Competency Based Certification for HIV Rapid Testing ...

Competency Based Certification for HIV

Rapid Testing Personnel

Participant Workbook

COMPTENCY BASED

CERTIFICATION FOR HIV RAPID

TESTTING PERONNEL

A Skills Training Programme to Assess HIV

Testing Personnel

Table of Contents

Assessor of HIV-RT Personnel: Training Overview ............................................................. 1

Purpose of HIV-RT Competency Certification .................................................................... 7

Requirements to be a Certified Assessors ....................................................................... 15

Knowledge, Skills, Attitude, and Habits of Competent Assessors ..................................... 21

Competency Assessment for Testers: Tools and Scoring .................................................. 33

Electronic Tools: How to Download and Use the Tester Certification App ........................ 39

Being Prepared to Conduct Tester Competency Assessments at Site Visits ....………………. 47

Appendix.……………………………………………………………………………………………………………………. 53

HIV RAPID TESTING PERSONNEL COMPETENCY ASSESSMENT & CERTIFICATION

Assessor of HIV‐RT Personnel Competency:Training Overview

Facilitators Contact Information

Makhosazana Makhanya [email protected]

Paulah Wheeler [email protected]

Robert Molale [email protected]

Dumisani Mhlongo [email protected]

1

Goal of the Training

To develop a pool of competent assessors to assess HIV‐RT personnel competency in support of the DoH’s initiative to roll‐out personnel certification; ensuring qualified, competent testers are performing HIV‐RT.

Training Objectives

Upon successful completion of this workshop, participants will be able to:

• Identify attributes and competencies of an assessor of HIV‐RT personnel competency.

• Develop an in‐depth understanding of the personnel competency assessment tools (written assessment, practical observation, App)

• Demonstrate the required skills/knowledge to perform effective personnel competency assessments.

• Serve as assessors of HIV‐RT personnel competency.

2

SPI‐RT Assessment Areas % Achieved

Percentage scored 82%

Personnel Training and Certification 46%

Physical Facility 93%

Safety 92%

Pre/testing Phase 87%

Testing Phase 83%

Post/testing Phase & Documentation 86%

External Quality Audit 87%

Rationale for Tester Certification

Tester Certification Overview

Training of Assessors for HIV‐

RT personnel competency

Training Program:

• 2 days didactic sections (competency assessment tools, knowledge and skills required for assessment, providing feedback, etc.)

• 1‐2 days onsite mentorship

Written Exam

Practical exam

Theory and practical

testing areas score+

Final performance

score

Panel testing final status

score+

Direct Observation

score

Manual entry of

competency results in central database (app)

3

Agenda Schedule

• Facilitators will present a topic followed by an activity which allows participants the opportunity to practice using the information in small / large groups

• There will be one Tea Break and a Lunch Break on each day of in‐class training

• There will be dedicated time for questions and comments for each topic. Extra discussion time will occur at the end of the day for subjects in the “Parking Lot”.

Housekeeping & Expectations

Group decides the ground rules and their individual expectations for this workshop!

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Ground Rules• Show up and CHOOSE to be present

• Silence cell phones

• Participate 100%

• Respect each others’ thinking and value their contributions

• Staying on schedule is everyone’s responsibility; honor time limits

• With transformation, expect anxiety

• Stay open to new ways of doing things

• Success depends on participation – share ideas, ask questions, draw others out

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Purpose of HIV-RT Personnel Competency CertificationRTCQI PROGRAM


BACKGROUND

• In 2006, the HIV Rapid Testing Quality Assurance was approved

• TQMS, RTQII and eventually RTCQI program introduced in SA to facilitate the implementation of best practices and innovative strategies to strengthen the quality of HIV Counseling and Testing Services (HTS) provided in health care facilities

• The NDOH, PDOH, NICD, NHLS and DSPs cooperated to establish the community of HIV rapid test QA networks, while helping ensure national coverage of HTS

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BACKGROUND

• In 2015, following RTCQI implementation, the outcomes of the baseline assessment led to various remedial interventions

• These interventions included the integration of CLI and RTCQI programs, decentralization of technical support to provincial HIV Prevention Directorates and incorporating CLI/RTCQI program into DSPs workplans for continuous training and mentoring

• Need to ensure every individual seeking HIV testing receives an accurate result

• However, previous quality measures and funding commitments were not sufficient to ensure the accuracy of testing

• Innovative strategies were key to addressing these quality assurance gaps

BACKGROUND

7.7 millionpeople on treatment

Fewer than240,000new HIV

infections annually

8

WHO CONTRIBUTIONS TO QA

• WHO-developed handbook aimed to assist with addressing the weaknesses identified in HIV testing programs

• In addition, it assisted countries in adhering to a new set of minimum standards to promote quality assurance and quality improvement processes

BACKGROUND: RTCQI PROGRAMME

GOALS:To ensure the quality of HIV rapid testing

nationally

To expand upon current in-country

HIV RT quality improvement work

5 KEY ACTION AREAS:

Policy Engagement

Human Resources

Proficiency Testing

Programs

Standardized Register

Post Market Surveillance

NDOH adopted RTCQI as policy and is seeking to standardise the quality of testing across the board.

