Coupled with a shortage of trained health care workers in the 48 public health care facilities assessed, researchers also found that despite the provision of post-exposure prophylaxis (PEP) being government policy, some of the health facilities surveyed did not even have the guidelines for the administration of PEP.
‘Only 29% of the facilities that we assessed had health care workers that were trained on sexual assault care and PEP service provision. We also found that policies and guidelines were not universally available. Some of the facilities actually had guidelines that were old and in one facility we even found guidelines that were not even South African’, says Dr Elizabeth Mbizvo, a programme director with the Population Council, which conducted the study.
While all facilities were found to have testing kits and medication for PEP services, it was found that data collection mechanisms were lacking. That made it difficult to interpret whether survivors of sexual assault received the care that they needed.
‘Data recording tools with comprehensive indicators for sexual assault were generally not available. Client flow, generally, was not clear. And so, you could not identify where the delays occurred. If the clients do not get their PEP medication within 72 hours, then they are ineligible. They can receive PEP for sexual assault, they can get medication for STIs and, if they are women, they can get medication to prevent pregnancy. But they will have missed on the HIV PEP’, Mbizvo says.
She says the study also showed that a small but significant number of survivors of sexual assault in Limpopo and the North West provinces were men. She also went on to list how the PEP service in the two provinces has failed them.
‘We reviewed 1390 records. Forty-three (3%) were male survivors. The age range of those male survivors was from 18 months to 70 years. Sixty percent of those survivors were children below 14 years. Twenty-five of the 43 client survivors were tested for HIV and 84% of them were HIV-negative. However, only 22% of those eligible clients received PEP medication. And only 20% of them received STI treatment. If this had been done properly there should have been 100% coverage’.
Post-exposure prophylaxis or PEP is a course of antiretroviral medication taken over time to prevent developing HIV infection after being exposed to the virus. In clinical settings, health care workers take it after needle-stick injuries. In the general population it’s normally taken after sexual assault or rape. Clinical manager of the Simon Nkoli Clinic, an Anova Health Institute’s Health4Men project in Soweto, Dr Micheal Laurino, says it’s imperative for PEP services to be administered within a maximum of 72 hours after exposure.
‘PEP is a combination of antiretroviral drugs given to an eligible client within 72 hours of HIV exposure for a 28-day period with a specific intent to avert HIV infection in the host. PEP utilises the same ARVs that we would use for patients on treatment. Adherence to PEP is essential for efficacy. PEP isn’t going to work if PEP isn’t taken for the full course or is taken intermittently. And it’s very, very important that it’s taken within 72 hours of the sexual exposure’, Dr Laurino explains.
Mbizvo says part of the assessment was to provide solutions. In that regard part of their strategy was to provide training, which included educating the police on the needs of survivors of sexual assault. This was important as many survivors were transported to health facilities by the police.
‘What we trained them on was the science of HIV and PEP ‘ how the PEP drugs work. They responded very positively. They were not aware of the emergency nature of PEP provision. In fact, one comment from the police was that: ‘When I take my client to the health facility, I am going to tell the health workers to immediately give my client post-exposure prophylaxis medication’, which actually showed that they now understood what was going on. We also trained multi-disciplinary health care workers. We trained 700 health workers, including doctors, nurses, counselors and pharmacists. We also trained their facility managers’, she says.
Interim results show that the uptake of PEP services in the two provinces increased from 40% to almost 60% over a period of six months. Mbizvo says the Population Council is planning to run similar assessments of PEP services in more provinces in the country.