Background: Pact''s USAID-funded REACH III (2015-2018) project is designed to respond to the HIV prevention and impact mitigation needs of vulnerable populations in Swaziland. In 2015, Pact conducted a vulnerability assessment of adolescents (10-19 years) to determine enrollment eligibility and service needs of orphans and vulnerable children (OVC). Based on the results of the vulnerability assessment REACH III tailors services to OVC in the areas of HIV/health, education, household economic strengthening, child protection, and psychological support. The assessment also acts as a mechanism for monitoring the level of OVC vulnerability and determining the appropriate time for graduation from the program.
Methods: The baseline and follow-up vulnerability assessments were conducted with a cohort of OVC (n=18,042) and their caregivers in 2016 and 2017. The assessment scores and ranks vulnerability into three categories: most vulnerable (qualified for OVC and HIV prevention and/or care and treatment services); at risk of becoming OVC (qualified for HIV prevention services); and good wellbeing. Descriptive analyses and the Stuart-Maxwell test were conducted in Stata to determine statistically significant differences between enrollment and reassessment. Cohen''s kappa analyzed inter-rater reliability.
Results: The Stuart-Maxwell test yielded statistically significant (p=0.00) change in the OVC vulnerability, with 10.2% of OVC shifting from the “most vulnerable” category at enrollment up to “at risk” at follow-up. Fifty-five percent of OVC who did not disclose their HIV status at enrollment reported being HIV-negative at reassessment, and 15.7% of OVC remained HIV-negative at reassessment. Self-reported VMMC rates climbed 9.1% at reassessment.
The cohort also saw statistically significant improvements in OVC school enrollment, attendance, and progression, and household economic security at follow-up over baseline.
Conclusions: The results demonstrate that providing a tailored package of services to OVC based on a vulnerability assessment is associated with decreased vulnerabilities and improved social and health outcomes for OVC, which leads to OVC graduation from support programs. The results also suggest that OVC support services and demand creation services at the household level over time may lead to HIV status disclosure, as well as increased uptake of health and HIV services, including VMMC, HIV testing services and linkages to care and treatment services.

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