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SPI-RT ASSESEMENT 2019

SPI‐RT Assessment Areas % Achieved

Percentage scored 82%

Personnel Training and Certification 46%

Physical Facility 93%

Safety 92%

Pre/testing Phase 87%

Testing Phase 83%

Post/testing Phase & Documentation 86%

External Quality Audit 87%

GAME CHANGERS

RTCQI training to all implementers

Robust rollout of personnel certification program nationwide

Continuous monitoring of QA through the use of the SPI-RT checklist

10

PURPOSE

This training program aims to develop a pool of competent assessors for HIV-RT personnel competency…

…in support of the country’s initiative to roll-out personnel certification; ensuring qualified, competent testers are performing HIV RT.

HIV RT Personnel Competency Assessment & Certification Workshop

OBJECTIVES

• To identify attributes and competencies of an assessor of HIV-RT personnel competency

• To develop an in-depth understanding of the personnel competency assessment tools

• To demonstrate the required skills/knowledge to perform effective personnel competency assessments


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EXPECTED OUTCOMES

• There will be a pool of competent assessors identified and certified for the national certification program

• Competency assessments will be conducted for testing personnel at HTS sites

• Competency data will be reviewed and analyzed in order to develop an improvement plan


Personnel Training and Certification Process

Demonstrate Initial & Continued Competency of Testing Personnel

Certify & Re-Certify Testing Personnel

Perform Accurate & Reliable Testing Results

Ensure Accurate & Reliable Diagnosis & Treatment

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Activity: Why?

He who has a “why” can endure any “how.”

- Friedrich Nietzsche

What do you currently do to help improve the performance of HIV testers and/or the quality of HIV testing?

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Requirements to be a Certified Assessor

How trainees will be deemed competent and Certified as Assessors:

1. Complete the training program

2. Pass written exam (pre- and post-test; post-test score must be >80%)

3. Demonstrate ability to successfully conduct competency assessment process (Introduction, Observation, Scoring, and Feedback) during Mock Assessment and Post-Training Observation

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Mock Assessment process flowFacilitator

Tester from Group

Remaining workshop participants

Introductions and Instructions

Score written exam

Complete Practical Observation form

Complete PT Results form

1

Give feedback to tester

2b

32c

4

Perform Practical Exam/PT

2a

Assessor from Group

Mock Assessment process

Assessor and Tester

Remaining workshop participants

Reflective Practice

Facilitators will provide feedback to trainees. As a group, we will discuss:

• Description – What happened?• Feelings – What were you thinking

and feeling?• Evaluation: What was good and bad

about the experience?• Analysis – What sense can you

make of the experience?• Conclusion – What else could you

have done?• Action Plan – Next time, what will

you do?

Facilitator

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Practical Observation Tools

1. Direct Observation Checklist (paper and app)

2. PT Results Form

Criteria for success in conducting the competency assessment process

What knowledge, skills, and attitudes would make an assessor successful in conducting the HIV Rapid Testing Personnel Competency Assessment?

Activity:Write down all the knowledge, skills, or attitudes for success that you can think of on sticky notes (one per sticky).

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Knowledge:The condition of being aware of something. It includes the recall, recognition, understanding, application, and evaluation of facts, patterns, and concepts.

Skills:Skills relate to the ability to physically perform an activity or task. It includes physical movement, coordination, and the application of knowledge.

Attitudes:A way of thinking or feeling about someone or something. It includes the manner in which a person may deal with things emotionally, and is reflected in a person’s behavior.


Assessor Attributes and Performance

Introduction given (of both self and topic)

Comfortable using direct observation checklist, paper or app version

Assistance and guidance to the tester when necessary

Feedback/conclusion/summarization to tester

Organization and preparedness: do they have all components of the Site Visit Documents Package for Assessors

Time management

Subject matter knowledge/command on subject/topic

Communication (language, choice of words, spoke clearly and easily understood)

Assessor Attitude: Confident, ethical, professional

Professionalism exhibited throughout assessment (appropriate dress, not using phone during assessment)

Accurate scoring of tester

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Post-Training

Upon completion of this workshop:Participants must complete an assessment under observation by training facilitators and be deemed a competent assessor

Thank you!

