESCRIBE the four most common methods of TB         |
|                 | diagnosis                                           |
|                 |                                                     |
|                 | MENTION the skin test and chest x-ray as non        |
|                 | specific diagnostic tools                           |
|                 |                                                     |
|                 | REITERATE that this training will be focused on AFB |
|                 | smear microscopy                                    |
+-----------------+-----------------------------------------------------+
| 14.             | **[Advantages of AFB Smear                          |
|                 | Microscopy]{.underline}**                           |
|                 |                                                     |
|                 | EXPLAIN that sputum smear microscopy has a number   |
|                 | of advantages over other techniques:                |
|                 |                                                     |
|                 | -   For universal application in resource-limited   |
|                 |     countries it is the best choice among           |
|                 |     diagnostic methods                              |
+-----------------+-----------------------------------------------------+
| 15.             | **[Limitation of Microscopy]{.underline}**          |
|                 |                                                     |
|                 | STATE the limitations detailed on the slide         |
|                 |                                                     |
|                 | DEFINE DST as Drug susceptibility testing and       |
|                 | limitation of AFB smear microscopy in performing    |
|                 | DST                                                 |
|                 |                                                     |
|                 | **[EMPHASIZE]{.underline} that these limitations    |
|                 | can be overcome by performing culture of AFB**      |
+-----------------+-----------------------------------------------------+
| 16.             | **[Limitations of Culture]{.underline}**            |
|                 |                                                     |
|                 | EXPLAIN that *M. tuberculosis* is a slow growing    |
|                 | organism that takes weeks to grow on culture        |
|                 |                                                     |
|                 | -   Culture techniques are demanding and require a  |
|                 |     high level of technical skill                   |
|                 |                                                     |
|                 | -   Increased resources are needed in comparison to |
|                 |     microscopy                                      |
|                 |                                                     |
|                 | -   Increased safety including the use of           |
|                 |     Biological Safety Cabinets are essential        |
|                 |                                                     |
|                 | For these reasons, culture is difficult to make     |
|                 | widely available                                    |
+-----------------+-----------------------------------------------------+
| 17.             | **[National Tuberculosis Control Program            |
|                 | (NTP)]{.underline}**                                |
|                 |                                                     |
|                 | STATE the objectives of the NTP from the slide      |
|                 |                                                     |
|                 | EXPLAIN that the NTP accomplishes its objectives by |
|                 | means of:                                           |
|                 |                                                     |
|                 | -   early detection of infectious cases, and        |
|                 |                                                     |
|                 | -   appropriate treatment until cure                |
+-----------------+-----------------------------------------------------+
| 18.             | **[Goals of the NTP]{.underline}**                  |
|                 |                                                     |
|                 | STATE the message on the slide                      |
+-----------------+-----------------------------------------------------+
| 19.             | **[What is STOP TB Strategy]{.underline}**          |
|                 |                                                     |
|                 | STATE from the slide                                |
|                 |                                                     |
|                 | EXPLAIN each term                                   |
+-----------------+-----------------------------------------------------+
| 20.             | **[DOTS Component of STOP TB                        |
|                 | Strategy]{.underline}**                             |
|                 |                                                     |
|                 | DOTS is an internationally recommended strategy for |
|                 | TB control in response to the global emergency      |
|                 |                                                     |
|                 | STATE the message from the slide                    |
+-----------------+-----------------------------------------------------+
| 21.             | **[Benefits of DOTS]{.underline}**                  |
|                 |                                                     |
|                 | STATE the message on the slide                      |
+-----------------+-----------------------------------------------------+
| 22.             | **[Role of Laboratory]{.underline}**                |
|                 |                                                     |
|                 | EMPHASIZE that smear positive cases are the         |
|                 | greatest sources of transmission in the community   |
|                 |                                                     |
|                 | -   AFB microscopy is the only reliable tool to     |
|                 |     detect these cases and to stop ongoing          |
|                 |     transmission                                    |
|                 |                                                     |
|                 | EXPLAIN that the individual patient must be         |
|                 | monitored by AFB microscopy to ensure that the      |
|                 | treatment is working and that cure is achieved at   |
|                 | the end of treatment                                |
+-----------------+-----------------------------------------------------+
| 23.             | **[Detection and treatment of infectious cases      |
|                 | reduces the spread of Tuberculosis!]{.underline}**  |
|                 |                                                     |
|                 | STATE the message from the slide                    |
+-----------------+-----------------------------------------------------+
| 24.             | **[Pulmonary Positive Patients]{.underline}**       |
|                 |                                                     |
|                 | STATE the message from the slide                    |
+-----------------+-----------------------------------------------------+
| 25.             | **[Laboratory Network]{.underline}**                |
|                 |                                                     |
|                 | EXPLAIN that theTB laboratory services should be    |
|                 | organized according to the three levels of health   |
|                 | services                                            |
|                 |                                                     |
|                 | -   Peripheral (often district laboratory)          |
|                 |                                                     |
|                 | -   Intermediate (often regional laboratory)        |
|                 |                                                     |
|                 | -   Central (often national laboratory)             |
|                 |                                                     |
|                 | In terms of complexity, the level of service        |
|                 | performed at each level is different                |
+-----------------+-----------------------------------------------------+
| 26.             | **[Peripheral Laboratory]{.underline}**             |
|                 |                                                     |
|                 | STATE the message from the slide                    |
+-----------------+-----------------------------------------------------+
| 27.             | **[Intermediate Laboratory]{.underline}**           |
|                 |                                                     |
|                 | STATE the message from the slide                    |
+-----------------+-----------------------------------------------------+
| 28.             | **[Central Laboratory]{.underline}**                |
|                 |                                                     |
|                 | STATE the message from the slide                    |
+-----------------+-----------------------------------------------------+
| 29.             | **[Laboratory is the key Component in TB            |
|                 | Control]{.underline}**                              |
|                 |                                                     |
|                 | STATE the message from slide                        |
|                 |                                                     |
|                 | EMPHSIZE the role of laboratory in TB control       |
+-----------------+-----------------------------------------------------+
| 30.             | **[Summary]{.underline}**                           |
|                 |                                                     |
|                 | ASK the participants to answer the questions        |
|                 |                                                     |
|                 | ANSWER any questions the participants may have      |
+-----------------+-----------------------------------------------------+