PRACTICE QUALITY IMPROVEMENT REPORT Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: the Refentse intervention study

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 serviceutilisation (numberofserviceprovidersseenonfirst visit and number of rape cases presenting to hospital per month). Strategies for change After completing baseline research, we introduced a five part interventionmodel, consisting of a sexual violence advisory committee, hospital rape managementpolicy, trainingworkshop for serviceproviders, designated examining room, and community awareness