Appraisal of HIV post exposure prophylaxis program amongst sexual assault victims at Kenyatta National Hospital
BACKGROUND: The infection rates following occupational exposure to HIV in a variety of settings have been documented facilitating the use of post-exposure prophylaxis (PEP) among exposed health workers. The merits of post-exposure prophylaxis in non-occupational HIV exposures e.g. in sexual violence is however unknown partly because the risk of acquiring HIV and/or other sexually transmitted diseases due to the circumstances involved are not well characterized. While the incidence of sexual assault is on the rise in many African countries including Kenya, the efficacy of PEP amongst individuals who have experienced sexual violence is still unclear. AIM: The aim of this study was to evaluate the profiles of victims and perpetrators of sexual violence who attended the gender based violence recovery center (GBVRC) program at Kenyatta National Hospital (KNH) and exposed to the non occupational human immunodeficiency virus post exposure prophylaxis for management. In addition, we also reviewed the uptake, compliance, experiences and outcome of those initiated on PEP as part of their intervention .. METHODS: Post-rape survivor records of patients who accessed services from 1 st June 2009 up to 1st June 2012 were retrieved from the Kenyatta National Hospital Gender Based Violence Recovery Center. A retrospective cross-sectional study was then used to examine the biodata of both victims and perpetrators, nature of sexual assault, HIV serostatus, proportion initiated on post-exposure prophylaxis, experiences, compliance and outcome of use. In addition, qualitative data was collected from health care workers interviewed at the gender based violence recovery centers in Nairobi during the data abstraction phase of the study. The staff members were interviewed as key informants on service delivery issues. DATA ANALYSIS: The quantitative data was coded and analyzed using a statistical program SPSS@ version 17 for Windows@ 7. Chi square test was performed to better understand associations between use of PEP, outcomes of interest and specific patient characteristics. Thematic analysis was used for the qualitative data. Tables, charts and.~atter graphs were then used to illustrate the findings. RESULTS: There were 391 participants in the study out of which 385 (98.5%) were sexual assault survivors and 6(1.5%) were key informants. Out of the 385 sexual assault survivors who accessed services at KNH-GBVRC, 53(13.8%) were males. Condoms were also not used in 347(90.1%) of the sexual assault cases while the perpetrators were known in 164 (42.6%) of the cases. Of all the perpetrators 12 (3.1%) were females while 7(2%) were under the age of 18 years. In 15(3.9%) assault cases, the perpetrators committed the crimes under the influence of alcohol while in 6 (1.6%) of the cases the perpetrators had taken other drugs. There was no previous relationship between the perpetrators and survivors in 330 (85.7%) of the cases in the study. When we examined the time taken by survivors to seek help, 184(47.8%) of them had presented to the recovery center within 72 hours of exposure for treatment. However, 207(53.8%) were started on post exposure prophylaxis (PEP). The median, minimum and maximum time taken for PEP initiation after a sexual assault was 17 hours, 2hours and 168 hours respectively. Of the 207 sexual assault survivors who were started on PEP, 49(23.7%) adhered to the regimen while only 43(20.8%) completed the 28 day PEP dose. Only 4 participants out of the 207 initiated on PEP came back for a repeat HIV test after 3 months. CONCLUSIONI RECOMMENDATIONS Surprisingly, 53(13.8%) sexual assault victims were males although the majority of the survivors were students and pupils attending schools and colleges. Policy makers therefore need to take note of these changing trends. At the KNH-GBVRC, service providers flouted the PEP service guidelines, kept poor records and there was also poor adherence to the prescribed antiretrovirals by most of the survivors. Training of service providers on the PEP guidelines, enhanced counseling on PEP adherence among the survivors, follow-up of survivors when on treatment, improved data collection practices and storage for all sexual assault cases are highly recommended if the program efficiency is to be improved.