RT Journal Article SR Electronic T1 A Qualitative Comparative Analysis of the Drivers of HIV Status Knowledge in Orphans and Vulnerable Children in Mozambique JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 534 OP 548 DO 10.9745/GHSP-D-20-00311 VO 8 IS 3 A1 Allie Davis A1 Zola Allen A1 Nena do Nascimento A1 Jenifer Chapman A1 Rotafina Donco A1 Daan Velthausz YR 2020 UL http://www.ghspjournal.org/content/8/3/534.abstract AB Key FindingsUsing fuzzy-set qualitative comparative analysis, we identified combinations of modifiable factors that HIV programs that support orphans, vulnerable children, and their families may be able to act on to increase the proportion of beneficiaries who know their HIV status.Key ImplicationsTo improve HIV status knowledge, programs should consider implementing a formal process to: Assign cases considering case complexity and caseload to reduce overworkProvide activistas with supervision supportHire experienced activistasTrain activistas to address challenging casesReimburse activistas for work-related expensesIn Mozambique, more than a million children are living with HIV or are otherwise vulnerable due to HIV. In response to this crisis, the US President’s Emergency Plan for AIDS Relief funds programs that serve orphans and vulnerable children affected by HIV and their families. These programs retain case workers, known as activistas, who provide and refer beneficiaries to services to increase beneficiaries’ knowledge of their HIV status and to improve retention in care among those living with HIV. To improve program effectiveness, implementing organizations need to understand how different case management attributes affect beneficiary outcomes. We applied fuzzy-set qualitative comparative analysis (QCA), based on 119 interviews, to identify the combinations of case management attributes that led to (1) increased knowledge of HIV status, and (2) high percentages of beneficiaries with known HIV status. We identified 6 pathways for the first outcome and 5 pathways for the second outcome. Each pathway demonstrates an alternative combination of conditions that positively influences the outcome and is equally sufficient in achieving the outcome. To improve knowledge of HIV status, programs in a similar context as this study may select any of the identified pathways based on their existing resources and work on ensuring the presence of each of the conditions in the pathway. Overall, based on the presence of some of the factors in multiple pathways, we conclude that to improve knowledge of HIV status it is important that programs implement a formal process to assign cases considering case complexity and existing caseload to reduce overwork; provide activistas with external support such as weekly care team meetings, weekly supervisor meetings, and/or low supervision ratios; hire experienced activistas; provide all activistas with follow-up trainings so they have the tools to address challenging cases; expand the financial resources offered to activistas; and reimburse activistas for work-related expenses.