Monitoring & Evaluation Division

HIV Sentinel Surveillance Round 2012-13 Training Report Two Days training of ANC sentinel site staff (19 th -22 nd, Mop up- 28 th Dec 12, on the site- 4 th - 5 th Jan 2013) Monitoring & Evaluation Division Haryana State AIDS Control Society C-15, Awas Bhawan, Sec-6, Panchkula, Haryana 1

Contents S.No Title Page No. 1. Acronyms 3 2. Executive summary 4 3. Overview &Objective of training 5-6 4. Highlights of Batch 1 including Pics 7-10 5. Highlights of Batch 2 including pics 11-14 Highlights of Batch 3 Mop up training 15-16 Highlights of on the site training 4-5 th 17-19 Jan 2013 6. Summary & Conclusion 20 7. Annexure Annexure A- Training Schedule Annexure B- List of participants Annexure C- List of Facilitators Annexure D- Attendance sheets Annexure E- Correspondence protocol Annexure F- ANC lab site linkage and target sample Annexure G- Stamp of site codes 21-23 24-25 26 Attached separately as scanned copies 27-28 29 30-34 2

Acronyms ANC CHC DFTS HIV HSS ICTC LT OPD PPTCT RI RPM SACS SOP SMM SST STS UAT Ante Natal Clinic Community Health Centre Data Form Transportation Sheet Human Immuno-deficiency Virus HIV Sentinel Surveillance Integrated Counseling and testing Centre Lab Technician Out Patient Department Prevention of Parent to Child Transmission Regional Institute (PGIMER Chandigarh for Haryana state) Rotation per Minute State AIDS Control Society Standard Operating Procedure Single Male Migrant State Surveillance Team Sample Transport Sheet Unlinked Anonymous Testing strategy 3

Executive Summary Two days Training in two batches on 19 th Dec to 22 nd Dec 2012 and Mop up training on 28 th Dec 12 and on the site training on 4-5 th Jan 2013 was conducted of all ANC sentinel sites for HSS Round 2012-13. On 19 th -22 nd Dec 2012 at Conference hall, State Institute of Health & Family welfare, sec-6 Panchkula and on 28 th Dec 2012 at Conference Hall, Housing board, Sec-6, Panchkula. There were 36 participants (Deputy CMO (TB/HIV), MO In charge ANC, Counselors & LTs) from 13 sites/subsites on 19 th 20 th Dec 12, 36 participants (Deputy CMO (TB/HIV), MO In charge ANC, Counselors & LTs) from 13 sites/subsites on 21 st 22 nd Dec 12, and 8 participants (MO ANC, Counselors and LTs) from 7 sites on 28 th Dec 2012 (Mop up batch) and on 4-5 th Jan 2013 at Mewat and Palwal (for on the site training) that received training. 100% attendance of all ANC staff (78 in number) of 26 sites/subsites all over Haryana was achieved through initial 2 days training in 2 batches (1th -22 nd Dec 2012), mop up training (28 th dec 2012) and on the site training on 4-5 th Jan 2013. Resource Persons among SST members, Dr BM Vashisht (Professor, Deptt of Community Medicine, PGIMS Rohtak), from SACS (Dr Bindya Jain, State Epidemiologist Haryana) from RI, PGIMER Chandigarh, Ms Navkiran and Ms Chanderkanta Chauhan facilitated the training. The purpose of the training was to impart technical skill regarding HSS to all designated staff with special emphasis on documentation, Data form filling and Lab procedures. Know your site session was introduced for the first time that led to discussion on site wise scenario of routine ANC, PPTCT and Lab work and issues supposed to face during surveillance. Pre prepared resource material was used for providing knowledge and developing skills on all aspects of HSS. The expected training outcomes was to increase their knowledge about HSS and ensure high quality surveillance at their sites. The training was participatory and interactive as most of the sessions were conducted based on the learning needs of the participants. Besides explanation using exercise and real examples of sites were discussed to understand problems being faced and solutions to be proposed to tackle these. The training encouraged open discussions. The sessions were summarized in the end of each session. Training kit comprising following logistics were provided to all site personnel:- 1. Data forms- 1 for training practice + As per target sample with wastage/site 2. Data From Transportation Sheet (DFTS)- 1 for training practice + 20/site 3. Sample Transportation Sheet (STS)-1 for training practice + 20/site 4. Correspondence protocol (Annexure E) 5. ANC lab site linkage and target sample sheet (Annexure F) 6. Stamp of individual site (Format as Annexure G) 7. Pre/post test questionnaire- 2 copies 8. Know your site exercise 9. ANC wall chart- 2/site 10. SIMS wall chart- 1/site 11. Training schedule Overview of HSS Training 4

