Stigma and Exclusion from Care Reduction using Virtual-Reality Experiences (SERVE) Uganda

The specific problem our project is aiming to address centers on the stigma and discrimination faced by individuals with HIV (PWH) in Uganda, particularly key populations (KPs) like sexual and gender minorities, sex workers, and people who inject drugs. This stigma is a critical barrier to effective HIV prevention and care services and directly hampers efforts to reach the UNAIDS 95-95-95 targets for HIV status awareness, treatment, and viral suppression.

The scale of the problem is substantial both locally and globally. In Uganda, a significant portion of the 1.2 million PWH faces stigma, which exacerbates the already difficult challenges of living with and managing HIV. This stigma, both enacted by healthcare providers and experienced by PWH, can lead to delays in accessing care, loss to follow-up, and decreased prescription refill rates, particularly among marginalized groups. It has a cascading effect on the health outcomes for PWH, including viral load and CD4 counts.

Our solution proposes to adapt virtual reality (VR) technology to immerse healthcare providers in the experiences of PWH. This innovative strategy aims to increase empathy among healthcare providers, leading to a reduction in enacted stigma in clinical settings. The use of VR as a training tool is supported by evidence that suggests it can effectively enhance the acquisition of practical knowledge and skills relevant to clinical practice, including empathy.

Globally, healthcare provider stigma has been recognized as a significant source of HIV stigma, driven by misconceptions about transmission and pre-existing biases against marginalized groups. Addressing these stigmas is key to improving the clinical experiences of PWH and ensuring better health outcomes.

Our project aligns with successful strategies implemented in sub-Saharan Africa and elsewhere. For example, interventions in South Africa and Kenya have shown promise in mitigating discriminatory attitudes within healthcare settings, leading to improved access to HIV services for adolescent girls, young women, and sex workers. The criminalization and resulting stigma associated with sex work in these regions have been linked to higher HIV prevalence and adverse health outcomes due to mistreatment in healthcare settings.

In Uganda, programs like the Most At Risk Populations Initiative (MARPI) demonstrate the potential success of culturally responsive HIV and sexual healthcare training for healthcare providers serving sexual and gender minority (SGM) communities. The nationwide scaling of MARPI's approach by the Ministry of Health exemplifies the effectiveness of targeted interventions.

By implementing VR technology, we can further these efforts, utilizing the medium's immersive capabilities to foster a deeper understanding and empathy among healthcare providers. This enhanced empathy has the potential to significantly reduce the stigma experienced by clients, improving their engagement in care and health outcomes.

Ultimately, our project seeks to contribute to a stigma-free healthcare environment, which is essential for reaching global HIV prevention and care goals and ensuring equitable health outcomes for all PWH, regardless of their background or identity.

Our solution builds on our Virtual Reality (VR) intervention designed to reduce stigma among healthcare providers (HCPs) among Black or Latinx communities in the healthcare setting at UCSF. The intervention, called CULTIVATE (Combating Unequal Treatment in Health Care Through Virtual Awareness and Training in Empathy), employs immersive VR scenarios that place HCPs in the shoes of patients facing racial bias and language barriers in healthcare settings.

The VR experience is developed to make HCPs vividly feel the patient’s predicament – for example, in the US, as a Latinx individual grappling with language barriers or as a Black woman subjected to microaggressions by healthcare staff. Our pilot study has shown that such immersive experiences can significantly increase clinicians’ self-reflexivity regarding their interactions with patients and the potential impact of their unconscious biases. We hope to expand this tool to the context of HIV care in Uganda with relevant marginalized populations, building on UCSF’s experience and the tools that the African Center for Excellence in Bioinformatics and Data Sciences has developed.

To evaluate the impact of this VR training on HCPs’ attitudes and behaviors, we use 'mystery clients' – individuals trained to simulate real patients in a controlled manner. They covertly audio-record interactions with HCPs pre- and post-intervention, capturing tangible evidence of any changes in attitude or practice. These recordings are then analyzed using natural language processing (NLP) algorithms to quantitatively and qualitatively assess shifts in communication styles, linguistic markers of empathy, and stigma.

This innovative mixed-methods approach leverages sophisticated technology not only to enhance the quality of care and empathy in HCPs but also provides a measurable, scalable solution to address the persistent problem of stigma in healthcare settings.

