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Table 3 PALM PLUS Training the Trainer to Train (TtTtT) case scenario training plan

From: From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi

Day Session Description
Sun   Travel to venue
  1 Introduction to TtTtT PALM PLUS
Mon 1, 2 Straightforward symptom scenarios:
• Cough and difficulty breathing -severe pneumonia
• Runny/blocked nose - URTI
• Blood in urine - Bilharzia
• Confused patient - delirium
• Fever - Malaria
  3,4 HIV testing
• Headache - sinusitis
• Approach to STI
• Lymphadenopathy - Bubo
• Vaginal discharge/sexually abused
Tues 1 Managing HIV - routine care & ART
• Weight loss & sore mouth - focus on routine care
• Asymptomatic - oral thrush - focus on starting ARVs
• Diarrhoea - focus on ART follow-up
  2 TB - diagnosing, treatment & follow-up
• Cough - HIV negative, sputum positive - focus on TB follow up
• Fever - HIV unknown, 1 smear positive - educate about Malaria
  3 TB and HIV - diagnosing and treating both TB & HIV
• Discharging ear - HIV positive, 1 smear positive - TB care
• Cough - HIV positive, smear negative - Health worker with TB & HIV
  4 ART and/or TB drug side effects
• Burning feet - peripheral neuropathy TB med related
• Abdominal pain - drug related - drug related hepatitis - NVP or TB treatment
• Vomiting - lactic acidosis - ARV side effect - ARV care
• Skin rash - ARV side effect
Weds 1 Pregnancy: Unwell and tired - HIV pregnancy/PMTCT
  2 Chronic respiratory disease: Cough, difficult breathing with wheeze - acute asthma
  -- Free time
Thurs -- Full day training experience - consolidation of content knowledge and training skills
Fri 1 Making PALM PLUS your own - a creative exercise
  2 Evaluation & Closure