HIV Sentinel surveillance is most important tool to monitor HIV Epidemic in country. It helps to understand the dynamics of the HIV epidemic and monitor the trend among different population groups and geographical areas and thus provides input to programme for strengthening, prevention and control activities. For surveillance among high risk groups, selected targeted intervention project sites are designated as sentinel sites where a predetermined number of samples (400 for ANC sites) are collected. At each sentinel site, three designated staff (MO In charge (ANC)/Counselor and Lab Technician) is given the responsibility to implement the surveillance activities. The MO In charge ANC of the site is designated as the site in charge. Site in charge is supported by Counselor in documentation and data collection and by laboratory Technician in collection of blood specimens under strict SOP. HIV Sentinel Surveillance is being carried out at all 16 ANC sites (26 total including sub sites) (Annexure 1). Objective of Training: The objective of the training was to impart technical skill to sentinel site staff of ANCs viz., Site In charge/lmo (ANC), Counselor and Lab Technician to carry out high quality surveillance at their sites. Orientation of deputy CMOs for HSS, local issues being faced and the solutions to tackle the problems so as to conduct smooth functioning of HSS in Hayana. Dates of the Training: 1 st Batch: 19 th -20 th Dec 2012 2 nd Batch: 21 st -22 nd Dec 2012 Mop Up Batch: 28 th Dec 2012 On the site training: 4 th Jan 2013 at Mewat (CHC Nuh, Mandikhera and Ferozpurjhirka) Venue of Training: 5 th Jan 2013 at Palwal (GH Palwal) 19 th -22 nd Dec 2012: Conference hall, State Institute of Health & Family welfare, sec-6, Panchkula 28 th Dec 2012: Conference Hall, Housing board,haryana, C-15, Awas Bhawan, Sec-6, Panchkula 4 th Jan 2013: Meeting room, CHC Nuh, Mewat Haryana 5 th Jan 2013: ANC clinic, GH Palwal, Haryana Resource persons: 5

1. Dr BM Vashisht, prof, Deptt of SPM, PGIMS Rohtak (SST member) 2. Ms Navkiran, Research Officer, School of Public Health, PGIMER Chandigarh (RI personnal) 3. Ms Chander kanta Chauhan, Research Officer, School of Public Health, PGIMER Chandigarh (RI personnal) 4. Dr Bindya Jain, State Epidemiologist, Haryana SACS Participants: 1. Sentinel site in charges/lmos (ANC), 2. Counselor 3. Lab Technicians 4. Deputy CMOs (HIV/TB) on 1 st day of both batches 6

Highlights Of Day 1 of 1 st Batch (19 th Dec 2012) Districts participated in Day 1 were- Bhiwani, Fatehabad, Hisar, Jind, Kaithal, Panchkula, Sirsa and Rewari 36 participants from 13 sentinel sites attended the training. (Counselors of CHC Raipurani, PHC Kot and GH Jind and LTs of PHC Barwala and GH Kaithal who didn t attned training were trained later in Mop up training on 28 th Dec 2012 at HSACS office.). Deputy CMOs of 4 districts- Fatehabad, Sirsa, Bhiwani and Rewari attended the first day of training. Attendance sheets Annexed at D are attached separately with this report. Sessions of Day I The first day included sessions on: 1. Introduction to HIV Sentinel Surveillance 2. Know your site -Group Work and discussion 3. Methodology of Sentinel surveillance at ANC sites Group work and discussion on methodology of HSS at ANC sites Day one started with registration of all participants and pre test was conducted by M&E Division staff. Session 1: Introduction to HIV sentinel surveillance Dr BM Vashisht threw light on broad objectives and uses of doing HSS at ANC sites, explained the roles and responsibilities of site Personnel: MO In charge/lmo (ANC), counsellor and Lab Technicians. Session 2: Know your site -Group Work and discussion Dr Bindya Jain mentored the group work on know your sentinel site, explained the objectives of session and instructions to do group work. After competing session, randomly 3 site personnel were called to present their site findings and discussions were done to highlight and sort out their local issues that would hamper smooth functioning of HSS. In GH Bhawanikhera (composite site Bhiwani), it was observed that due to distance in Gynae OPD and Lab, consecutiveness might be affected. Although staff was oriented and guided for coordination for strict maintenance of consecutiveness, intensive supervision was proposed to support and ensure the strict follow up of consecutiveness. In GH Fatehabad, it was observed that since ANC clients are tested twice first in general lab and then in ICTC. ICTC LT was instructed to collect HSS samples by himself and then send the sera to general for testing. Close supervision was proposed to ensure strict following of methodology In GH Sirsa also issue of distance in all three points of ANC clinic was observed in counseling and lab. Intensive supervision is and site specific micro plan was proposed. Session 3: Methodology of Sentinel Surveillance Ms Navkiran, explained - Eligibility criteria, consecutive method of sampling and importance of doing UAT. She also explained in detail the recruitment process of ANC clients for sample collection by consecutive sampling method and testing strategy at ANC sites. Session 3: Group work and discussion data form completion Instructions were explained to do the exercise on methodology. Participants were told to complete the exercise on methodology after discussion in group and present the same next morning. 7

Highlights Of Day 2 of 1 st Batch (20 th Dec 2012) Sessions of Day 2 The second day included sessions on: Session 4: Managing Data Forms Session 5: Laboratory Procedures Session 6: Monitoring, Supervision & Coordination Recap of previous day sessions was done by Dr Bindya. Group work on methodology exercise was discussed among participants. Session 4: Managing data forms Dr Bindya explained in detail the general principles of filling up data forms, explained each variable in data form and instruction to avoid common errors. Examples of common errors observed were also demonstrated. This session was accompanied by exercises for practical experience in data form filling. Session 5: Laboratory procedures Ms Chanderkanta Chauhan discussed in detail the standard operating procedures for sample collection under HSS. She explained in detail the method of blood collection, sample processing, serum preparation, aliquoting and labelling. She also explained the method of storage at 4 degree and transportation of samples under strict cold chain. Session 6: Monitoring, Supervision & Coordination Dr BM Vashisht explained in detail the monitoring and supervision structure and objective. Documentation involved with supervision. He informed the sites to maintain the HSS supervisory register at their sites to ensure the action oriented supervision and to help in coordination among all levels for effective, intensive and supportive supervision. He also explained the do s and don ts for high quality surveillance. Day 2 ended with summary of all session and post test was conducted by M&E division staff. Outcome of the 1 st batch training: Knowledge and skill about Documentation and Data form filling up, Lab procedures under strict SOP imparted effectively to all participants. Site specific issues related to HSS were discussed and solutions proposed. 8

