Hamlet (community) health workers in Vietnam learn to interact with mCare (Photo credit: FHI360)

With international development program cycles often having a “project design phase”, how can online learning as a team improve project design?

How do you design a technology program intervention to improve health outcomes?

HIV Challenges and Keeping Up with mHealth

According to the WHO, HIV has claimed 39 million lives so far globally with 1.5 million lives in 2013 alone. At the end of 2013, there were 35 million people living with HIV, with 2.1 million becoming newly infected. With 24.7 million people living with HIV in 2013, Sub-Saharan Africa is the most affected region in the world accounting for almost 70% of the global HIV infections.

HIV often gets highlighted as a major problem in Sub-Saharan Africa, but it is also a major public health concern in Southeast Asia, particularly in Vietnam where the use of needles to inject drugs drives the epidemic. As of 2012, 260,000 (of the 89 million) people in Vietnam are living with HIV, according to UNAIDS Vietnam. As a result, FHI 360 is working with the Government of Vietnam to address the country’s HIV challenges with “effective programs that cost less, are implemented locally, and decrease donor dependence”.

Technology developments in public health change very quickly, especially with the emergence of mHealth – there’s more mHealth programming, new applications, and emerging research.

MHealth is a key strategy for us as these applications can be used to incentivize health-seeking actions, increase the timeliness of data collection, improve patient communications, and document system-client interactions. MHealth can also facilitate workforce development through task shifting, performance support, and human resources management.

According the blog Tech in Asia, “For every 100 Vietnamese people, there’s 145 mobile phones. For a country whose population is just over 90 million, that amounts to more than 130 million mobile phones.” RefWorld.org reported that, as of January 2012, census data indicated there were 119 million mobile users in Vietnam when the population was at 88 million. Given the emergence of the mHealth industry and the large percentage of the Vietnamese population with cell phones, we at FHI 360 need to effectively mobilize this ubiquitous technology for impactful programming that helps individuals in all areas of the country protect their health and well-being.

A Social Online Learning Solution

In 2012, I first participated in TechChange’s 4-week online certificate course called “Mobile Phones for Public Health.”  I decided to take the course again in 2013 – this time with numerous colleagues — to share our mHealth programming experiences and to continue to learn from renowned mHealth practitioners around the world.

Like all busy development professionals, it is difficult to find time to cultivate learning during our day-to-day work.  The TechChange course was structured and delivered to meet our needs.

Nick Martin mHealth course social map

Here’s a social graph from Mobile Phones for Public Health showing participant interaction

Cutting-edge, timely, and relevant information

  1.  TechChange updated its courses at least once every 3-6 months, based on direct feedback (through crowdsourcing and surveys) from its broad learning community to deliver the most up to date and relevant course content.

Great format for busy working professionals in Vietnam and beyond

  1.  Keeping our busy schedules in mind, the course content was designed to be mobile and tablet-friendly, allowing us to learn wherever and whenever fit our schedules. All live events were recorded so that learners could access materials according to their schedules.
  2. For those of us who had difficulty finishing the course in the one-month period, access (and technical support) is available for four months after the end of the course so that we can complete our final project and receive the formal certificate.
  3. The online interface was the most intuitive learner platform we have ever used:  An online course map visually illustrated all components of the program, while a calendar highlighted a variety of live discussion events with renowned experts from around the world.
  4. The main facilitator actively participated in all discussion boards; introduced weekly themes (through video, email and platform) and summarized (through print and video) the highlights of each week.  He and a facilitation team also provided “office hours” for those who needed extra support (and this support was provided in various time zones).

Interactive learning experience

  1. There was great communication between facilitator and learners. The course required 7-9 hours of effort per week and the 50 or so participants were motivated to actively participate. Learner outcomes were clearly defined and each week’s themes were well-articulated so that we knew what to expect and what was expected from us.
  2. Instead of relying primarily on print materials, sharing video, audio and weekly live events/”chats” allowed learners from various cultural backgrounds to gain knowledge and skills through a variety of channels through interactive learning.
  3. Practical exercises and interactive simulations ensured knowledge application and exchange.
  4. Individuals got to know each other through a variety of “get to know you” activities and collaborative exercises.
  5. TechChange added some fun by integrating game dynamics into the course, awarding points each time a person participated in a discussion or attended an event, with a minimum participation threshold established in order to earn a certificate.

Joining a professional network and community

  1. All learners also became TechChange alumni upon finishing the course. We are now connected through social media with others in mHealth (and offered substantial discounts on upcoming courses).
  2. It’s been great to see other mHealth alumni like Lauren Bailey making strides in the field after joining this course.

Here are some additional comments from two of my colleagues:

“I really enjoyed reading the forums at my own pace. I liked that other participants put so much thought into them.” – Deen Gu

“I like the discussion parts most as they offer me many interesting thoughts and experiences of TechChange’s members on different topics.” -Nguyen Thi Van Anh

As a recent graduate of TechChange’s courses, I can speak to the benefits of participation.