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Knowledge, Attitude, Skills, and Habits of Competent Assessors

Learning Objectives

At the end of this session, participants will be able to:• Describe the knowledge, attitude, skills, and habits required

to be a successful assessor of HIV tester competency• Distinguish between acceptable and unacceptable practices

when conducting a tester competency assessment• Understand how to continue to improve as an assessor using

reflective practice

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Do you have KASH?

= Individual Performance

Knowledge Required to be an Assessor

Knowledge is the condition of being aware of something. It consists of facts, concepts, as well as the understanding and application of information.

Knowledge is acquired through education, training, and experience.

Knowledge of facts and concepts form the foundation for the ability to apply the skills to perform a specific task.

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Knowledge Required to be an Assessor

A competent assessor must:• Have a general knowledge of quality control & quality assurance• Possess technical knowledge related to the current national HIV-RT

algorithm• Understand the tester competency assessment tools, scoring, and

corrective action (remediation)

Assessor’s Attitude

Attitude is a way of thinking or feeling about someone or something. A person’s attitude affects feelings, values, appreciation, and motivation towards something.If a person has a positive attitude towards a topic, they will likely be more motivated to learn about that topic and develop a skill.

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Assessor’s Attitude

Unbiased and impartial

Independent

Ethical

Decisive

Motivated to do a good job

Concerned about quality of HIV RT

Passionate about reducing HIV burden

Skills Required to be an Assessor

Skills relate to the ability to physically perform an activity or task.Competency and proficiency in the execution of skills requires training and practice. Usually a person acquires the knowledge of how to perform a task and then begins to physically perform the task.

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Skills Required to be an Assessor

• Observant and detail-oriented• Proficiency in providing instructions

and guidance for the assessment • Proficiency in scoring the tester using

the Direct Observation Checklist paper form and app; and scoring the written exam

• Diplomacy and conflict resolution• Communication• Leadership• Providing positive reinforcement and

constructive criticism• Professionalism and respectfulness• Problem-solving• Patience• Empathy• Ability to build relationships and trust

Skills Required to be an Assessor: Communication

Activity

MirroringHow well do you communicate?

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Good communication starts with listening.• What is said may not be what is heard

– Choose your words carefully– Observe how they are received

• What is heard may not be understood– Engage in discussion to ensure understanding

• What is understood may not be accepted– The HIV tester may be defensive during the tester competency

assessment


80% of Communication is Non-VerbalBody Language• Posture• Eye contact• Arm position

Facial Expression• Eyes• Mouth

Overall attentiveness


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“Communication is culture and culture is communication”

Habits are behaviors that are repeatedly and consistently done.

Excellent performance is a result of doing the appropriate and most effective actions repeatedly. Skills practiced correctly over and over develop into habits.

A habit is not something a person learns, but rather it is something that they create.

Habits of a Successful Assessor

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Be responsible.

Assessors must:• Have contacted all relevant people in advance of the site

visit to ensure that they are aware of and approve the assessment date

• Understand the assessment process and be able to provide clear instructions to the tester

• Bring all necessary materials and forms to the site visit• Manage time • Be prepared for questions


Be professional.

Assessors must be professional:• Make intelligent, authoritative decisions• Control conflict between others• Effectively assess and solve problems • Attitude and behaviors: Non-judgmental & respectful• Communication: Address issues not personalities• Your ethical positions – trustworthy• Demonstrate investment in improving tester competency by

offering constructive feedback and remediation planning


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Be observant.

Assessors must:• Interpret and apply the appropriate direct observation

checklist items to different tester competency assessment situations

• Collect relevant, reliable, factual evidence from observing tester and surroundings

• Be very detail focused• Exercise sound judgment & analytical skills


Why are these skills, abilities, and actions important?

= Individual Performance

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Assessor Do’s & Don’tsDO:

• Give compliments when deserved• Encourage staff to achieve competency objectives • Be fair to all • Use respectful and tactful language to give feedback• Remember that quality is generally about

systems/protocols/habits and not personalities• Remember that tester competency assessments are to

ensure improved reliability and better patient care

Assessor Do’s & Don’tsDON’T:• Focus on insignificant issues• Intimidate and ‘talk down’ to staff• Try to find only ‘what’s wrong’ and ignore ‘what’s right’• Stimulate conflict• Be prescriptive and dogmatic (i.e. only your view counts)• Give unclear feedback• Base observations on unvalidated information

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Description

Feelings

Evaluation

Analysis

Conclusion

Action Plan

What happened

What were you thinking and feeling

What wasgoodand bad about the experienceWhat sense

can you make of the experience

What elsecould you have done

If it aroseagain what would you do

Continuously learning from experience…..