Pictures of the interactive training sessions (Batch 1):- Pic 1: Participants listening to one of the session Pic-2 Dr Vashisht explaining Importance and uses of HSS 9

Pic 3: Dr Bindya giving instruction on know your site group work Pic 4:Ms Chanderkanta Chauhan explaining lab procedures 10

Highlights Of 1 st day of 2 nd Batch (21 st Dec 2012) Districts participated in Day 1 were- Faridabad, Jhajjar, Karnal, Kurukshetra, Mewat, Palwal, Panipat and Gurgaon 36 participants from 13 sentinel sites attended the training. (Mo of GH Mandikhera, CHc Nuh, GH Panipat, Red cross maternity Panipat, Counselors of CHCNuh, CHC Ferozputjhirka, GH Mandikhera and LTs of GH Panipat and Red cross Panipat who didn t attned training were trained later in Mop up training on 28 th Dec 2012 at HSACS office and were provided on the site training). Deputy CMOs of 6 districts- Palwal, Mewat, Faridabad, Panipat, Kurukshetra and Karnal attended the first day of training. Attendance sheets Annexed at D are attached separately with this report. Sessions of Day I The first day included sessions on: 1. Introduction to HIV Sentinel Surveillance 2. Know your site -Group Work and discussion 3. Methodology of Sentinel surveillance at ANC sites Group work and discussion on methodology of HSS at ANC sites Day one started with registration of all participants and pre test was conducted by M&E Division staff. Session 1: Introduction to HIV sentinel surveillance Dr BM Vashisht threw light on broad objectives and uses of doing HSS at ANC sites, explained the roles and responsibilities of site Personnel: MO In charge/lmo (ANC), counsellor and Lab Technicians. Session 2: Know your site -Group Work and discussion Dr Bindya Jain mentored the group work on know your sentinel site, explained the objectives of session and instructions to do group work. After competing session, randomly 6 sites/subsites personnel were called to present their site findings and discussions were done to highlight and sort out their local issues that would hamper smooth functioning of HSS. In all site/subsites of Mewat, GH Mandikhera, CHC Nuh and CHC Ferozpurjhirka,not only Staff of all three sites of Mewat were irregular in attending training in this round as well in last round but also post of Gyaene is temporary and not filled up with LMOs. It is proposed to supervise intensively to ensure quality surveillance and provide on the site support. Regular MOs of Three sites were provided on the site training along with their staff nurse/anm to ensure quality surveillance in coordination with each other. In both GH Jhajjar and GH Bahadurgarh, Labs and Gynae OPD are in different building. Although staff was guided for close coordination in order to strictly maintain consecutiveness, it was proposed to supervise intensively to ensure strict following of methodology. In GH Palwal also, Issue of distance in Gynae OPD and ICTC was observed. ICTC is in separate building in the back of hospital. Therefore counselor was directed to sit with MO Gynae for the surveillance period and also strict supervision proposed as MO was not cooperating in attending training. She was later provided on the site training at GH palwal. 11

Session 3: Methodology of Sentinel Surveillance Ms Navkiran, explained - Eligibility criteria, consecutive method of sampling and importance of doing UAT. She also explained in detail the recruitment process of ANC clients for sample collection by consecutive sampling method and testing strategy at ANC sites. Session 3: Group work and discussion data form completion Instructions were explained to do the exercise on methodology. Participants were told to complete the exercise on methodology after discussion in group and present the same next morning. Highlights Of Day 2 of 2 nd Batch (22 nd Dec 2012) Sessions of Day 2 The second day included sessions on: Session 4: Managing Data Forms Session 5: Laboratory Procedures Session 6: Monitoring, Supervision & Coordination Recap of previous day sessions was done by Dr Bindya. Group work on methodology exercise was discussed among participants. Session 4: Managing data forms Dr Bindya explained in detail the general principles of filling up data forms, explained each variable in data form and instruction to avoid common errors. Examples of common errors observed were also demonstrated. This session was accompanied by exercises for practical experience in data form filling. Session 5: Laboratory procedures Ms Chanderkanta Chauhan discussed in detail the standard operating procedures for sample collection under HSS. She explained in detail the method of blood collection, sample processing, serum preparation, aliquoting and labelling. She also explained the method of storage at 4 degree and transportation of samples under strict cold chain. Session 6: Monitoring, Supervision & Coordination Dr BM Vashisht explained in detail the monitoring and supervision structure and objective. Documentation involved with supervision. He informed the sites to maintain the HSS supervisory register at their sites to ensure the action oriented supervision and to help in coordination among all levels for effective, intensive and supportive supervision. He also explained the do s and don ts for high quality surveillance. Day 2 ended with summary of all session and post test was conducted by M&E division staff. Outcome of the 2 nd batch training: Knowledge and skill about Documentation and Data form filling up, Lab procedures under strict SOP imparted effectively to all participants. Site specific issues related to HSS were discussed and solutions proposed. 12

Pics of 2 nd batch training: Pic 5: Participants listening attentively to session Pic 6: Dr Vashisht explaining about importance of supervision and monitoring 13

Pic 7: Ms Navkiran explaining methodology of HSS Pic 8: Dr Bindya Explaining data form and documentation maintenance at sites. 14

