Developing an integrated model for post rape care in a rural South African hospital

Dwane, Ntabozuko Ngxalasi Ncumisa
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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.
sexual assault, rape, pep