Assessors Practice Reflection to Continuously Improve

Assessment Role Play

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Competency Assessment for Testers: Tools and Scoring


Learning Objectives

• Describe the components and tools of a HIV-RT personnel competency assessment

• Describe how the final assessment score is calculated and how an assessor determines if a tester is deemed competent or needs further training

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Competency Assessment Components

Competency Assessment

Introduction• Assessor and topic/purpose introduced

Practical Observation • PT Results form (paper, but enter score into app)• Observation Checklist (paper and app)• Assistance and guidance only when necessary

Written Assessment• Giving instructions for the written exam• Enter final scores of each section into the appFeedback• Summary, assessment conclusions, remediation

plan

Three Factors…

1.Direct Observation – 90% or higher required to pass

2.PT Results – 100% required to pass

3.Written Assessment– 80% required to pass

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Direct Observation Score

– x/22 points *100% – Must get 90% or higher to pass

Practical Observation: Observation Form

Review this form:Direct Observation Checklist

NOTE:This form is also in

the app!

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Practical Observation: PT Results Form

Review this form:HIV Rapid Testing Result Form

PT Results

– Test Interpretation: 1 point for each sample, based on 6 samples = 6 points

– Final Result: 1 point for each correct result, based on 6 samples = 6 points

– X/12 * 100% = ?– Must get 100% to pass

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Written Exam

• Must get 80% or higher to pass (“Satisfactory”)

• X / 25 points * 100• Must also record number

of points per section

Review this form: Written Examination Results Sheet

Feedback

• Use the Summary and Remediation Plan form to provide feedback to the in-charge

• To be completed for ALL testers on one form (not one form per tester) –protect confidentiality of tester performance– Individual tester performance can

be found in your app

• Make copy or take a picture for your records, leave original with in-charge

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Electronic Tools: How to Download and use the Certification App

2

• Demonstrate how to Download the Certification App

• Use App to enter written exam score

Learning Objectives

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DOWNLOAD PROCESS

https://seadsolutions.co.za/apk/seadcollect_v_2.apk

Please follow the above link and download the application from our SEAD Solutions platform and follow below step:

SEAD COLLECT SETUP

Step 1:

Application Main Menu

The application consists of 6 tabs Fill Blank Form, Edit Saved Form, Send Finalized Form, View Sent Form, Get Blank Form and Delete Saved Form, the below refers:

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SEAD COLLECT SETUP

Step 2

Logging in and Connecting to Server

Select the submenu item option in the right‐hand corner of the application.

A Drop‐down menu will display, select the General Setting option.

Select the Server option in General Settings.

Please type in the Username and Password credentials provided to you by the SEAD team.

Password: dog4desk

SEAD COLLECT SETUP

Step 2 (Continued…)

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SEAD COLLECT SETUP

Step 2 (Continued…)

SEAD COLLECT SETUP

Step 3

Form Management Settings

Select Form Management

Select Constraint Processing

Ensure constraint processing behaviour is “Validate upon forward swipe”

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SEAD COLLECT SETUP

Step 4

User and Device identity (Anonymous Submission turn off)

Select menu option

Select User and device identity

Select Form Metadata 4.1. Select Username and enter your username provided.

Select Email and enter your email address

FORM INSTALLATION

Installing the form on your application. Select the Get Blank Form option in the Main Menu.

The Application will connect automatically to the server.

“Get Blank Form” screen will display with preloaded listed forms marked with blue boxes. Clear all boxes by selecting the “Clear All” option in the bottom left corner.

Double check that all the boxes are unticked by scrolling “Up” and “Down”.

Select the form you are instructed to do your assessments by management a blue ticked boxed should appear next to the form.

Select the “Get Selected” option in the bottom right corner

The application will connect to the server to get the form selected. The red circulation indicates the form being loaded to the application.

Select the “OK” option when the Download Result screen appears, the application will navigate to the Main Menu.

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FORM INSTALLATION

Installing the form (Continued…)

GETTING STARTED

Getting Started

Select the “Fill Blank Form” option in the main menu.

Select the form downloaded in the Fill Blank Form, the form will load and take you to the first page of the form application.

Your form is now ready to be used.

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FIRST POINT OF CONTACT

Contact details

Activity: Taking the Written Exam

• All trainees will now take the written assessments which will be given to testers

• The purpose of this activity is the following:

– All trainees should understand what the testers are being tested on

– Any problems with the written exams should be circled and reported to facilitators

– Practice scoring and entering tester exam score on the App

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Being Prepared for Conducting Competency Assessments at the Site Visit

• Describe the items and tools one must bring to an HIV-RT

personnel competency assessment (site visit)

• Understand the appropriate way to dress at the site

• Develop an introduction script

Learning Objectives

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Preparation• Site selection• Schedule an appointment with sites

– Contact the facility and confirm the date– Find out how many testers per site – Check back with facility 1-2 days before visit

• Procure PT panels

How will assessors procure PT panels?

