Population Council Research that makes a difference

It is estimated that a woman is raped in South Africa every 17 seconds. To address the many health needs of women suffering rape, and especially the possibility of acquiring HIV given the high prevalence of HIV, the Government of South Africa has developed national guidelines for the medical management of rape in hospital settings. How best to operationalize these guidelines so that hospitals can offer these services effectively and in an acceptable manner is not well understood, however.

Through the USAID-funded FRONTIERS program, the Council supported the Rural AIDS and Development Action Research unit at the University of the Witwatersrand to develop and test a nurse-led integrated delivery model for post-rape care in a 450-bed district hospital serving a large rural population in Mpumalanga Province. A five-part intervention was implemented. It included: (1) establishing a sexual violence advisory committee at the hospital; (2) instituting a hospital rape management policy; (3) holding a training workshop for healthcare workers and other providers; (4) centralizing and coordinating post-rape care through a designated outpatient department room; and (5) undertaking community awareness campaigns.

Following implementation of this intervention, an evaluation indicated a number of improvements.

Most importantly, the study showed that it is possible to improve the range and quality of services provided by a public-sector rural, district hospital for the medical management of sexual assault, including post-exposure prophylaxis for preventing HIV acquisition (PEP) using existing staff and resources, and that with additional training, nurses can play an expanded role in this care. Quality of care improved significantly after the model (known as Refentse) was implemented, and there was a three-fold increase in patients reporting adherence to the full PEP regimen.

Following the demonstrated feasibility and effectiveness of the Refentse model, the Council partnered with the Tshwaranang Legal Advocacy Centre (TLAC) to sustain the medical management services, strengthen provision of legal services to assist rape survivors by establishing a legal aid center at the nearest police station, and developing a referral service for survivors who access the hospital. TLAC also conducted research to understand formal and informal institutional responses to domestic violence.

Related project: Improving Access to and Delivery of Comprehensive Post-exposure Prophylaxis (PEP) for Sexual Assault and Occupational PEP Through Training and Systems Strengthening