Our study's innovation lies in its application of VR technology to a novel context—enhancing empathy in HCPs to improve care for key populations (KPs) like adolescent girls and female sex workers. This approach has not been widely used for stigma reduction in healthcare settings, especially in resource-variable environments such as sub-Saharan Africa. Additionally, creating VR scenarios that reflect local experiences and employing them in clinics in Kampala represents a groundbreaking application of this technology.

By capitalizing on the rising affordability of VR hardware and the existing digital capacity in Uganda, our team combines UCSF’s experience in VR for empathy enhancement with IDI’s technical expertise in VR scenario development. We aim to be at the forefront of using VR for capacity building in HIV care, making this intervention both timely and imperative given the current technological landscape.

Ultimately, our VR-based training aims to create a significant shift in the quality of patient-provider interactions, leading to improved care for people living with HIV and the advancement of client-centered care, particularly for KPs who face pervasive stigma in healthcare settings.

Meeting the 95-95-95 UNAIDS targets in Uganda requires reducing stigma especially stigma enacted on key populations (KP). Despite longstanding recognition that tackling HIV stigma is ‘a critical element in combating the global HIV pandemic”,26 it remains a major impediment to reaching UNAIDS’ global 2025 targets: 95% of people with HIV (PWH) know their status, 95% of those diagnosed are on antiretroviral treatment (ART), and 95% of those receiving ART are virally suppressed. This is especially true in Uganda, where stigma is a major barrier to care for key populations with HIV or at risk for HIV, especially MSM27,28, FSWs;29,30 and adolescent girls, legal precarity for sexual minorities and FSWs, as a result of recent legislation in Uganda,7 will likely worsen stigma for these groups, who are already more likely to delay accessing care, more likely to be lost to follow up and less likely to pick prescription refills, compared to other PWH.8,10,31,32 Therefore, it's essential to develop interventions aimed at reducing stigma, which not only diminish individuals' internalized stigma but also significantly enhance the health outcomes for PWH. This solution will develop a new tool to train providers, putting them in the shoes of their clients and building empathy towards them. This tool can be scaled to other parts of Africa where key populations experience persistent stigma when accessing care. This solution has the potential to be a scalable training tool that improves the quality of care that marginalized clients in sub-Saharan Africa experience and as a result support better care for HIV and reduce HIV transmission and health disparities.

Team Overview: Our team is highly experienced in conducting culturally sensitive behavioral and laboratory studies in the areas of HIV prevention with vulnerable and marginalized populations, both in the US and Uganda.

Dr. Jjingo is a faculty member at Makerere University and Senior Scientist at the Infectious Disease Institute in Kampala. He currently serves as the PI for the Fogarty U2R Bioinformatics training grant at Makerere University and the founding Director of the African Center of Excellence in Bioinformatics and Data Intensive Sciences. Furthermore, he currently serves a co-investigator on the NIH supported Open Data Science Platform (ODSP) which supports the computational and data science needs of the network of data science training and research hubs across the African continent under the NIH’s Data Science for health innovations program.  Dr. Jjingo also leads IDI’s work using VR to enhance training and capacity building efforts, including developing VR tools to assist in the Ugandan response to COVID.

Dr. Taylor is a faculty member at the Division of Prevention Sciences at UCSF and the PI of the CULTIVATE study, the California- based research evaluating the role of Virtual Reality (VR) technology to train providers on implicit bias and discrimination towards racial and ethnic minorities.18,43

Dr. King is a faculty member at UCSF, and since 2010, the UCSF in-country director. As the PI for 2 NIH funded studies developing and testing interventions to prevent HIV transmission and unintended pregnancy among young sex workers 15-24 years old in Kampala, Uganda using techniques based on cognitive behavioral therapy concepts, introducing technology and testing uptake of PrEP and HIV oral fluid self-tests, she has in-depth knowledge of highly vulnerable populations in Kampala. This study will leverage Dr. King’s expertise in qualitative research and experience working with Kampala’s key populations, ensuring that qualitative analyses are rigorous and study analyses are responsive to the research context.

Dr. Liu is Professor at the School of Nursing at UCSF. She is a health economist who has worked on designing ‘girl friendly’ interventions in Tanzania and she will support the mystery client design and the evaluation of scalability and feasibility, doing some basic costing activities.

Dr. Aggrey Semeere is a Ugandan trained Physician, Researcher and the Head of HIV Prevention, Care and Treatment at the Infectious Disease Institute at Makerere University in Uganda. He obtained his qualification in Internal Medicine from Makerere University, and Epidemiology with Implementation science training from the University of California, San Francisco. He will also engage Ministry of Health partners and community partners engaged with providing supportive services to KPs at the stud sites.