Tools

• Use this form ->• Bring this form

with you to every site visit, review and make sure you have all tools listed on this form!

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Although the assessor can choose to use the paper form of

the Direct Observation Checklist, the assessor must enter

the scores of the practical observation and written

assessment into the app.

True or False?

• Use the Summary and Remediation Plan to deliver feedback at the end of the assessment

• Share and make copies of this form for the in-charge

• To be filled out generally for findings from assessments of all testers, not one form per tester (individual tester data is confidential and can be found in the app)

Feedback

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What should you wear?

From your professional experience and your knowledge of the community in which you will conduct site visits –

What is the appropriate and professional way to dress? Describe clothing, shoes, style of hair, and anything else that is relevant.

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Imagine it is your first time visiting a site to perform the HIV RT Personnel

Competency Assessment.

What will you say to the tester?

In groups, develop an introduction script.

Activity

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APPENDIX

A. Procedure for Administering Tester Competency Assessment (SOP)…page 55

B. Procedure for Remediating Tester Unsatisfactory Performance (SOP)…page 59

C. Site Visit Documents Package for Assessors…page 61

D. Introduction Script for Assessors…page 63

E. Direct Observation Checklist Form…page 65

F. Proficiency Testing Results Form…page 67

G. Written Examination Results Sheet…page 69

H. Summary and Remediation Plan…page 71

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Purpose: To describe how to properly administer both the written and practical assessments to assess tester competency to perform HIV rapid tests in preparation for the national certification program.

Resources:

1. Tester Certification App (Tablet/Mobile Phone with Android OS)

2. Direct Observation Checklist Form

3. Written Assessment Results Sheet

4. Written Assessment Questions (versions #1 - #5)

5. Written Assessment Memorandums for each version

6. Practical Assessment – PT Sample Panel

7. Practical Assessment – PT Results Form

8. Introduction Script for Assessors

Assessor Criteria:

All assessors must have the minimum qualifications in order to administer tester competency assessment for

HIV rapid testing:

1. Successfully completed a nationally recognized tester competency assessment training or refresher

training within the last two years.

2. Completed a nationally recognized Rapid Test Continuous Quality Improvement (RTCQI) or refresher

training within the last two years.

3. Have knowledge of the three phases of HIV rapid testing, general safety practices, and biohazard waste

management.

Criteria for Individuals to be Assessed:

1. Performs HIV rapid testing: everyone who tests clients must be assessed.

2. Have completed a nationally recognized Rapid Test Continuous Quality Improvement (RTCQI) or

refresher training within the last two years.

o However, if the individual has not completed RTCQI training, they should still be assessed and

a plan for training should be made as part of the remediation process.

Note: Multiple number of testers in a facility can take the written assessment at the same time and, with prior

arrangement, take the written assessment or practical assessment alternatively at a different point in time.

Step Description Resources

1 Planning for the assessment visit: Plan the practical assessment by informing the

health facility, the person in-charge, and the testers. Agree on the date and time of the

assessment. Follow up 1-2 days before the scheduled assessment to confirm the visit.

Note: Based on the number of testers, the assessor needs to estimate the length of the

assessment and the most efficient procedure (i.e., number of rooms needed, when the

written assessment will be done).

• E-mail and phone

call to health

facility leadership

Procedure for Administering Tester Competency Assessment for HIV Rapid Testing Written Assessment and Practical Assessment

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2 Introduction: The assessor will introduce to the OPM and individual testers the

purpose of the assessment including:

• Goals and objectives of the assessment

• Components of the assessment

• How the tester will be scored

• General guidelines for the tester during assessment

• How the results for the assessment will be used

• Introduction

Script

3 Registration: Registration is completed using the Tester Certification App and on the

top portion of the Written Assessment Results Sheet labeled Tester Information.

Note: Registration should be completed prior to administering the assessment. The

assessor will have to work with the facility management to ensure all testers have

enrolled for competency assessment. The tester will fill out their information on the

Written Assessment Results Sheet. Next, they will follow the instructions on the sheet

to ensure they receive full credit for their assessment.

• Tester

Certification App

or TESTER

INFORMATION

section of the

Written

Assessment

Results Sheet

4 Conducting the Written Assessment:

The assessor will give each tester two documents to complete the written assessment:

• Written Assessment Question Sheet

• Written Assessment Results Sheet

Note: give different versions of the question sheet to different testers.

The assessor will give instructions for completing the written assessment:

1. The tester completes tester information on the written assessment results

sheet prior to beginning the assessment.

2. The assessor should remind the testers not to write anything on the

assessment question sheet.

3. The assessor should remind the testers not to communicate during the

assessment.

4. The assessor should remind the testers to read the questions carefully and

choose only ONE correct answer.

