Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: the Refentse intervention study
Open Access
- 13 March 2009
- Vol. 338 (mar13 1), b515
- https://doi.org/10.1136/bmj.b515
Abstract
Problem Although international guidelines specify the central role of the health sector in providing comprehensive care, including HIV post-exposure prophylaxis (PEP), after sexual assault, in both industrialised and developing countries there are many challenges to providing timely and comprehensive services. Design A nurse driven model of post-rape care was integrated into existing hospital services; the before and after study design evaluated impacts on quality of care, reviewing 334 hospital charts and conducting interviews with 16 service providers and 109 patients. Setting 450 bed district hospital in rural South Africa. Key measures for improvement Quality of care after rape (forensic history and examination, provision of emergency contraception, prophylaxis for sexually transmitted infections, referrals); provision of HIV counselling and testing and provision and completion of full 28 day course of PEP; and service utilisation (number of service providers seen on first visit and number of rape cases presenting to hospital per month). Strategies for change After completing baseline research, we introduced a five part intervention model, consisting of a sexual violence advisory committee, hospital rape management policy, training workshop for service providers, designated examining room, and community awareness campaigns. Effect of change Existing services were fragmented and of poor quality. After the intervention, there were considerable improvements in clinical history and examination, pregnancy testing, emergency contraception, prophylaxis for sexually transmitted infections; HIV counselling and testing, PEP, trauma counselling, and referrals. Completion of the 28 day course of PEP drugs increased from 20% to 58%. Lessons learnt It is possible to improve the quality of care after sexual assault, including HIV prophylaxis, within a rural South African hospital at modest cost, using existing staff. With additional training, nurses can become the primary providers of this care.This publication has 10 references indexed in Scilit:
- Health Care-Based Interventions for Women Who Have Experienced Sexual ViolenceTrauma, Violence, & Abuse, 2007
- HIV Postexposure Prophylaxis in Sexual Assault: Current Practice and Patient Adherence to Treatment Recommendations in a Large Urban Teaching HospitalAcademic Emergency Medicine, 2005
- Postexposure Prophylaxis After Sexual Assaults: A Prospective Cohort StudySexually Transmitted Diseases, 2005
- Sexual assault forensic examinations in evolutionThe Journal of Emergency Medicine, 2003
- Should we offer antibiotic prophylaxis post sexual assault?International Journal of STD & AIDS, 2003
- Rape and HIV post-exposure prophylaxis: addressing the dual epidemics in South Africa.Reproductive Health Matters, 2003
- The Supreme Court's View of the Managed Care Industry's Liability for Adverse Patient OutcomesJAMA, 2000
- Efficacy of sane evidence collection: A minnesota studyJournal of Emergency Nursing, 1997
- Management of Occupational Exposures to Blood-Borne VirusesThe New England Journal of Medicine, 1995
- Primary Human Immunodeficiency Virus Type 1 Infection: Review of Pathogenesis and Early Treatment Intervention in Humans and Animal Retrovirus InfectionsThe Journal of Infectious Diseases, 1993