Ms. Grace Kebirungi is a bioinformatics scientist at IDI and serves as the administrator for IDI’s informatics unit. She has extensive expertise in VR design and implementation, including project management oversight for IDI’s recent COVID-related VR programming.23,24 She will coordinate the project team.

We have successfully developed and evaluated this tool in the context of healthcare in the US and are ready to grow the tool to other contexts including sub-Saharan Africa. With the advancement of technology and the cost of hardware and software reducing, this is a tool that is accessible in low and middle income countries and could be more cost effective than the current model of sending providers to train in a weeks long didactic training.

We want to find global partners to help test this tool and eventually scale it in different countries and also find different applications for this tool. We believe that it is a powerful tool that can help humans connect and relate in ways that have not been possible. We can envision other applications and eventually the creation of a VR lab for social good in sub-Saharan Africa.

The proposed study is innovative in at least four ways. 1) Using VR to heighten empathic tendencies is novel and limited data exists exploring the role of this kind of technology for this role. While VR has been widely employed to enhance acquisition of procedural skills in other clinical domains, e.g. laparoscopy surgery50 and endoscopy,65 there is only limited research evaluating the role of immersive VR experiences to address empathy.52,53,66 We recognize that it is specious to assume that experiencing a snapshot of an experience will be sufficient to develop and maintain empathy and compassion skills. Nonetheless, this study will allow us to better understand to what extend the VR experience leads to greater awareness of another’s lived experience and a change empathic communication. As such it will allow us to frame this technology within the context of other proven stigma-mitigating interventions that can be deployed to advance care for PWH. 2) Employing VR technology to enhance HIV care in resource-variable settings in SSA; while VR technology has been evaluated for use in to enhance clinical high-income countries, barriers to wider application have included the hardware expense and the lack of technical capacity to develop contextually relevant VR scenarios used. Our proposal is innovative insofar as we are proposing use of VR hardware in local clinics in Kampala. Given that this hardware is increasingly affordable, this innovation may have an important, future role in HIV capacity building activities in Uganda. There are limited data available on the use of VR tools in capacity-building activities in Africa, but what exists show a high level of acceptability among HCPs, and low levels of risk or social harm.23,24,67-69 3) Leveraging local technical expertise to create VR scenarios: Our study includes a unique partnership that builds on the UCSF’s teams experience using VR to address empathy, and IDI’s technical expertise in developing VR scenarios.23,24 As such, our study offers an innovative model that builds and sustains local technical capacity in support of local clinical problem; 4) Finally, to our knowledge, this is the first study to focus on the client-centered care as a pathway to reducing stigma. As noted previously, few KP services are available in Uganda and stigma towards KPs is pervasive among health workers. As such, VR training is a novel option to address stigma as a key impediment to delivering client-centered care. There are not studies in Uganda that has sought to evaluate if and how mitigating provider stigma leads to subjective improvements in care among people living with HIV.

Our solution involves the adaptation and application of Virtual Reality (VR) technology to foster empathy in healthcare providers (HCPs) towards key populations (KPs) in Uganda, particularly those affected by HIV. The intervention is expected to reduce the stigma enacted by HCPs, ultimately improving the quality of care and health outcomes for these populations.

In the VR scenarios, HCPs will virtually experience the challenges faced by KPs during healthcare encounters. For instance, they might experience the role of an adolescent girl or a sex worker navigating through a health system that is rife with microaggressions and bias. This immersive experience is designed to enhance self-reflexivity among HCPs regarding their interactions with patients, and to sensitize them to the negative impact their unconscious biases can have on patient comfort and care.

The intervention operates on the principle that empathy can be cultivated through experiential learning. VR, being a fully immersive technology, is uniquely suited for this purpose. It blocks out the user's physical environment and replaces it with a digital scenario that can elicit a strong sense of presence and emotional engagement. Through this, we anticipate HCPs will gain a deeper understanding of their clients' experiences, leading to more compassionate and stigma-free interactions in real-life clinical settings.

Our theory of change asserts that by modifying HCPs' attitudes and behaviors through VR-induced empathy, we can influence the immediate outputs of increased understanding and reduced bias, resulting in longer-term outcomes of improved patient engagement in care and better health indicators, such as ART adherence and viral load suppression.

The impact of this VR training on HCPs’ attitudes will be rigorously evaluated using a mixed-methods approach, incorporating the use of 'mystery clients' who will simulate patient interactions with HCPs before and after the intervention. These encounters will be recorded and analyzed using Natural Language Processing (NLP) to assess changes in the way HCPs communicate with KPs.

