Article Text

Download PDFPDF

Delivering integrated care after sexual violence in the Democratic Republic of the Congo
  1. Joshua Bress1,
  2. Givano Kashemwa1,
  3. Christine Amisi2,
  4. Jean Armas1,
  5. Cindy McWhorter1,
  6. Theodore Ruel3,
  7. Arthur J Ammann1,
  8. Denis Mukwege2,
  9. Lisa M Butler4
  1. 1 Global Strategies, Albany, California, USA
  2. 2 Department of Obstetrics and Gynecology, Panzi Hospital, Bukavu, The Democratic Republic of the Congo
  3. 3 Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California, USA
  4. 4 Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
  1. Correspondence to Dr Joshua Bress; josh.bress{at}globalstrategies.org

Abstract

In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all survivors of GBV. A specific challenge is providing emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections to all survivors within 72 hours of violence. To address the multiple barriers to providing this time-sensitive medical care, Global Strategies and Panzi Hospital implemented the Prevention Pack Program. The Prevention Pack is a pre-packaged post-rape medical kit containing antiretroviral post-exposure prophylaxis, antibiotics for treatment of sexually transmitted infections and emergency contraception. The Prevention Pack Program combines community sensitisation about post-rape medical care with the provision of Prevention Packs and the implementation of a cloud-based and Global Positioning System (GPS)–enabled inventory management system. The Panzi Hospital gender-based violence team implemented the Prevention Pack Program at Panzi Hospital and 12 rural clinics in the South Kivu Province. The data manager took GPS coordinates of each site, provided an initial stock of Prevention Packs and then called all sites daily to determine demand for post-rape care and Prevention Pack consumption. Inventory data were entered into the GPS-enabled cloud-based inventory management system. Project personnel used the consumption rate, trends and geolocation of sites to guide Prevention Pack restocking strategy. Between 2013 and 2017, a total of 8206 individuals presented for care following rape at the study sites. Of the 1414 individuals who presented in the rural areas, 1211 (85.6%) did so within the first 72 hours of reported rape. Care was delivered continuously and without a single stockout of medication across all sites. The Prevention Pack Program provided timely and consistent access to emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections for rape survivors in the eastern Democratic Republic of the Congo.

  • gender-based violence
  • HIV
  • post-exposure prophylaxis
  • mHealth
  • Democratic Republic of Congo

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

View Full Text

Statistics from Altmetric.com

Footnotes

  • GK, CA, JA, CM, TR, AJA, DM and LMB contributed equally.

  • Handling editor Seye Abimbola

  • Contributors All authors contributed to the design of the programme. GK, CA, JA, CM and DM collected the data. JB and TR interpreted the data. JB, JA, TR and LMB analysed the data. JB, JA, TR, AJA and LMB contributed to writing the report. All authors meet the criteria for authorship. The guarantor is JB. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication.

  • Funding The programme was funded by the non-governmental organisation Global Strategies and the author is an employee of that organisation. Global Strategies is funded by corporate grants, private foundations and individuals. Global Strategies used seven funding sources to fund this work, one of which was a grant from Gilead Foundation. The emtricitabine/tenofovir disoproxil fumarate was provided by Gilead Sciences.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by Comite D’ethique, République Démocratique du Congo, ESP/CE/05113. The study was also approved by the University of California San Francisco IRB, no. 11-08229, reference no. 149347.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.