5. To complete the results sheet, the assessor should remind the testers to write

ONLY the letter corresponding to a selected answer e.g. D on the column ‘Your

Answer’

6. There is no time limit for completing the written assessment.

7. Once the assessment is completed, the tester will sign and date written

assessment results sheet before turning it to the assessor.

8. The assessor will collect both the QUESTION sheet and RESULTS sheet from

the testers.

9. The assessor will use the written assessment memorandum to mark the

testers’ answers. Note: each question with correct answer will receive ‘1’

point and incorrect answer ‘0’.

10. The assessor will indicate the correct answer in the shaded column ‘Correct

Answer’.

• Written

Assessment

Question Sheet

(versions #1- #5)

• Written

Assessment

Results Sheet

• Written

Assessment

Memorandum

(for assessor only)

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11. The assessor will tally and indicate the final percentage score obtained by the

tester and performance (satisfactory or unsatisfactory).

12. The tester performance is graded satisfactory if ≥ 80% or unsatisfactory if <

80% final score was obtained.

13. The assessor will sign and date the written assessment answer sheet.

14. The assessor will enter the score of the written assessment into the app.

15. If the tester is unsuccessful in written assessment, the tester should be given

another opportunity to write on the next available date.

5 Conducting the Practical Assessment

To begin the process of practical assessment, the assessor must:

• Describe the objectives of the practical assessment

• Instruct the tester on general process and guidelines for completing the

practical assessment

Beginning the assessment process: 1. The assessor will ask the tester if he or she is ready to begin the assessment. 2. The assessor will provide the tester with the PT Sample Results Form and the

PT Sample Panel. 3. The assessor and tester will complete the top part the direct observation

checklist (names and date of assessment and training) prior to beginning the assessment.

4. The assessor will instruct the tester to proceed testing using their usual procedure.

5. Using the direct observation checklist paper form or app, the assessor

observes if the tester is accurately following the testing procedures and

process including safety and the national algorithm for HIV rapid testing.

6. To score each step of the observation checklist, the assessor will assign ‘1’

point if the step is accurately followed or ‘0’ if the step was missed or ‘0.5’ if

the step was partially completed.

If the following issues are observed during the assessment, the assessment will

immediately be stopped:

• Tester uses expired test kits

• Tester uses incorrect test kits (e.g. syphilis test instead of HIV, or

switch the test in the algorithm)

• Tester compromises safety (e.g., not wearing gloves or appropriate

PPE, no waste disposal containers, etc.)

• Tester does not follow the national algorithm

7. If assessment is stopped, the assessor will explain to the tester why it was stopped.

8. The tester completes the practical assessment results in the PT Results Form. 9. The assessor will tally and indicate the final percentage score obtained by the

tester in both the direct observation and PT sample testing.

• PT Sample Panel

• Direct

Observation

Checklist (Form

and App)

• PT Sample

Results Form for

tester to

complete

• PT Sample

answer key (for

the assessor

only)

57

10. The assessor and the tester will date and sign both the Direct Observation and PT Sample Results forms, on paper and in the app.

11. A tester’s performance is deemed satisfactory if the tester obtained a score of ≥ 80% on direct observation and 100% on PT sample results.

12. A tester’s performance is deemed unsatisfactory if the tester obtained a score of < 80% on direct observation and < 100% on PT sample results.

13. The assessor will provide verbal and written feedback to the tester and document the feedback in the app.

14. Feedback should include:

• The final scores obtained by the tester

• The assessor’s performance recommendation and plan for remediation (in service training, offsite training, etc.)

• The feedback should be brief and highlight both the areas of improvement and best practices

• Avoid criticism and embarrassment 15. Summary of performance of all testers assessed should be provided to the

OPM/in-charge. 16. If the tester is unsuccessful in practical assessment, the tester should be given

another opportunity to be assessed in the next available date.

Note: If the tester’s performance is repeatedly unsatisfactory, both on written and practical assessment, an interview with the tester should be conducted to identify areas of weaknesses and concern, and further remedial action should be implemented.

Final Score Calculations Written Assessment: tester score ÷ total points for written assessment (25) x 100 = % Direct Observation: tester score ÷ total points for direct observation (22) x 100 = % Practical Sample Testing: tester score ÷ total points for sample testing (6) x 100 = % Criteria for Tester Competency Satisfaction Written Assessment: ≥ 80% Direct Observation: ≥ 80% Practical Sample Testing: 100% Remedial Action An interview with the tester should be conducted to identify areas of weaknesses and concern. Any weakness identified should be tailored to address the needs of the individual tester. If written language is a barrier, other means of assessment should be considered e.g. oral evaluation. See the Remedial Action SOP.

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Purpose: To describe the key players, requirements, processes, tools and procedures needed for the process of

remediation for testers in HIV Rapid Testing who do not meet competency criteria during the first or subsequent

attempts.