USAID/SMART TA training

USAID/SMART TA team provides hands-on training to hamlet health worker in Nghe An (Photo credit: FHI360)

Results of mHealth Training with TechChange

Through this mHealth course, my team learned best practices as a group to explore ways to implement mHealth projects. My colleagues learned how mobile technologies are being used in other countries and sectors and thought about ways it could be applied in Vietnam. The individuals who have participated in the TechChange course are now our office mHealth champions and are actively identifying areas of work where mHealth solutions can be applied.

Here are two current mHealth pilots we have launched in Vietnam through the USAID/SMART TA program to address HIV challenges:

1.  Fansipan Challenge – uses the metaphor of Fansipan mountain (Vietnam’s highest peak), gamification, and mobile technologies to support people who inject drugs and their intimate partners to test for HIV and be linked to care if they are positive.

Fansipan was created by USAID funded SMART TA project in Vietnam. Learn more about SMART TA here.

Here is a Prezi presentation explaining the Fansipan project in Vietnam called How Mobile Technologies and Gaming are Improving HIV Program

2.  mCare – is the first case management application in Vietnam that utilizes mobile technologies to support and track clients across the cascade of HIV outreach, testing, care and treatment services.  It also manages performance-based incentives for hamlet health workers who identify potential clients, encourage them to test for HIV, and support them to enroll and be re-engaged in HIV care and treatment and methadone maintenance treatment.

confirmation message

A confirmation message sent from mCare (Photo credit: FHI360)

The Results of the mHealth Pilots So Far

While mCare is in its early stages of deployment and refinement, the Fansipan Challenge has shown a dramatic reduction in programmatic unit costs, combined with significant increases in testing uptake and HIV yield among underserved key populations.  Between June – November 2013, 62% of 656 injecting drug users and their intimate partners tested for HIV after a single contact. Approximately 71% of these individuals were first time testers; 17.8% were diagnosed as HIV positive. Comparative expenditure analyses of USAID/SMART TA-supported outreach services show a 50% reduction in costs associated with identifying an HIV positive person.  And preliminary data further suggest that HIV positive people identified through Fansipan have higher CD4 levels (average 287.5 cells/mm3) and will thereby have better treatment outcomes than those who initiate treatment when they are severely immuno-compromised.

These new initiatives rely on mobile technologies and we, like other technical assistance providers in the development sector, need to be constantly learning about mHealth innovations, and emerging knowledge and applications.  The TechChange mHealth class was a great investment in having my team become more familiar with mHealth as we introduced our mHealth initiatives.

About Caroline Francis

Caroline Francis

Caroline Francis is FHI360’s Deputy Country Director in Vietnam and completed TechChange’s Mobile Phones for Public Health course in 2012 and in 2013 when she took the course again with her team in Hanoi and Ho Chi Minh City. She is currently involved in FHI360’s Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance (SMART TA) project in Vietnam and her areas of expertise include HIV and AIDS prevention and care and Social and behavior change communications. Caroline has previously worked as the Associate Director (HIV Prevention, Mitigation, Strategic Behavioral Communications and M&E) and Deputy Director for FHI 360 Cambodia. She received her M.A. in Anthropology from University of Victoria.

After a study-abroad semester in Spain and a summer at TechChange in Washington D.C., Emily Fruchterman is heading back to William & Mary to finish the final year of her undergraduate career. Before heading to Williamsburg to finish her Biology degree, she looks back on her summer internship at TechChange as an educational technologist.

1. How did you hear about TechChange?

At the start of 2014, summer internships were the last thing on my mind. I was off to spend the semester in Seville, Spain, and any thought relating to life-after-study-abroad was a painful reminder that my time in paradise wouldn’t last forever.

When my final exams forced me to face reality, I wasn’t quite sure where to start my search (the ocean between me and potential employers seemed pretty daunting). A friend referred me to internships.com, where I found out about TechChange.

2. Why did you choose TechChange to spend the summer between your junior and senior years?

TechChange piqued my interest with its goal of using the power of technology to advance social change. The broad range of courses that demonstrate the utility of technology to a very international audience showed me that this was more than a cursory commitment. Contributing to an organization with such goals seemed like a worthwhile way to spend the summer.

On a personal level, TechChange seemed like a great complement to many of my previous experiences at nonprofits and NGOs doing research while giving me new exposure to a startup culture. TechChange’s upcoming projects also aligned well with my interest in public health, plus the networking opportunities afforded by spending a summer in DC seemed too good to pass up.

