SIG’s Global Research Projects Respond to COVID-driven Challenges

June 9, 2021 @ 9:42 pm
By Alissa Davis (SMART Couples II), Yong Gun “YG” Lee (UNI), Louisa Gilbert and Danil Nikitin (WINGS and GLORI Foundation) & Timothy Hunt (UNICEF)

In this post for our special series on social work in times of crisis, several researchers who are involved in the global initiatives of the Social Intervention Group (SIG) share lessons learned and some new directions and priorities for their current and post-COVID research agendas.

  • SMART Couples II is working to develop a couples-based intervention to improve HIV medication adherence among HIV-positive people who inject drugs in Kazakhstan.
  • UNI is testing the efficacy of a peer-driven intervention designed to ensure that men who have sex with men have access to the HIV continuum of care in Kazakhstan.
  • WINGS is an evidence-based tool that aims to identify and address intimate partner violence and gender-based violence; it is now being adapted for use globally—most recently in Kyrgyzstan.
  • A recent project, funded by UNICEF, aims to expand the capacity of the social service workforce and strengthen social service competencies in Eastern Europe and Central Asia.

The Social Intervention Group (SIG) of the Columbia School of Social Work is known for its interventions in New York City and now, with the advent of the HEALing Communities study, across New York State. But SIG also has an active presence overseas dating from 2007, when it founded the Global Health Research Center of Central Asia (GHRCCA) with a multidisciplinary team of faculty, scientists, researchers, and students committed to advancing solutions to health and social issues in Central Asia and the surrounding region. Two of the projects described below—UNI, and SMART Couples II—are run by members of GHRCCA’s leadership team. One of them, WINGS, is run by GHRCCA in partnership with the Kyrgyzstan-based Global Research Institute (GLORI Foundation). More recently, UNICEF funded a study that has extended SIG’s focus to countries in Eastern Europe.

While the impact of the pandemic on Central Asia and Eastern Europe has not been so severe in terms of deaths, in these regions as elsewhere the pandemic exposed a lack of preparedness in the public health and emergency sectors.

SIG researchers share how their global projects have continued work during COVID-19 and what the pandemic has taught them.

Connectivity issues and other disruptions for SMART Couples II

With the advent of COVID, SMART Couples II—an in-person intervention to ensure adherence to HIV medication—had to be moved to an online format, with special training offered to intervention facilitators. Then we ran into hurdles upon discovering that some of our participants did not have a strong Internet connection. Those individuals would lose connectivity during the intervention sessions. Sometimes they had to reconnect multiple times, thereby interrupting session flow.

Also as part of the SMART Couples II intervention, participants are provided with a smartphone and an electronic pill bottle to monitor medication adherence. It is easy to demonstrate how to use the smartphone and electronic pill bottles when meeting with couples in person. But with the arrival of COVID, the decision was taken to send pre-set smartphones and pill bottles to participants by mail. Our IT specialist then had to call them to complete the set-up process. Some of our participants had never used a smartphone before in their lives, so found it intimidating. Staff frequently had to make follow-up calls to show participants again how to use the phone and pill bottle.

Another part of the study entails collecting hair samples as a biological measure of adherence to the HIV medication. As this task could no longer be handled by our research staff, the study box that we mailed to each of our participants also contained a kit for collecting their own hair samples. Participants were instructed how to do this on video call with our staff, and the kit also included written instructions on how to mail the samples back to our research office—a much more cumbersome procedure than would have taken place in person.

Moving forward, because we can see the impact the pandemic is having on people who are HIV-positive and inject drugs, we hope to be in a position to recommend the kinds of policies that will need to be put into place, not only to help this population recover from COVID’s effects but also to prepare for future pandemics.

Perhaps the biggest lesson learned is that in Kazakhstan, as elsewhere, people react to stressful situations differently and need different tools.

Remote delivery of HIV preventive intervention services in three Kazakh cities

At the time the COVID-19 pandemic struck, the UNI project was operating in three cities in Kazakhstan—Almaty, Nur-Sultan, and Shymkent—to test the efficacy of a peer-driven intervention designed to increase the number of sexual and gender diverse individuals, including men who have sex with men (MSM) and transgender and gender nonconforming persons (TGNC), in the HIV continuum of care.

Kazakhstan’s decision to go into lockdown at the onset of COVID gave our team no choice but to suspend all in-person study activities (including enrollment of new participants), and to shift all operations online. To ensure that current participants would be able to fully and safely engage with the project, we added protocols for addressing potential disruptions (such as a technical difficulty or a sudden privacy loss) that could arise during a remote interaction.