Highlights Of Mop up batch on 28 th Dec 2012 Districts participated in Mop up batch were- Jind, Kaithal, Panchkula and Panipat 8 participants from 7 sentinel sites attended the training. (Staff who didn t turn up for mop up even after repeated reminders- MOs of CHC Nuh, GH Mandikhera, GH Palwal, and Red cross panipat, Counselors of CHCMandikhera, CHC Nuh and CHC Ferozpurjhirka were trained later on their sites on 4 th Jan-5 th Jan 2013). Attendance sheets Annexed at D are attached separately with this report. Sessions of batch The sessions included: 1. Introduction to HIV Sentinel Surveillance 2. Know your site -Group Work and discussion 3. Methodology of Sentinel surveillance at ANC sites Group work and discussion on methodology of HSS at ANC sites 4: Managing Data Forms 5: Laboratory Procedures 6: Monitoring, Supervision & Coordination Training was initially arranged at PD room HSACS office but due to electricity failure in whole SACS office, immediately conference hall, housing board was booked and training started asap. Training started with registration of all participants and pre test was conducted. Session 1: Introduction to HIV sentinel surveillance Dr Bindya threw light on broad objectives and uses of doing HSS at ANC sites, explained the roles and responsibilities of site Personnel: MO In charge/lmo (ANC), counsellor and Lab Technicians. Session 2: Know your site -Group Work and discussion Dr Bindya Jain and Ms Navkiran mentored the group work on know your sentinel site, explained the objectives of session and instructions to do group work. All the site personnals experience of their site were discussed and solution to local issues that would hamper smooth functioning of HSS were proposed. Session 3: Methodology of Sentinel Surveillance Ms Navkiran, explained - Eligibility criteria, consecutive method of sampling and importance of doing UAT. She also explained in detail the recruitment process of ANC clients for sample collection by consecutive sampling method and testing strategy at ANC sites. Session 4: Managing data forms Dr Bindya explained in detail the general principles of filling up data forms, explained each variable in data form and instruction to avoid common errors. Examples of common errors observed were also demonstrated. This session was accompanied by exercises for practical experience in data form filling. Session 5: Laboratory procedures Ms Navkiran discussed in detail the standard operating procedures for sample collection under HSS. She explained in detail the method of blood collection, sample processing, serum preparation, aliquoting and labelling. She also explained the method of storage at 4 degree and transportation of samples under strict cold chain. 15

Session 6: Monitoring, Supervision & Coordination Dr Bindya explained in detail the monitoring and supervision structure and objective. Documentation involved with supervision. She informed the sites to maintain the HSS supervisory register at their sites to ensure the action oriented supervision and to help in coordination among all levels for effective, intensive and supportive supervision. Do s and don ts for high quality surveillance were also explained to participants. Training ended with summary of all session and post test was conducted. Outcome of the Mop up batch training: Knowledge and skill about Documentation and Data form filling up, Lab procedures under strict SOP imparted effectively to all participants. Site specific issues related to HSS were discussed and solutions proposed among sentinel site staff that didn t turn up for initial training. Though the mop up batch was covered in one day only, on the request of participants all the sessions and important messages were conveyed in a right manner to all site staff for quality HSS. 16

On the site training Highlights of on the site training (4 th Jan 2013) District Mewat was covered on 4 th Jan 2013. Sentinel site staff that didn t turn up for any of the training including mop up were trained on their site. Resource person- Dr Bindya Jain 15 participants from 3 sites/subsites of sentinel sites CHC Nuh, GH Mandikhera and CHC Ferozpurjhirka attended the training including MOs, Counselors and LTs. Deputy CMO Dr Ajay Aggrawal hosted and convened the training in the meeting room of CHC Nuh, Mewat. Attendance sheets Annexed at D are attached separately with this report. All the sentinel site staff were provided Operational manual, copies of data forms, DFTS, STS, Correspondence protocol and ANC site lab linkage and target sample sheet. After brief introduction, sentinel site staff was apprised of importance of HIV sentinel surveillance, its uses and objectives. Site specific issues were discussed individually with all three site/subsite staff and solutions were proposed to tackle those for smooth functioning of HSS under strict quality and strict follow up of consecutive methodology and eligibility criteria. General principles of filling up data forms were explained including each variable in data form and instruction to avoid common errors were told. Participants were encouraged to use hard ball point pen for filling up all documents related to HSS and MO in charges were requested to ensure quality of documentation and that UAT is followed strictly. Though all LTs of three sites were already trained in earlier training at Panchkula still Laboratory procedures were explained in summary to all sentinel site staff for their knowledge and to help them understand how to help and avoid common errors done by LTs and for MOs to strictly supervise the lab procedures so that SOP are followed as per guidelines. Staff was also explained in detail the monitoring and supervision structure and objective. Documentation involved with supervision. Sites were told to maintain the HSS supervisory register at their sites to ensure the action oriented supervision. Do s and don ts for high quality surveillance were also explained to participants. Outcome of the on the site batch training: Knowledge and skill about Documentation and Data form filling up, Lab procedures under strict SOP imparted effectively to all participants. Site specific issues related to HSS were discussed and solutions proposed among sentinel site staff that didn t turn up for any of the training. It was ensured that important messages were conveyed in a right manner to all site staff for quality HSS. Session proved to be interactive and leaning experience. 17

