Ajema Carolyne, Mbugua Charity, Memiah Peter, Wood Camille, Cook Courtney, Kotut Ronald, Digolo Lina
Research and Strategic Information Department, LVCT Health, Nairobi, Kenya.
Post Rape Care Department, LVCT Health, Nairobi, Kenya.
Adolesc Health Med Ther. 2017 Dec 19;9:1-9. doi: 10.2147/AHMT.S149416. eCollection 2018.
Child sexual abuse and HIV are key health challenges in Kenya. In 2015, LVCT Health conducted a study aimed at assessing the quality of HIV-related services offered to child survivors of sexual violence in public health facilities.
A qualitative data collection approach was utilized. Qualitative data were collected through in-depth interviews with 31 providers. Quantitative methods included a retrospective review of 164 records of child survivors of rape who had accessed services 6 months prior to the commencement of the study. SPSS Version 22 was used in the descriptive analysis of the medical records. Client exit interviews and observation data were analyzed using MS Excel. In-depth interviews were analyzed using a thematic analytical approach.
Twenty-seven percent (n=164) survivors were documented to have received the first dose of postexposure prophylaxis (PEP). Providers did not conduct HIV pre- and posttest counseling for the survivors. There were no longitudinal follow-up mechanisms to ensure child survivors initiated on PEP adhered to the treatment plan. Less than 30% of survivors returned to the facility for PEP adherence counseling and follow-up HIV testing. Twenty providers cited capacity gaps in undertaking HIV risk assessment for child survivors. Limited availability of PEP is a barrier to HIV prevention, as most departments only offer services between 8 am and 5 pm. HIV tests were only available on weekdays before 5 pm. PEP being out of stock remains a barrier to HIV prevention.
Existing post-rape care services are not adequately structured to facilitate delivery of quality HIV-related services to child survivors. Health provider capacity in the management of children remains weak due to lack of skill-based training on the dynamics of responding to the needs of child survivors. There is a need for standard operating procedures and training modules on the prevention of HIV in the context of child sexual abuse.
儿童性虐待和艾滋病毒是肯尼亚面临的关键健康挑战。2015年，LVCT健康组织开展了一项研究，旨在评估公共卫生机构为性暴力儿童幸存者提供的艾滋病毒相关服务的质量。
采用定性数据收集方法。通过对31名服务提供者进行深入访谈收集定性数据。定量方法包括回顾性审查164名强奸儿童幸存者的记录，这些幸存者在研究开始前6个月接受了服务。使用SPSS 22版对医疗记录进行描述性分析。使用MS Excel分析客户出院访谈和观察数据。采用主题分析方法对深入访谈进行分析。
有记录显示，27%（n = 164）的幸存者接受了首剂暴露后预防（PEP）。服务提供者没有为幸存者进行艾滋病毒检测前和检测后咨询。没有纵向随访机制来确保开始接受PEP治疗的儿童幸存者遵守治疗计划。不到30%的幸存者返回该机构接受PEP依从性咨询和后续艾滋病毒检测。20名服务提供者指出在对儿童幸存者进行艾滋病毒风险评估方面存在能力差距。PEP供应有限是艾滋病毒预防的一个障碍，因为大多数科室仅在上午8点至下午5点提供服务。艾滋病毒检测仅在工作日下午5点前提供。PEP缺货仍然是艾滋病毒预防的一个障碍。
现有的强奸后护理服务结构不完善，无法为儿童幸存者提供高质量的艾滋病毒相关服务。由于缺乏针对应对儿童幸存者需求动态的技能培训，卫生服务提供者在儿童管理方面的能力仍然薄弱。需要制定关于在儿童性虐待背景下预防艾滋病毒的标准操作程序和培训模块。