Resources: Written assessment results, direct observation results, PT sample results, Competency Assessment

Remediation Plan

Step Description Resources/Tools

1 Identify and document the gaps after the written and practical assessment in the Competency Assessment Summary and Remediation Plan.

• For the written assessment, the topic area(s) where the tester performed unsatisfactory should be documented by the assessor (e.g. QA, Safety, algorithm, etc.) to be addressed in the remediation plan.

• For the practical assessment, the results from the direct observation checklists and the PT sample testing result form will inform the topic areas (e.g. testing algorithm, test procedures, recording) that need to be addressed.

• Written Assessment

Results

• Direct Observation

Results

• PT Sample Testing

Results

• Competency

Assessment Summary

and Remediation Plan

2 Develop an improvement plan to address gap(s) identified. Based on

the gaps identified, the improvement plan may include:

• initial training if the tester has never been trained

• refresher training

• onsite coaching/mentoring

• supportive supervision visit by HTS Coordinator

• Competency

Assessment

Remediation Plan

3 In following the Competency Assessment Remediation Plan, the

assessor will work with the facility in charge or HTS coordinator or

Support Partner to document and implement further gaps and

remedial actions taken, as well as the outcomes.

• The remedial action taken should seek to identify tester areas

of weaknesses and concern. Any weakness identified should

be tailored to address the needs of the individual tester. If the

assessment approach is in itself a barrier, other means of

assessment should be considered.

• Competency

Assessment

Remediation Plan

• HIV RT Training

Materials and manual

• RTCQI Training

Materials and manual

Procedure for Remediating Tester Unsatisfactory Performance

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Step Description Resources/Tools

4 Schedule the next competency assessment for the tester 3 months

following the completion of the remediation process.

Note: For the re-assessment, it will be important to determine who

will be responsible and whether to use the same or different assessor

as the original/previous assessment.

5 The assessor should make a copy of the Competency Assessment

Summary and Remediation Plan for his/her records and leave the

original document with the OPM/in-charge of the facility.

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South Africa National HIV Tester Certification

Site Visit Documents Package for Assessors

Assessment Package Checklist – 9 items to bring to every assessment!

Item Yes/No

1. Site Visit Documents Package for Assessors (this sheet)

Written Assessment (one of the following for each tester):

2. Blank Written Assessment Results Sheet

3. Written Assessment Questions (bring different versions)

4. Written Assessment Memorandums (only for assessor)

Practical Assessment (one of the following for each tester):

5. PT Results form

6. Direct Observation Checklist Form and App

Feedback:

7. Summary and Remediation Plan

Supplies:

8. PT samples, 1-2 extra sets of samples (in the event of spills or contamination), and answer key for PT

#9 – a positive attitude! Remember the purpose of your role: to give an accurate, ethical assessment and provide helpful feedback.

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62

HIV Rapid Testing Personnel Competency Assessment & Certification

Workshop

Introduction Script for Assessors

To be read to HIV Rapid Testing personnel prior to each assessment.

I. Greeting and Introduction:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

II. Goals and objectives of the assessment:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

III. Components of the assessment:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

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IV. How the tester will be scored:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

V. General guidelines for the tester during the assessment:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

VI. How the results of the assessment will be used:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

VII. Closing remarks (Is there anything else you want the tester to know?):

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

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Practical Examination - Direct Observation Checklist (For use while observing PT sample testing)

______________________________________ Name of Tester

__________________________________________________ Name of Evaluator

__________/___________/________________

_____________/__________________/_____________________

Last Training Date Date Direct Observation was Conducted

Scoring Criteria 1 = Step performed correctly; 0 = Step incorrectly performed or skipped; ½ is Partially Correct; N/A= Not applicable

Steps to be observed (Evaluator to score each step observed) Score Comments

1 Followed all safety precautions as per SOP (lab coat, apron, gloves, etc.…)

2 Working area is disinfected and organized (i.e., free of clutter)

3 The content of the PT pack is verified

4 The integrity of the PT pack is verified (i.e. PT sample tubes are not leaking)

5 Check and record expiry date of test kits and buffer Note: Verify if the HIV RT kit lot is within the expiration date. If it has expired; stop the examination

6 Correct test kit used to perform testing Note: Verify if the correct HIV RT kit is being used. If the national algorithm is not being followed; stop the examination

7 Write PT sample ID on test device?

8 Test 1 -> Correctly set timer before proceeding with testing AND start timer after buffer is added to the last sample

9 Test 1 -->Use correct Sample Volume using the correct sample collection device

10 Test 1 -->Use correct Buffer Volume

11 Test 1 -->Record Test Result on PT form only at the end of the wait time

12 Followed the job aid or test procedure while performing Test 1

13 Test 1 -->Use correct result interpretation/documentation (i.e., reactive, non-reactive or invalid)

14

Test 1 -->Final result Correctly identify and document non-reactive samples and document the test result for them as negative. Correctly identify and document reactive samples that need to be confirmed by Test 2. Correctly identify and document invalid results.