Highlights of on the site training (5 th Jan 2013) District Palwal was covered on 5 th Jan 2013. Sentinel site staff (MO In charge GH Palwal) that didn t turn up for any of the training including mop up were trained on their site. Resource person- Dr Bindya Jain MO Incharge (Dr Sachita Chowdhary and Counselor (Ummed Singh) of sentinel site GH Palwal attended the training. Attendance sheets Annexed at D are attached separately with this report. They sentinel site staff were provided Operational manual, copies of data forms, DFTS, STS, Correspondence protocol and ANC site lab linkage and target sample sheet. After brief introduction, sentinel site staff was apprised of importance of HIV sentinel surveillance, its uses and objectives. Site specific issues were discussed and solutions were proposed to tackle those for smooth functioning of HSS under strict quality and strict follow up of consecutive methodology and eligibility criteria. General principles of filling up data forms were explained including each variable in data form and instruction to avoid common errors were told. Participants were encouraged to use hard ball point pen for filling up all documents related to HSS and MO in charges were requested to ensure quality of documentation and that UAT is followed strictly. Though all LTs of three sites were already trained in earlier training at Panchkula still Laboratory procedures were explained in summary to all sentinel site staff for their knowledge and to help them understand how to help and avoid common errors done by LTs and for MOs to strictly supervise the lab procedures so that SOP are followed as per guidelines. Staff was also explained in detail the monitoring and supervision structure and objective. Documentation involved with supervision. Sites were told to maintain the HSS supervisory register at their sites to ensure the action oriented supervision. Do s and don ts for high quality surveillance were also explained to participants. Highlights of on the site training (5 th Jan 2013) Red Cross Panipat was covered on 5 th Jan 2013. Sentinel site staff (MO In charge Red cross Panipat and Counselor) that didn t turn up for any of the training including mop up were trained on their site. Resource person- Dr MS Punia, Proff, Deptt of Community Medicine, Govt women Khanpur Kalan, Sonipat MO Incharge (Dr Rani Kalra) and Counselor/staff nurse (Ummed Singh) of sentinel site Red cross Panipat attended the training. The sentinel site staff were provided Operational manual, copies of data forms, DFTS and STS After brief introduction, sentinel site staff was apprised of importance of HIV sentinel surveillance, its uses and objectives. Site specific issues were discussed and solutions were proposed to tackle those for smooth functioning of HSS under strict quality and strict follow up of consecutive methodology and eligibility criteria. General principles of filling up data forms were explained including each variable in data form and instruction to avoid common errors were told. Participants were encouraged to use hard ball point pen for filling up all documents related to HSS and MO in charges were requested to ensure quality of documentation and that UAT is followed strictly. 18

Laboratory procedures were also explained in summary to all sentinel site staff for their knowledge and to help them understand how to help and avoid common errors done by LTs and for MOs to strictly supervise the lab procedures so that SOP are followed as per guidelines. Staff was also explained in detail the monitoring and supervision structure and objective. Documentation involved with supervision. Sites were told to maintain the HSS supervisory register at their sites to ensure the action oriented supervision. Do s and don ts for high quality surveillance were also explained to participants. Outcome of the on the site training: Knowledge and skill about Documentation and Data form filling up, Lab procedures under strict SOP imparted effectively to all participants. Site specific issues related to HSS were discussed and solutions proposed among sentinel site staff that didn t turn up for any of the training. It was ensured that important messages were conveyed in a right manner to all site staff for quality HSS. Most importantly sentinel site staff that could not turn up for any of the training including mop up were trained effectively at their sites to ensure quality surveillance. Pic 9: On the site training batch 4 th Jan 2013 at CHC Nuh Mewat. (Dr Ajay Aggrawal Deputy CMO Mewat on the right to Dr Bindya Jain) 19

Summary: The training program as a whole was quite intensive and interactive. All the participants were made sensitized to HSS and its implementation at their sites under strict quality control and SOP. Overall impression:- The objective of the training to impart technical skill to sentinel site staff of ANC viz., Site In charge, Counselor and Lab Technician to carry out high quality surveillance at their sites was met with effectively. The 100% attendance of all ANC staff of 26 sites/subsites all over Haryana was achieved through initial 2 days training in 2 batches, mop up training and on the site training on 4-5 th Jan 2013. Action points: - 1. Site In charges have been directed to carry out orientation of rest of the staff at their respective sites whom they consider to be involve actively in surveillance at their sites. 2. This training will be supported by supervisory visits of SST members, RI members and SACS personnels to support and monitor the effective surveillance activities at the sentinel sites spreaded over three months of sample collection. Site wise list for intensive supervision has been prepared based on training observations. 3. CMOs of concerned districts will be requested to avoid transfer/long leave of any trained sentinel site staff and to recruit someone in place on time if that is unavoidable and inform the SACS immediately. 20

Annexure A Training schedule for 19 th -22 nd Dec 2012 Haryana State AIDS Control Society C-15 Awas Bhawan, sec-6 Panchkula Haryana Training Schedule for HIV Sentinel Surveillance Round 2012-13 Date: 19-20 th Dec 2012 & 21 st -22 nd Dec 2012 (Two days training in two batches) Resource Persons: - Dr MS Punia (Prof. Deptt of Community Medicine,BPS Khanpur kalan Sonipat), Dr BM Vashist (Prof, Department of Community Medicine, PGIMS Rohtak), Ms Chandekanta Chauhan, Research Officer, School of Public Health, PGIMER Chandigarh Participants:- ANC In charges, Counselors and LTs of 26 ANC sites/sub sites. DTOs of all districts will attend training on 1 st day of both batches. SCHEDULE OF TRAINING FOR ANC SITES Timings Sessions Batch 1 Date 19-20 th Dec 12 Batch 2 Date 21-22 nd Dec 12 Day 1 Districts Districts 10.00-10.30 Inauguration and Opening Remarks Bhiwani Fatehabad Hisar Jind Kaithal Panchkula Sirsa Rewari PD/APD HSACS Faridabad Jhajjar Karnal Kurukshetra Mewat Palwal Panipat Gurgaon PD/APD HSACS 10.30-11.00 Pre-Test Questionnaire M&E Staff M&E Staff 21