Our approach is supported by third-party research indicating the effectiveness of VR in empathy training, and by preliminary findings from our pilot study, CULTIVATE, which show promising shifts in clinicians’ attitudes post-intervention. The successful application of this model in San Francisco provides a strong foundation for adapting it to the Ugandan context, supported by feedback from local stakeholders and experts.

Our study is innovative as it applies VR technology, often used for enhancing clinical skills, to the realm of empathic communication and bias reduction in healthcare settings. The solution is expected to be feasible and acceptable in resource-variable settings due to the falling costs of VR hardware and growing digital capacity in Uganda.

By directly addressing the problem of healthcare stigma, our VR intervention stands to make a meaningful difference in the lives of KPs affected by HIV in Uganda. It holds the potential to be a scalable tool that can contribute significantly to the global effort to reduce HIV-related stigma and improve care for all those living with HIV.

Our impact goals for the VR intervention aimed at healthcare providers (HCPs) in Uganda are twofold:

1. To Reduce Stigma and Discrimination in HIV Care Settings:

• Goal: To lower the incidence of enacted stigma by HCPs towards key populations (KPs) by 50% within one year of implementing the VR training.

• Indicators:

  • Change in self-reported empathy levels by HCPs using the existing stigma scales before and after VR training.

  • Reduction in negative linguistic markers identified through NLP analysis of mystery client encounters.

  • Decrease in the number of reported stigma-related incidents in participating healthcare facilities.

2. To Improve Engagement and Health Outcomes for Key Populations:

• Goal: To increase ART adherence rates and clinic retention for KPs by 30% within two years of implementing the VR training.

• Indicators:

  • Improvement in ART adherence rates, measured by pharmacy refill records and self-reporting by KPs.

  • Increase in retention rates for KPs, monitored through appointment attendance records.

  • Improvement in CD4 counts and virologic suppression rates documented in patients' medical records.

Measuring Progress:

Quantitative Measures:

• Mystery Client Assessments: This strategy involves deploying trained individuals who simulate real patients and provide an objective measure of provider practices and attitudes. By analyzing pre- and post-intervention recordings using NLP, we can quantitatively measure improvements in communication and reduction in stigma indicators.

• Clinical Data Monitoring: By tracking clinical outcomes such as CD4 counts and viral load measurements, along with ART adherence and clinic retention statistics, we will assess the direct impact of improved HCP attitudes and behaviors on patient health outcomes.

Qualitative Measures:

• Provider Feedback Sessions: Conducting in-depth interviews and focus groups with HCPs to gather qualitative data on their experiences with the VR intervention. This feedback will provide insight into the intervention's acceptability and any shifts in attitudes or self-perceived empathy towards KPs.

• Patient Satisfaction Surveys: Regularly surveying KPs on their experiences in healthcare settings to measure perceived changes in the quality of care and treatment received post-intervention.

Formative and Process Evaluation:

• VR Training Participation Rates: Monitoring the number of HCPs who complete the VR training to ensure high participation rates and identify any barriers to engagement.

• Community Advisory Feedback: Involving a community advisory committee in the evaluation process to ensure the VR scenarios remain authentic and relevant to KPs' experiences.

Long-Term Impact Assessment:

• Follow-Up Studies: Conducting longitudinal studies to measure sustained changes in HCP behavior and long-term health outcomes for KPs.

• Scale-Up Analysis: Evaluating the scalability of the VR intervention across multiple settings and its effectiveness in diverse cultural contexts.

Our approach aligns with several UN Sustainable Development Goals, including Goal 3: Good Health and Well-being. We are committed to using evidence-based metrics to measure our progress toward transforming the quality of HIV care for KPs in Uganda, with the ultimate aim of creating a stigma-free healthcare environment that supports the well-being and dignity of all individuals.

Our Virtual Reality (VR) intervention is powered by a synergy of cutting-edge VR hardware and culturally nuanced software applications developed at the African Center for Excellence in Bioinformatics and Data Sciences. This core technology transcends traditional learning modalities, providing an immersive, interactive experience that’s both visceral and instructive.

At the heart of our solution is a sophisticated VR platform that leverages high-fidelity graphics, responsive controls, and immersive audio to create realistic scenarios. Our hardware setup includes VR headsets equipped with motion tracking and spatial audio, offering users an enveloping experience that replicates real-life interactions and emotions. This is complemented by haptic feedback devices that simulate touch and enhance the realism of the scenarios.

