Delivering integrated care after sexual violence in the Democratic Republic of the Congo

• Published in: BMJ global health Vol. 4; no. 1; p. e001120
• Main Authors: Bress, Joshua, Kashemwa, Givano, Amisi, Christine, Armas, Jean, McWhorter, Cindy, Ruel, Theodore, Ammann, Arthur J, Mukwege, Denis, Butler, Lisa M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2019; BMJ Publishing Group
• Subjects: Antibiotics; Antiretroviral agents; Antiretroviral drugs; Birth control; Clinics; Curricula; Disease prevention; Domestic violence; Drug dosages; Gender-based violence; Global health; Global positioning systems; GPS; Gynecology; Health care; HIV; Hospitals; Human immunodeficiency virus; Infections; Inventory; Inventory management; Pharmacy; Practice; Prevention; Prophylaxis; Rape; Rural areas; Sexual assault; Sexually transmitted diseases; Software; STD; Violence; Womens health; mHealth; HIV; gender-based violence; post-exposure prophylaxis; Democratic Republic of Congo
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2018-001120

In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all survivors of GBV. A specific challenge is providing emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections to all survivors within 72 hours of violence. To address the multiple barriers to providing this time-sensitive medical care, Global Strategies and Panzi Hospital implemented the Prevention Pack Program. The Prevention Pack is a pre-packaged post-rape medical kit containing antiretroviral post-exposure prophylaxis, antibiotics for treatment of sexually transmitted infections and emergency contraception. The Prevention Pack Program combines community sensitisation about post-rape medical care with the provision of Prevention Packs and the implementation of a cloud-based and Global Positioning System (GPS)–enabled inventory management system. The Panzi Hospital gender-based violence team implemented the Prevention Pack Program at Panzi Hospital and 12 rural clinics in the South Kivu Province. The data manager took GPS coordinates of each site, provided an initial stock of Prevention Packs and then called all sites daily to determine demand for post-rape care and Prevention Pack consumption. Inventory data were entered into the GPS-enabled cloud-based inventory management system. Project personnel used the consumption rate, trends and geolocation of sites to guide Prevention Pack restocking strategy. Between 2013 and 2017, a total of 8206 individuals presented for care following rape at the study sites. Of the 1414 individuals who presented in the rural areas, 1211 (85.6%) did so within the first 72 hours of reported rape. Care was delivered continuously and without a single stockout of medication across all sites. The Prevention Pack Program provided timely and consistent access to emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections for rape survivors in the eastern Democratic Republic of the Congo.