Administration 11.00-11.15 am 11.15-12.00 Session1: Introduction to HIV Sentinel Surveillance 12.00-01.30 Session 2: Know your Sentinel Site - Group Work and discussion Tea Break Dr Vashisht, Proff SPM, PGIMS Rohtak SACS Dr Vashisht, Proff SPM, PGIMS Rohtak SACS 1.30-2.30 pm Lunch break 2:30-3:30 Session 3: Methodology of HIV Sentinel Surveillance at ANC sites Ms Navkiran, PGIMER Chandigarh Ms Navkiran, PGIMER Chandigarh 3.30-3.45 pm Tea break 3:45-5:30 Session 3: Methodology of HIV Sentinel Surveillance at ANC sites (group Work and discussion) SACS SACS Day 2 10:00-11:00 Recap and Discussion SACS SACS 11.00-11.15 am 11:15-01:00 Session 4: Managing Data Forms Tea Break Dr Bindya Jain Stat Epidemiologist Haryana SACS Dr Bindya Jain Stat Epidemiologist Haryana SACS 1.00-2.00 PM Lunch Break 2:00-3:30 Session 5: Laboratory Procedures Ms Chander kanta Chauhan, Research Ms Chander kanta Chauhan, Research 22

Officer, SPH, PGIMER Chandigarh Officer, SPH, PGIMER Chandigarh 3.30-3.45 PM Tea Break 3:45:4:30 Session 6: Monitoring & Supervision; Coordination 4:30:5:00 Post-Test Questionnaire Administration Dr Vashisht, Proff SPM, PGIMS Rohtak M&E Staff Dr Vashisht, Proff SPM, PGIMS Rohtak M&E Staff 5:00-5:30 Closing Remarks PD/APD PD/APD *Mop up training will be scheduled on 28 th 29 th Dec 2012 for staff that won t turn up for any of the earlier two batches of training. 23

Annexure B List of Participants who attended trainings (19 th 22 nd Dec 2012, 28 th Dec 2012 and 4-5 th Jan 2013) HIV Sentinel Surveillance Round 2012-13, Haryana Surveillance sites list- ANC S. District Site type Name of site MO Incharge Counselor LT DTO N 1 Bhiwani ANC ( R) 2 Fatehabad ANC CHC Tosham, Subsite- GH Bawanikhera, Subsite- CHC Bondkalan GH Fatehabad Subsite- CHC tohana Dr. Sudha garg 9315372200 drsudhagarg@gmail.com Dr JS Chauhan 9416072707 Dr. Naresh 8950426647 Dr. Renu Bala 9467059922 sano1977@rediffmail.co m Dr. Kusum Gupta 9896681178 Vinod kumar9255931784 vinodcouselor@gma il.com Amit Pawar 9812054304 ghbawanikhera@ya hoo.com Ramotar 9991105800 Jalendraramotar04 @gmail.com Diivesh Dhajka 9355555834 deenudhaka@gmail. com Ramphal 9812513705 Surinder singh 9728261782 skstosham@gm ail.com Ved Priya 9253021016 Neeraj 9671717170 n.kashyap2905 @gmail.com Vikas Kumar 9896700784 Gurdas Mathur 9466283292 Dr. Randeep Poonia 9812294050 randeepsinghpoo nia@gmail.com Dr HL Gupta 9416343608 3 Hisar ANC GH Hisar 4 Jhajjar ANC GH Jhajjar Subsite GH Bahadurgarh, Dr. Anita Bansal 8950644063 jaswantbabansal@hotm ail.com Dr Renu Gehlot 9210887887 Dr Dirender Singh 9315849101 urendersingh@gmail.co m Mamta jangra 9164655834 mamtajangra@rediff mail.com Anju 9729855415 dtohrjjr@rntcp.org Dev Kumar 9466448744 ghbahadurgarh@red iffmail.com Pardeep kumar 9466668363 pardeepkumar @gmail.com Hari parsad 9812138454 dtohrjjr@rntcp. org Ashok hooda 9466895541 5 Jind ANC GH Jind 6 Kaithal ANC GH Kaithal 7 Karnal ANC GH Karnal Dr. Shyam Sunder 9416077727 gargshyamsunder@yaho o.in Dr. Hamita 9467766714 Dr. Prem Lata 9416221167 Satinder Pal 7206512091 Suman Devi 9671930247 Hawa Singh 9896977300ictcghka rnal@gmail.com Ramesh Kumar 9996766100 Gurmeet Singh 9813913913 Rekha Sharma 9466256974 ictcghkarnal@g mail.com Dr. Ashwani Ahuja 9466708412 ictcghkarnal@gma il.com 8 Kurukshet ra ANC LNJP Hospital KKR, Subsite CHC shahbad Dr Neha Khajuria 9416481133 nookaushal@gmail.com Dr. Sunita Sharma 9050744454 leena.sharma9090@gma il.com 9 Mewat ANC CHC Nuh Dr Sanjay Phogat (Trained on the site) Nisha 9992670400 ictckkr@gmail.com Varun Kaushik 9896222004 chcsbd@gmail.com varun_redcross@ya hoo.com Meena kumari(train on the site) 9813423565 Randhir Singh 9416895025 khushboo 9729364444 khushboo.sidhi @yahoo.com Mukesh Kumar 9050898655 chcnuh@gmail. Dr. NK Jhomb 9466522936 Dr. Ajay Kumar Aggarwal 9466359251 24

