Between 2010 and 2019, HIV incidence in Kazakhstan increased by 85%, yielding the decade’s highest increase in the Eastern Europe and Central Asian regions. Among the most affected have been sexual and gender expansive (SGE) persons including men who have sex with men (MSM). As of 2019, HIV prevalence among MSM in Kazakhstan was estimated to be over 6%. While many HIV-related services are free of charge in Kazakhstan, such services may not be adequately reaching SGE persons. UNI Project is a NIDA-funded clinical trial of a social network-based intervention increasing linkage to HIV care among SGE persons in Kazakhstan. The intervention was originally designed to be delivered in-person. However, COVID-19-related restrictions on in-person gatherings led to transitioning UNI intervention delivery and necessary facilitator training to a remote modality (e.g., via smartphones, laptops). We report on strategies involved in—and lessons learned about—conducting a remote training for a remotely-delivered intervention.
The UNI intervention is tested in an ongoing stepped-wedge trial in three Kazakhstan cities: Almaty, Nur-Sultan, and Shymkent. Throughout intervention, facilitators and participants crowdsource information useful in overcoming and circumventing barriers to HIV testing, treatment, and prevention services in their local area. Through didactic instruction and information sharing, practice and role-/real-play focusing on participant strengths, group problem-solving to overcome barriers and challenges, and homework, participants build knowledge and skills for sharing such information with their in-person and digital social networks. Knowledge dissemination training includes skill development around both in-person and digitally-based social marketing. Overall, UNI emphasizes that facilitators nurture and empower SGE individuals in supporting fellow members of their SGE community. Facilitator training originally involved an intensive one-week in-person training; due to COVID-19, training was reconfigured for remote delivery across different cities in Kazakhstan and the U.S. team.
Training remotely expanded opportunities to incorporate existing online technologies that enrich connection and interactivity among training recipients. As technology was incorporated into the modified intervention, the training served as an important ‘parallel process’, imparting key skills and techniques specific to remote intervention delivery; i.e. training activities used the same technologies as the intervention. Having training recordings available for facilitator reference has streamlined and sustained on-going practice and will support the development and delivery of future trainings. Remote training substantially lowered financial demands (e.g., travel/lodging expenses) of multi-site training. Despite many positive attributes, remote training presented new challenges. Training recipients reported varying levels of comfort and confidence using newly incorporated technologies, and (sometimes unexpected) disruptive technical difficulties arose. Additionally, some recipients had difficulty securing space that provided a suitable environment for attending remote training. These challenges prompt need for on-going practice and support for UNI facilitators to master remote intervention delivery skills while adhering to public health safety measures.
Conclusions and Implications:
Remote training for a remotely-delivered HIV prevention intervention can be a highly feasible and successful training modality. Moreover, remote training offers numerous key advantages that may make remote training an attractive alternative for intervention delivery during and after the COVID-19 pandemic.