The software component is equally crucial, incorporating advanced programming and narrative design that portray the lived experiences of individuals living with HIV in Uganda. These scenarios are crafted following extensive research and consultation with key populations, ensuring authenticity and relevance. By virtually stepping into the lives of marginalized communities, healthcare providers can confront and reflect upon the stigma and discrimination faced by these individuals.

Underpinning the software is a sophisticated AI engine that adapts the VR scenarios in real-time, responding to user interactions to provide a tailored experience that maximizes engagement and empathy. This dynamic storytelling is crucial for educating and challenging preconceived notions, encouraging a shift in attitudes and behaviors.

We’re also leveraging the potential of Machine Learning (ML) to analyze and improve our interventions. Post-scenario data gathered from users is processed through ML algorithms to evaluate the impact and to refine the scenarios for even greater effectiveness.

Our technology isn’t just modern; it’s meaningful. It embodies an innovative approach to an age-old problem – the human need for connection and understanding. By combining the latest in VR and AI with traditional, community-centered wisdom, our intervention builds bridges across divides, fostering empathy and inclusivity in healthcare settings. This blend of modern and traditional knowledge systems ensures our solution is both revolutionary and grounded, embodying the very essence of innovation for the benefit of humanity.

2 Full time people. Grace Kebirungi the project coordination and 1 full time VR programmer.

6 Part time technical experts. Dr. Kelly Taylor who will lead the adaption of the use of VR for this purpose in Uganda. Dr. Daudi Jjingo who will lead the development of VR in Uganda. Dr. Rachel King who will lead the community engagement and the qualitative components. Dr. Aggrey Semeere who will lead the integration into the healthcare setting. Dr. Jenny Liu who will lead the evaluation based on her work with mystery clients for interventions among young women in Tanzania. 

Dr. Kelly Taylor has been working on CULTIVATE since 2021 and Dr. Daudi Jjingo has been working on VR for the healthcare space (PPE during COVID) since 2020.

Our team is a tapestry of diverse backgrounds, expertise, and perspectives, reflecting the multifaceted communities we serve. Dr. Kelly Taylor is a black American researcher who focuses on health equity in the US and globally. Dr. Daudi Jjingo is a Ugandan bioinformatician and data scientist with a PhD from the US. Dr. Aggrey Semeere is a Ugandan physician with decades of experience treating KPs in the HIV epidemic in Uganda. Dr. Rachel King is an American researcher who has lived in Uganda for over 20 years and focuses on HIV care and access for young women and mental health. Dr. Jenny Liu is an asian American health economist who researchers interventions to improve contraceptive and HIV prevention uptake among young women in Africa. Grace Kebirungi is a Ugandan woman who leads the VR work at IDI. We recognize that diversity is not only about visible differences but also about the invisible attributes that make our team unique. As such, we are committed to creating a space where every member feels seen, heard, and valued.

In leadership, we strive for a balance that represents gender, ethnicity, age, and cultural backgrounds, ensuring that decision-making benefits from a wealth of lived experiences. We actively recruit team members from various socio-economic statuses, educational backgrounds, and those with differing abilities, understanding that each brings a valuable viewpoint to our work.

Our goal for diversity and inclusivity is an ongoing journey. We've taken actionable steps by implementing hiring practices that reach underrepresented groups, offering internships and mentorship programs to individuals from marginalized communities, and engaging in partnerships with organizations that advocate for diversity and equity.

To minimize barriers, we've embraced flexible work arrangements and remote work capabilities to accommodate different lifestyles and responsibilities. We work across many time zones and are respectful of that when scheduling meetings, regularly checking to make sure we are equally sharing the burden of disruption with life activities. Both IDI and UCSF conduct regular equity audits of our pay scales and advancement opportunities to ensure fairness and remove systemic barriers that could impede the progress of any team member.

We foster an inclusive environment through regular sensitivity and inclusivity training sessions, creating platforms for open dialogue, and establishing clear channels for addressing any concerns related to discrimination or exclusion. Our code of conduct sets a standard for behavior that is accepting and respectful of all individuals, and we hold each other accountable to these principles.

We believe that by nurturing a team environment where diversity, equity, and inclusion are not just buzzwords, but lived values, we can create solutions that are as diverse as the problems we're trying to solve. This environment enriches our team and ensures that we're building products and services that are considerate of the broad spectrum of human experience.