Even in the best of times, social networks play an invaluable role in providing sexual and gender diverse individuals with access to HIV-related services. The pandemic only reinforced this principle, with many individuals leveraging their social networks, especially online, to find ways of staying healthy and safe. To that end, we adapted our social network-based HIV preventive intervention to be delivered remotely. We wanted to ensure that participants could continue helping their peers access services, without interruption.

While many aspects of the COVID-19 pandemic have been unprecedented, the UNI team found that reports of stigma and discrimination against sexual and gender minority communities during COVID resonated strongly with our experience of the 40-year HIV pandemic, with its disproportionate effect on sexual and gender diverse communities around the world.

Using the data we have recently begun collecting on various aspects of COVID, our future research may consider how UNI project participants managed in the face of multiple pandemics.

The need to mitigate rising violence against women in Kyrgyzstan

Women Initiating New Goals for Safety (WINGS) was initially created to address intimate partner and gender-based violence in New York City. It has since expanded and been adapted globally including, most recently, in Kyrgyzstan. WINGS provides an evidence-based screening, a brief intervention, and a referral to treatment services for women who use drugs and are at risk of intimate partner and gender-based violence.

We know worldwide the rates of intimate partner violence have spiked during COVID, largely because of people being shut down with abusers—a trend that has worsened as many people faced greater financial and economic stress, along with social isolation, during these difficult times.

Kyrgyzstan was no exception: there was a 65 percent increase in gender-based violence incidents from April 2020 to April 2021, with the majority of the victims being between the ages of 21 and 50. Four women were murdered.

Since the pandemic struck, the WINGS team in Kyrgyzstan has been communicating with clients primarily online. WINGS’ local partner, GLORI, developed consent forms and data collection procedures for online interactions.

As the pandemic wore on, we also created a new internal client management protocol giving women access to free COVID testing resources. Those who tested negative were eligible for shelter services.

Success in boosting online social service capacity building for UNICEF project

SIG and GHRCCA’s UNICEF-funded “Building Competencies” project seeks to strengthen interpersonal communication and community engagement competencies (ICCEC) for social workers and other social service workforce professionals to boost the social service workforce capacity in Eastern Europe and Central Asia.

The project entailed designing a training package with the aim of increasing knowledge and strengthening ICCEC skills to address social injustice, violence against children, interpersonal partner violence, stigma, and discrimination based on gender, ethnicity, disability, poverty, and other factors in the context of ECA. Our capacity-building model includes a 10-day, two-part training of trainers (ToT) along with the establishment of a community of practice (collective learning) comprising these trainers. By providing a comprehensive curriculum for online and face-to-face implementation following a ToT and mentoring process, we seek to contribute to changing behavioral and social outcomes of vulnerable children, families, groups, and communities.

We had just begun our work in three pilot countries—Kazakhstan, Georgia, and Albania—when all travel was cancelled due to the pandemic. Suddenly, we faced the challenge of designing and offering all of our trainings online—no easy feat given that our project involves extensive international collaboration.

As we considered how best to adapt our classroom trainings across cultures and languages, we heard from stakeholders that families and children in our three pilot countries were struggling with new, pandemic-related needs, calling for still more virtual and online service competencies than countries in this part of the world could provide.

Fortunately, our team was able to harness Zoom for both online training and translation services. Our trainees adapted quickly to the revised online design, and even voiced enthusiasm for incorporating the teaching methods in their universities and in their community-based delivery. Providers utilized telepractice core competencies and methods to expand critical services for families at risk, especially in rural settings where social services tend to be much more limited.

We are pleased to report that the partnership with UNICEF will expand into nine countries in 2021–22, largely due to the team’s successful demonstration of online capacity-building efforts during COVID. We look forward to collaborating with more countries along with Columbia University’s global centers as we address country needs for core competencies in social work and contribute to the evolution of a new world of virtual service delivery and teaching methods.

Alissa Davis is an assistant professor at CSSW. She works extensively on a number of studies in New York City and Central Asia with researchers at SIG and the Global Health Research Center of Central Asia.

Yong Gun “YG” Lee is the project director for UNI Project of SIG’s Global Health Research Center of Central Asia (GHRCCA) and a doctoral candidate at CSSW.

Louisa Gilbert is an associate professor of social work at CSSW and a leading researcher on interventions for women suffering from the co-occurring conditions of gender-based violence, substance use, and HIV. She has served as the co-director of the Social Intervention Group (SIG) since 1999 and co-founder and co-director of the Global Health Research Center of Central Asia (GHRCCA) since 2007. Danil Nikitin is the chairperson of the Global Research Institute (GLORI Foundation) in Kyrgyzstan. He previously served as GHRCCA’s representative in the Kyrgyz Republic.

Timothy Hunt is the associate director of the Social Intervention Group and of CHOSEN. He is also a co-investigator for the SIG-led HEALing Communities Study.