Developing an integrated model for post rape care in a rural South African hospital
Date
2008-04-04T10:52:28Z
Authors
Dwane, Ntabozuko Ngxalasi Ncumisa
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Abstract
ABSTRACT
Introduction
The health system is struggling with the implementation of a comprehensive and
systematic approach to post rape management and HIV prevention, Post Exposure
Prophylaxis (PEP). The main aim of this study was to evaluate the impact of an
intervention programme implemented at a rural hospital.
Methods
The study was conducted in Acornhoek from March 2004 - August 2006. A five-part
intervention was introduced, that included centralisation and coordination of post
rape care; implementing a hospital rape management policy; a 2 day training
workshop for HCW; engaging a broader group of stakeholders and raising community
awareness.
Three hundred and sixty five of 409 rape survivor patient records were reviewed to
assess changes in quality of care of (Voluntary Counselling and Testing) VCT, Post
Exposure Prophylaxis (PEP) and Emergency Contraception (EC). One hundred and
fifteen clients were followed up to assess clients perceptions of quality of care and
their adherence to PEP treatment. Key informant interviews were conducted with 19
service providers to assess whether the intervention had any impact on VCT, PEP
and EC services.
Results
There were improvements in HCW knowledge: when to prescribe EC (22.7% vs.
79.0% OR 12.4 CI 2.5- 60.7); correct prescription of EC (10.3% vs. 61.9%; OR 12.5
CI 2.7-55.8 P<0.001) and use of anti-emetics (17.2% vs. 36.9% P<0.001). VCT
services were provided more consistently at the first visit during Phase 2 compared
to the Phase 1 (44.1% vs. 59.6% P<0.001). In the Post-Intervention phase 28 day
PEP was introduced, thus minimising return visits.
Conclusions
Improvements in knowledge of the use of EC were greater than improvements in
knowledge about the correct use of PEP. There are systematic obstacles to providing
VCT and PEP which are difficult to address. One of the repeatedly cited obstacles was
the shortage of trained VCT providers. The improvement of sexual assault services
hinges on demonstrable commitment from senior management officials to providing
good quality post rape care.
Description
Keywords
sexual assault, rape, pep