com Subsite GH Mandikhera, CHC Ferozpurjirk ha 10 Palwal ANC GH Palwal 11 Panchkula ANC ( R ) CHC Raipurani Dr Raman Kapil(Trained on the site) 9467738495 Dr. DP Malik 9416762711 smojirka28@yahoo.com Dr Sachita(Trained on the site) 9136685159 Salma Khatun(Trained on the site) Jawed Khan(Trained on the site) 9671028225 Umed Singh 9467736334 ictcpalwal@gmail.co m STI Coun Naresh Kumar 946745697 Dr. Rakesh Goyal 9569698334 Sarita 9416725122 Subsite PHC Kot, Dr. Aruna 9855477647 mailphckot@gmail.com Durgesh (MPHW) 9467122741 Sabir Hussain 9050645006 Bhagirath 9034704951 smojirka28@ya hoo.com Deepak Kumar 9466777424 ictcpalwal@gm ail.com Rajender Kumar 9467529377 Pooja Saini 9896415184 Madan Lal 9416324632 Dr. A K Gupta 8901327817 akgupta279om PHC Barwala Dr. Kusum (DS) 7837394152 phcbarwalamo@gmail.c om Somvati (MPHW) 01733-256521 phcbarwalamo@gm ail.com Neelam 8901265210 12 Panipat ANC 13 Sirsa 14 Faridabad 15 Rewari 16 Gurgaon ANC new site ANC new site ANC new site ANC new site GH Panipat Subsite Red Cross maternity Hospital GH sirsa BK Hospital Faridabad GH Rewari Gh Gurgaon Dr. Raghvendra Singh 9996208580 raghvendra2974@gmail. com, Dr. Manisha 8950266884 Dr Rani Kalra (Trained on the site) 9354908491 Dr. Punam Lata 9467019479 punam9774@gmail.com Dr.S.Sarup9818165014 drssarup@gmail.com Dr. Sarita Rani 9560052577 drsarita1609@gmail.com Dr. Sunita Sharma 9871041765sunitasharm a2910@yahoo.co.in Josna Juneja 9729216290 jjuneja82@gmail.co m Post not available Sarika 9729293217 lac.sirsa@gmail.com priti Narwal 9911921454 ictcghfbd@gmail.co m Suman Yadav 9466227810 sumanil79@rediffm ail.com Poonam Rathi 9711272539 ictcgnggn@yahoo.co m Yellow highlighted are- those trained on the site at Mewat, Palwal and Panipat Punam Lata Om Parkash 9416835189 Nitin Kumar 9996688898 Nisha Kaushik 8586026687 Seema Rani 8901533978 Sanju Yadav 9466607172 ictcgurgaon@g mai.com Dr. S.K Nagpal 9896013738 Dr. Rohtas Kumar 9417669446 dr.rohtask@uaho o.com Dr. Bina Sharma 9268571150 dtohrftb@rntcp.or g Dr.T.C.Tanwar 9416117878 dtohrrwr@rntcp.o rg 25

Annexure C LIST of facilitators/resource persons S No Name Designation and address 1 Dr. B.M. Vashisht (Provided training on 19 th -22 nd Dec 2012) 2 Dr. M.S.Punia (provided on the site training at Red cross Panipat on 5 th Jan 2013) 3 Ms Navkiran Kaur (Provided training on 19 th, 21 st and 28 th Dec 2012) 4 Ms Chanderkanta Chauhan (Provided training on 20 th and 22 nd Dec 2012) 5 Dr Bindya Jain (Provided training on 19 th 22 nd Dec, 28 th Dec 2012 and 4-5 th Jan 2013) Professor, Department of Community Medicine, PGIMS Rohtak Professor, Department of community Medicine, PGIMS Rohtak Research Officer, HIV Sentinel Surveillance, School of Public Health, PGIMER Chandigarh Research Officer, HIV Sentinel Surveillance, School of Public Health, PGIMER Chandigarh State Epidemiologist, Haryana SACS Annexure D (Attendance sheet attached separately as scanned copies of all batches including mop up and on the site training-4-5 th Jan 2013) 26

Annexure E Correspondence protocol for HIV Sentinel Surveillance Round 2012-13 Haryana State AIDS Control Society Documents to be sent to Regional Institute 1. Data Forms 2. Data Transportation sheet in duplicate Documents/Items to be sent to sentinel lab Address for correspondence of Regional Institute (RI), PGIMER Chandigarh:- Dr Rajesh Kumar, Prof & Head, School of Public Health PGIMER Sec-12, Chandigarh-160012 Contact: 9988955016 (Ms. Chanderkanta Chauhan) Address for correspondence of sentinel labs (with label HSS Samples) Frequency of Documents to be sent Weekly Weekly Frequency of Documents to be sent 1. Serum samples in proper sample transportation boxes 2. Sample transportation sheet in duplicate In charge, Deptt of Microbiology,PGIMS Rohtak Districts linked Bhiwani, Hisar,Jhajjar, Jind, Mewat, Palwal, Faridabad, Rewari, Gurgaon Weekly Contact: 9896296249 (Dr PJS Gill) Dr Bharti, Lab In charge,general Hospital Ambala City, Haryana Fatehabad, Kaithal, Karnal, Kurukshetra, Panchkula, Panipat, Sirsa Weekly Districts linked Contact: 9416110322 (Dr Bharti) Correspondence be sent to Haryana SACS office Address for correspondence to Haryana State AIDS Control Society 27