3. What are your interests?

While I’m generally interested in the field of development, my passions really lie with public health. I’d really like to work for organizations (like TechChange) that have projects relating to the various aspects of health and healthcare – although my dream is to work for an organization that coordinates healthcare responses and works to improve health outcomes on an international basis. I’m also an avid coffee drinker, science fiction fan, and aspiring flamenco dancer (my time in Spain might have influenced this last one).

Emily with TechGirls

Emily goes over how to create an online course with the TechGirls on TechGirls Job Shadow Day 

4. How did you use your TechChange internship to explore your interests?

Fortunately for me, TechChange had several different public health related courses this summer. I was able to engage with a course on Malaria, for use in Nigeria and Uganda, as well as take on a large part of a facilitated course on HIV for clinical and non-clinical care providers. Both of these have been extremely valuable experiences, as I’ve not only learned a great deal about both illnesses, but also looked at how to structure health-related interventions and training programs.

5. What did you do at TechChange this summer? What was your role at TechChange?

The instructional design team was finishing up a self-paced course on Malaria when I arrived in June. I was not only able to help with edits and testing, but built a few interactive elements. I got more experience building out lessons, writing storyboards, and coming up with engaging lessons while working on other instructional design projects.

I got my first taste of the facilitated platform as a teaching assistant (TA) for a course on Social Media for Social Change, during which I familiarized myself with WordPress and the structure/pacing of a four-week course. This came in super handy, as a couple weeks later I started to manage content development and build out the four modules for the course on HIV treatment. I also helped write several blog posts relating to projects, participated in meetings with clients, and taught the TechGirls from Tunisia and the Palestinian Territories how to create online courses.

6. What did you learn during your time at TechChange?

The first big thing I learned was how to use Articulate Storyline. This eLearning program might look like a fancier version of PowerPoint, but it has it’s tricks and idiosyncrasies. It was very cool to learn how to create interactions, design variables, and troubleshoot glitches to develop quality modules. This was super useful, as it helped me think about learning in a much more user-centered way.

I also learned to be much more comfortable in front of the camera – while I still had my fair share of outtakes, it became a lot easier to speak to a blinking red light instead of an audience. I learned how to manage time during interviews, ask the right kinds of questions, and (most importantly) what to do with my face when I wasn’t the one talking.

My tech skills also improved – my co workers tried to show me some coding basics (parts of which I picked up on better than others), I increased my audio editing abilities, became super familiar with WordPress, created several graphics, and set-up and took down AV equipment.

I also improved my communication skills by working closely with various members of the team on different projects and writing emails/participating in phone calls with clients.

Emily

Emily in the recording studio at TechChange before recording a live session for a course

7. Did your TechChange experience end up going as you expected?

In some ways – based on my impressions of TechChange from their website and my interview, I’d expected to find a group of young and tech savvy individuals interested in promoting social change.

I hadn’t expected how much support they’d give me for pursuing my own ideas from the get-go. I think it was my second or third day here that I suggested an interaction be added to a part of a self-paced course to a member of the instructional design team. The response I received – “great, want to build it?” – really surprised me. I’d barely started learning the program, was still figuring out where I fit in, and yet was already being offered the chance to work on the product. This “great, want to build it?” philosophy was present throughout my internship here – I had a lot of flexibility and opportunity to build off of assigned tasks.

8. Would you come back to work at TechChange one day? Why?

Yes, and without a second thought. TechChange has to be one of the best work environments I’ve ever encountered; it’s fun and collaborative, the work is engaging, and the company is small enough that everyone can play a variety of roles. You might be hired as an educational technologist, but you’ll have the chance to do a little bit of graphics editing, write blog posts, sit in on business development meetings, teach a course, and have your voice featured in animations.

More importantly, this work has real value. The courses developed by TechChange are used by different organizations around the world to train staff members and health providers, as resources to newly-formed NGOs, and to put the spotlight on the role technology can play in the developing world. TechChange collaborates with organizations that work for real, sustainable change, and TechChange alumni go on to do incredible work. Being a part of this team has been a wonderful experience.

9. What advice would you give to future TechChange interns?

Take initiative! This is an awesome opportunity to grow your skill set – make use of that. If something needs to be done, volunteer to do it. Even if it’s not something you’ve done before, the team will support you and make sure you learn how to do it well. The TechChange team is also super supportive – if there’s something you want to learn about (even if it’s not directly related to your job), they’re more than happy to help.

The Asian & Pacific Islander Wellness Center (A&PI Wellness Center) partnered with TechChange to develop a two-part training course designed for clinical and non-clinical providers to provide HIV education in California. For the first time ever, these trainings combined both the self-paced and facilitated course structures. Participants will be asked to proceed at their own pace through the Articulate Storyline-based APIWC 101 course, before taking part in the four-week facilitated course that features chats with guest experts.



HIV Today – The Context
We have come a long way when it comes to HIV treatment. Thirty years of research and campaigns have transformed HIV from being a death sentence into a chronic condition that permits those who properly manage it to live relatively normal lives. The problem is, only one in four HIV-positive Americans currently follow all recommendations for managing HIV.