15 Test 2--> Correctly set timer before proceeding with testing AND start timer after buffer is added to the last sample

65

Steps to be observed (Evaluator to score each step observed) Score Comments

Note: Verify if the correct HIV RT kit is being used. If the national algorithm is not being followed; stop the examination

16 Test 2 --> Use correct Sample Volume using the correct sample collection device

17 Test 2 -->Use correct Buffer Volume

18 Test 2--> Record Test Result on PT results form, only at the end of the wait time

19 Followed the job aid or test procedure while performing Test 2

20 Test 2 -->Use correct result interpretation/documentation (i.e., reactive, non-reactive or invalid)

21 Test 2 -->Final result Correctly identify and document the test result for each sample tested (i.e., negative, positive)

22 Disinfect and organize work space at the end of testing and dispose of wastes in correct bin (gloves, wrapper, pipette, test kits, samples, etc.)

Total Points

Direct Observation score: (…………/22)* 100= …………….% [Indicate the score obtained for the direct observation by the provider] For example if the provider got all of the direct observation questions correct, then score 100%. PT Sample results score: …………% [Indicate the score obtained for the panel by the provider – PT Results Column 3, Test Results] For example if the practical exam include 6 samples to be tested and all sample test results are correct, then score 100% (=6/6*100)=100%. If only 2 samples results are correct score 33.3% (=4/6*100] Overall Comments: (Document whether the provider demonstrated competency and indicate areas of improvement if any) Remedial Action (if applicable):

Date Examination completed: _______/_______/________ Tester Signature: ___________________________ Name of Evaluator: _______________________________ Evaluator Signature: _________________________

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68

Version of Written Examination: _____________

HIV Tester Certification - Written Examination Results Sheet

TESTER INFORMATION Last Name ……………………………………..…… First Name: ……………………..…………………. Middle Name: ……………………….…...…

(Surname) (Given name)

Province……………………………………. Facility Name: …………………………………………………………………………………

Date of last training: …………/……………/..……….. Length of training (days): ………………………………………………………………..

Time worked as tester to date (Years or months): ...........................................................................................................

Phone: …………………………………………….………... Email (if available): ………………….………………………………………... Written Examination Instructions

• Complete the Examination Information section before you begin the examination. Failure to do so will result in not scoring your test.

• For each question, indicate the question code and write the letter of the correct statement in the column labelled “Your answer”.

• Make sure to answer all the questions. Each correct answer will receive one (1) point. Incorrect answers or questions left unanswered will be scored zero (0) point. A total score of 80% (or 20 points) or higher is required to pass the examination.

• Before turning in your Examination Results Sheet, verify that you have answered all the questions, indicated your name, the date and signed the examination sheet.

Section S/N Your answer Correct Answer

Section S/N Your answer Correct Answer

QA

1 14

2

Logbook

15

3 16

Overview

4 17

5

PT

18

6 19

Safety

7 20

8 21

9 Ethics

22

Specimen 10 23

11 Inventory

24

Algorithm 12 25

13

Signature of Tester: Examination date: / /

Score to be summarized by Assessor only

Section Title Points obtained

Points expected

Section Title Points obtained

Points expected

1. Quality assurance 3 6. Record keeping/ Logbook 3

2. Overview of HIV RT 3 7. EQA/PT 4

3. Safety 3 8. Professional ethics 2

4. Specimen collection 2 9. Inventory 2

5. HIV testing algorithm 3

Overall score 25

Final score obtained: …………... % Performance recommendation: Satisfactory Unsatisfactory

Name and Signature of Proctor/Assessor: …………………………………………………………… Date: …….…/…….……/……..……

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70

HIV Rapid Testing Personnel Competency Assessment

Summary and Remediation Plan

Date of Assessment Assessor’s Name

Number of Testers Assessed Facility Name

WRITTEN EXAM Summary: best practices and/or deficiencies observed.

WRITTEN EXAM Plan for Remediation:

PRACTICAL ASSESSMENT Summary: best practices and/or deficiencies observed.

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PRACTICAL ASSESSMENT Plan for Remediation:

PT SAMPLE RESULTS Summary: best practices and/or deficiencies observed.

PT SAMPLE RESULTS Plan for Remediation:

General comments about the assessment:

Date of Next Training or Remediation

Action (if applicable)

Date of Next Assessment (if applicable)

Signature of Assessor Signature of Facility In-Charge

Name of Facility In-Charge

72