For logisitic/ Technical /operational / methodological or any other support from Haryana SACS Haryana State AIDS Control Society, C-15, Awas Bhawan, Sec-6 Panchkula Haryana Contact: Submit Supervisory register at the end of surveillance SST members For supervision of sentinel sites 0172-2587121 (Dr Ritu Chowdhry) 9878154544 (Dr Bindya Jain) Dr BM Vashisth-9812176692 Dr MS Punia-9416243144 Dr Sunder Lal-9996005095 Dr PJS Gill-9896296249 NACO Dr Pradeep Kumar- - 8373909907 Dr Kuru Dindi-9650383955 28

Annexure F ANC Lab- site linkage and target samples HIV Sentinel Surveillance Round 2012-13, Haryana Surveillance sites codes list- ANC S.No District Name of site No of samples to be collected Designated sentinel lab for testing Site codes CHC Tosham, 200 PGIMS Rohtak 060700111 1 Bhiwani Subsite- GH Bawanikhera 100 PGIMS Rohtak 060700112 Subsite- CHC Bondkalan 100 PGIMS Rohtak 060700113 2 Fatehabad GH Fatehabad 250 GH Ambala 060670111 Subsite- GH tohana 150 GH Ambala 060670112 3 Hisar GH Hisar 400 PGIMS Rohtak 060690110 4 Jhajjar GH Jhajjar 200 PGIMS Rohtak 060720111 Subsite GH Bahadurgarh, 200 PGIMS Rohtak 060720112 5 Jind GH Jind 400 PGIMS Rohtak 060660110 6 Kaithal GH Kaithal 400 GH Ambala 060620110 7 Karnal GH Karnal 400 GH Ambala 060630110 8 Kurukshetra LNJP Hospital KKR, 300 GH Ambala 060610111 Subsite CHC shahbad 100 GH Ambala 060610112 CHC Nuh 200 PGIMS Rohtak 066140111 9 Mewat Subsite GH Mandikhera, 100 PGIMS Rohtak 066140112 CHC Ferozpurjirkha 100 PGIMS Rohtak 066140113 10 Palwal GH Palwal 400 PGIMS Rohtak 066400110 CHC Raipurani 100 GH Ambala 060580111 11 Panchkula Subsite PHC Kot, 100 GH Ambala 060580112 PHC Barwala 200 GH Ambala 060580113 GH Panipat 200 GH Ambala 060640111 12 Panipat Subsite Red Cross 200 maternity Hospital GH Ambala 060640112 13 Sirsa GH sirsa 400 GH Ambala 060680110 14 Faridabad BK Hospital Faridabad 400 PGIMS Rohtak 065260110 15 Rewari GH Rewari 400 PGIMS Rohtak 065240110 16 Gurgaon GH Gurgaon 400 PGIMS Rohtak 065250110 Total 6400 GH Ambala- 2800 PGIMS Rohtak- 3600 29

Annexure G Stamp of all 26 sites/subsites (provided to sites) State- Haryana District: Bhiwani Site Name: CHC Tosham 0 6 0 7 0 0 1 1 1 State- Haryana District: Bhiwani Site Name: GH Bawani khera 0 6 0 7 0 0 1 1 2 State- Haryana District: Bhiwani Site Name: CHC Bondkalan 0 6 0 7 0 0 1 1 3 State- Haryana District: Fatehabad Site Name: GH Fatehabad 0 6 0 6 7 0 1 1 1 State- Haryana District: Fatehabad Site Name: GH Tohana 0 6 0 6 7 0 1 1 2 State- Haryana District: Hisar Site Name: GH Hisar 0 6 0 6 9 0 1 1 0 30

State- Haryana District: Jhajjar Site Name: GH Jhajjar 0 6 0 7 2 0 1 1 1 State- Haryana District: Jhajjar Site Name: GH Bahadurgarh 0 6 0 7 2 0 1 1 2 State- Haryana District: Jind Site Name: GH Jind 0 6 0 6 6 0 1 1 0 State- Haryana District: Kaithal Site Name: GH Kaithal 0 6 0 6 2 0 1 1 0 State- Haryana District: Karnal Site Name: GH Karnal 0 6 0 6 3 0 1 1 0 State- Haryana District: Kurukshetra Site Name: LNJP hospital 0 6 0 6 1 0 1 1 1 31

State- Haryana District: Kurukshetra Site Name: CHC Shahbad 0 6 0 6 1 0 1 1 2 State- Haryana District: Mewat Site Name: CHC Nuh 0 6 6 1 4 0 1 1 1 State- Haryana District: Mewat Site Name: GH Mandikhera 0 6 6 1 4 0 1 1 2 State- Haryana District: Mewat Site Name: CHC Ferozpur Jhirka 0 6 6 1 4 0 1 1 3 State- Haryana District: Palwal Site Name: GH Palwal 0 6 6 4 0 0 1 1 0 State- Haryana District: Panchkula Site Name: CHC Raipurani 0 6 0 5 8 0 1 1 1 32

State- Haryana District: Panchkula Site Name: PHC Kot 0 6 0 5 8 0 1 1 2 State- Haryana District: Panchkula Site Name: PHC Barwala 0 6 0 5 8 0 1 1 3 State- Haryana District: Panipat Site Name: GH Panipat 0 6 0 6 4 0 1 1 1 State- Haryana District: Panipat Site Name: Red Cross maternity hospital 0 6 0 6 4 0 1 1 2 State- Haryana District: Sirsa Site Name: GH Sirsa 0 6 0 6 8 0 1 1 0 State- Haryana District: Faridabad Site Name: B K Hospital 0 6 5 2 6 0 1 1 0 33

State- Haryana District: Rewari Site Name: GH Rewari 0 6 5 2 4 0 1 1 0 State- Haryana District: Gurgaon Site Name: GH Gurgaon 0 6 5 2 5 0 1 1 0 34