Kim Julia C, Askew Ian, Muvhango Lufuno, Dwane Ntabozuko, Abramsky Tanya, Jan Stephen, Ntlemo Ennica, Chege Jane, Watts Charlotte
RADAR, School of Public Health, University of the Witwatersrand, Acornhoek, South Africa.
BMJ. 2009 Mar 13;338:b515. doi: 10.1136/bmj.b515.
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.
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.
450 bed district hospital in rural South Africa.
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).
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%.
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.
尽管国际准则明确了卫生部门在提供包括性侵犯后艾滋病毒暴露后预防（PEP）在内的全面护理方面的核心作用，但在工业化国家和发展中国家，提供及时和全面的服务都面临诸多挑战。
一种由护士主导的强奸后护理模式被整合到现有的医院服务中；前后对照研究设计评估了对护理质量的影响，审查了334份医院病历，并对16名服务提供者和109名患者进行了访谈。
南非农村地区一家拥有450张床位的区级医院。
强奸后的护理质量（法医病史和检查、提供紧急避孕、预防性传播感染、转诊）；提供艾滋病毒咨询和检测以及提供并完成完整的28天PEP疗程；以及服务利用情况（首次就诊时见到的服务提供者数量和每月到医院就诊的强奸案件数量）。
在完成基线研究后，我们引入了一个由五个部分组成的干预模式，包括性暴力咨询委员会、医院强奸管理政策、服务提供者培训讲习班、指定检查室和社区宣传活动。变革的效果 现有服务分散且质量不佳。干预后，临床病史和检查、妊娠检测、紧急避孕、预防性传播感染、艾滋病毒咨询和检测、PEP、创伤咨询以及转诊方面都有了显著改善。PEP药物28天疗程的完成率从20%提高到了58%。
利用现有工作人员，以适度成本提高南非农村医院性侵犯后护理质量，包括艾滋病毒预防，是可行的。经过额外培训，护士可以成为这种护理的主要提供者。
