## 1 Introduction  
The World Health Organization's (WHO) recommended Directly Observed Treatment Short-courses (DOTS) strategy promotes de-centralized care and effective management of the tuberculosis (TB) control program, including training and supervision of healthcare providers [1]. Among other challenges of the healthcare systems in low and middle-income countries, poor quality, insufficient quantity, and partial distribution of the healthcare providers are significant concerns mentioned in the WHO Global Plan to Stop TB 2006-2015 [2; 3]. In addition, it is usually acknowledged that building the capacity of human resource is crucial for TB control efforts [4]. Recognizing the need of human resource capacity building, the Global Fund to Fight AIDS, Tuberculosis, and Malaria provided 16 million training episodes to healthcare providers (HCPs), which is almost ten times higher the number of HCPs training episodes given in 2005 [5]. In the past, most of the TB care and prevention focus remained on the coverage of services. However, current data trends show that there is a need to think about expansion of TB care services, thereby emphasizing quality of care, both in private and public sectors [6; 7]. Evidence indicated that improved training and continuous supportive supervision can improve providers' skills for TB case management, hence resulting in better treatment adherence [8]. It is also known that quality of training is directly associated with quality of TB care and treatment outcome. Additionally, knowledge deficiency in healthcare providers can result in a delayed or missed diagnosis [9]. Hence, troubling the overall efforts of the TB control program. Training is considered as an agent of change and lectures are the most common, simple, and low-cost method used in training programs in classroom settings [10]. However, disengagement of participants, likelihood of forgetting, and one-way communication are common issues associated with this method [11]. Therefore, importance of blended education is emphasized where two or more methods are used to impart training (e.g., multimedia course, seminar, and e-learning). Studies suggest that a combination of face-to-face training along with e-learning methods has generated better results [12]. An increasingly popular method, e-Learning, is a training method where trainer and trainee are not required to be co-located and technological capabilities (tools, technology, equipment) connect them together [13]. For these reasons, e-Learning or e-Training approaches have gained immense importance, especially when healthcare providers have limited time available, different work shifts, and high turnover rate in developing countries. Virtual reality (VR) is a methodology that has successfully been applied to the learning process and it can help to improve the traditional teaching methods. VR's adoption in the learning process allows participants to have intuitive understanding of what they learn [14]. Three-dimensional (3D) virtual worlds and graphical environments, such as Second Life ([[http://secondlife.com/](http://secondlife.com/)]([http://secondlife.com/](http://secondlife.com/))) and Sansar ([[https://www.sansar.com/](https://www.sansar.com/)]([https://www.sansar.com/](https://www.sansar.com/))), offer a number of unique edutainment affordances and opportunities (edutainment is education enhanced by entertainment and game-like elements, also known as'serious gaming'); for example, realistic immersion, visualization, and simulation, exploratory learning and training, networking and collaboration (in multi-player environments). [PERSON] et al. 's [15; 16] reviews of the subject toured some of the early medical and public, environmental, and occupational health examples in Second Life and highlighted the potentials of 3D virtual worlds in medical and health education. Serious gaming engages the learner through various game elements and challenges involving positive competition with other learners (or players), such as game points, badges, achievements, and leader boards.