According to the Center for Disease Control (CDC), only 25% of HIV-positive Americans reach viral suppression, the current end-goal of HIV treatment. This means that the other 75%, or roughly 825,000 of the 1.1 million Americans estimated to be HIV-positive, are not receiving the support they need to successfully navigate through the obstacles to seek care. As a result, these individuals are not getting the treatments they need to manage and maintain their personal health and consequently, have a greater risk of transmitting the virus to others.

Many agencies have encouraged use of the HIV Care Continuum, also called the HIV Treatment Cascade, as a tool to visualize the proportion of HIV-positive individuals engaged at each stage of care.

HIV Care Continuum

Source: AIDS.gov

This cascade shows an estimated percentage of how many people fall out of care at each step along the way to viral suppression. Nearly one in five HIV-positive Americans do not know their positive status, keeping them from engaging in the cascade at all. Of those that are initially linked to care, nearly half fall out of treatment before being prescribed antiretroviral therapy (ART).

Even more important than this cascade is the breakdown of HIV prevalence by race and sexual preference. African Americans, for example, bear the biggest burden. According to a 2013 CDC report, African Americans makes up 14% of the US population, accounting for 44% of Americans living with HIV. The burden is similarly unequal for other minorities and men who have sex with men (MSM).

CDC estimated rate of new HIV infections (2010)

source: CDC

These statistics highlight the need for responses tailored to the communities most affected by HIV; these groups are more likely to face poverty and racism, as well as distrust with the medical system. When societal challenges are combined with the challenges of navigating HIV, people tend to drop out of care. Diverse communities require varied responses that are culturally aware and take into account the needs of disenfranchised groups.

The Challenge of Scaling HIV Prevention
Response to HIV requires service providers to play clinical and non-clinical roles. Many counselors, social workers, advocates, lawyers, and clinicians frequently work with HIV-positive individuals and in the field of HIV prevention and treatment; it is vital that they understand both the medical and complex social realities faced by their clients.

Born out of a grassroots movement to combat the HIV/AIDS crisis in A&PI communities in the late 1980s, the A&PI Wellness Center works to address the health needs of marginalized and vulnerable groups, regardless of race, ethnicity, gender identity, sexual orientation, or immigration status. In collaboration with Project Inform, the A&PI Wellness Center developed the California Statewide Training and Education Program (CSTEP), a curriculum that sets the standard in HIV treatment and technically and culturally competent training for clinical and non-clinical providers working in the HIV field.

An eLearning Solution

APIWC Module 1

Participants will advance to APIWC 201 upon completion of the first course (APIWC 101). Hosted on TechChange’s facilitated course platform, this online course will provide more in-depth information about barriers to care and supporting clients in a dynamic era of HIV treatment. The month-long 201 course integrates elements of the self-paced course into the facilitated learning environment – participants are able to review the 101 content as well as slides specifically produced for the 201 course, share their knowledge with other providers in the forums, and interact with experts during live events. The ability to work with experts is what really sets this training apart – participants hear from former presidential advisors on HIV policy, specialists in linking HIV-positive people to care, HIV trainers, and those with decades of experience researching the virus and advocating for those affected.

APIWC Guest Expert Dr. Cynthia Gomez

Participants are able to engage with experts such as Dr. Cynthia Gómez (pictured above) during live events. These events are recorded and made available for later review.

The content of both courses is available 24/7 so that providers are able to take part whenever their schedules allow, while the forums and weekly live sessions add a social dimension uncommon in online learning. As all participants have some experience with HIV prevention or treatment, this course provides a unique opportunity for collaborative learning; providers can learn from the experiences of one another, share resources, and strengthen their networks of HIV prevention and treatment specialists.

In the first month alone, the training attracted over 70 participants from a variety of organizations. Additionally, the combined course has little in the way of overhead costs and can easily be repeated or scaled for different audiences, making it a viable strategy for training providers across California, with the goal of improving health outcomes and supporting HIV-positive individuals as they move toward viral suppression.

To register for these free online courses on HIV prevention training, please click here.

Live session recording

Charlie Weems and Emily Fruchterman of TechChange record a live session at the TechChange recording studio in Washington, DC.

Emily Fruchterman, Catherine Shen, Charlie Weems, and the A&PI Wellness Center contributed to this blog post.

If your organization is interested in developing online training with TechChange, please contact info@techchange.org.

We’re going to continue to look at  emerging mobile health applications this week. While last time the focus was on promising technologies on the horizon, these projects share an approach that maximizes the impact of what’s already available—in most places that means sending an SMS. The low cost and high penetration of mobiles make them an incredibly powerful platform for promoting health. In these examples, mobiles are used to expand public health education and improve patient monitoring.​

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