Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: The Refentse intervention study
Kim,Julia C.; Askew,Ian; Muvhango,Lufuno; Dwane,Ntabozuko; Abramsky,Tanya; Jan,Stephen; Ntlemo,Ennica; Chege,Jane; Watts,Charlotte
British Medical Journal 338(b515): published online, 13 March-
Publication date: 2009
Although international guidelines specify the centralrole of the health sector in providing comprehensive care, includingHIV post-exposure prophylaxis (PEP), after sexual assault, inboth industrialised and developing countries there are manychallenges to providing timely and comprehensive services.
A nurse driven model of post-rape care was integratedinto existing hospital services; the before and after studydesign evaluated impacts on quality of care, reviewing 334 hospitalcharts and conducting interviews with 16 service providers and109 patients.
450 bed district hospital in rural South Africa.
Key measures for improvement
Quality of care after rape (forensichistory and examination, provision of emergency contraception,prophylaxis for sexually transmitted infections, referrals);provision of HIV counselling and testing and provision and completionof full 28 day course of PEP; and service utilisation (numberof service providers seen on first visit and number of rapecases presenting to hospital per month).
Strategies for change
After completing baseline research, weintroduced a five part intervention model, consisting of a sexualviolence advisory committee, hospital rape management policy,training workshop for service providers, designated examiningroom, and community awareness campaigns.
Effect of change
Existing services were fragmented and of poorquality. After the intervention, there were considerable improvementsin clinical history and examination, pregnancy testing, emergencycontraception, prophylaxis for sexually transmitted infections;HIV counselling and testing, PEP, trauma counselling, and referrals.Completion of the 28 day course of PEP drugs increased from20% to 58%.
It is possible to improve the quality of careafter sexual assault, including HIV prophylaxis, within a ruralSouth African hospital at modest cost, using existing staff.With additional training, nurses can become the primary providersof this care.