Our business model is anchored on creating transformative social impact while ensuring sustainability through a mixed-revenue approach. We deliver value by providing a Virtual Reality (VR) training platform aimed at reducing stigma in healthcare settings, particularly towards individuals living with HIV. Our key customers include healthcare institutions, non-governmental organizations (NGOs) focused on health equity, and government health departments, while our primary beneficiaries are healthcare providers (HCPs) and, ultimately, the patients they serve.

Product/Service:

We offer a VR-based training service that equips HCPs with the tools to recognize and mitigate stigma, fostering empathetic patient care. This service includes the VR software tailored to the specific healthcare context of our customers, the required VR hardware, and training sessions for HCPs. Additionally, we provide continuous support and updates to ensure the VR scenarios remain relevant and effective. We will also leverage our learning management system that will accompany the VR training and track progress of providers while also being the tool that will be used to do pre and post intervention stigma scales.

Delivery:

We deliver our VR training through direct sales to healthcare institutions and through partnerships with NGOs and government bodies that have existing networks of healthcare facilities. We provide on-site training for HCPs, followed by a subscription-based model to the learning management that offers ongoing access to VR content, stigma training and measurement tools, technical support, and data analytics on training efficacy.

Value Proposition:

For healthcare institutions, our service offers an innovative approach to professional development, aiming to improve patient satisfaction and health outcomes, which are key metrics of healthcare success. NGOs and health departments are drawn to our solution as it aligns with their objectives of reducing healthcare disparities and improving the quality of care for marginalized populations. The HCPs value the immersive training that enhances their ability to provide compassionate care, thus fulfilling their professional and ethical mandate. Patients benefit indirectly through more respectful and considerate healthcare experiences. We will conduct cost-effectiveness studies to show how the costs of our tool compares with the current model of sending providers to didactic stigma training.

Revenue Streams:

Our revenue streams are diverse:

Direct Sales: We sell the VR training package directly to healthcare facilities, with pricing based on the scale of deployment and level of customization required.

Subscription Model: Post-initial training, we offer a subscription for continued access to the learning management and VR content updates, analytics, and technical support.

Grants and Funding: We secure grants from entities interested in healthcare innovation, technology in education, and HIV/AIDS prevention.

Partnerships: We partner with NGOs and government bodies for larger roll-outs, funded through their budgets allocated for healthcare training and improvement programs. Examples of this would be PEPFAR.

Our business model is designed to be adaptable and scalable, with the potential to expand into other areas of healthcare training and even into different sectors requiring empathy and stigma-reduction training.

1. Direct Sales: We offer a comprehensive VR training package that includes the software, the necessary hardware, and on-site training sessions. The sales model is tailored to the size and needs of healthcare institutions. The package aims to improve patient care quality, a key performance indicator for these facilities.

2. Subscription Services: Following the initial training package, we offer a subscription model for continuous access to the Learning Management System (LMS) with VR content updates, ongoing technical support, and access to stigma assessment tools. This ensures long-term engagement and sustained impact.

3. Grants and Donations: Our grant strategy involves securing funding from entities focusing on healthcare innovation, educational technology, and HIV/AIDS prevention and care. We have successfully obtained initial grants that affirm the confidence of stakeholders in our solution's potential.

4. Strategic Partnerships: We collaborate with NGOs and government health departments, which have extensive networks and resources, to implement our training at scale. These partnerships are usually financed through their allocated budgets for healthcare training and enhancement.

Evidence of Success: Our financial sustainability plan has already shown signs of success:

• Pilot Programs: Our pilot programs have demonstrated significant reductions in stigma, underscoring the efficacy and market demand for our VR training.
• Seed Funding and Grants: We have received funding from reputable sources, evidencing the viability and the perceived value of our solution.
• Service Contracts: We're in advanced negotiations for service contracts with government bodies, aiming to integrate our VR training into their healthcare programs.
• Partnerships: We have initiated partnerships with private sector networks, who see the value in investing in our solution for their in-service training.

Future Plans:

• Cost-Effectiveness Studies: To bolster our value proposition, we will conduct studies comparing the costs and benefits of our VR training against traditional stigma training methods.
• Expansion and Diversification: We plan to expand our service offerings into other healthcare areas and beyond, wherever empathy and stigma reduction are essential.

Sustainable Impact: Our solution not only meets a crucial need in healthcare education but also opens a path for financial self-reliance. By providing a service that healthcare facilities need and value, we ensure a steady stream of revenue while achieving our mission to combat HIV stigma. Our pricing strategy, combined with our diversified revenue streams, positions us well to cover operational costs and invest in growth and innovation.