Provider perceptions of the quality of post-rape care in Ekurhuleni district

A research report submitted to the School of Public Health, University of the Witwatersrand, in partial fulfillment of the requirement for the degree of Master of Public Health in Social and Behavior Change Communication.Background Rape and HIV are major public health issues in South Africa. Rape has negative short and long term health impacts, both physically and psychologically. Survivors are at high risk of sexual transmitted infections, including HIV. Health care services have two important roles in caring of survivors: attending to their physical and psychological health needs, and collecting evidence for court purposes. The national government has put measures in place to improve the quality of care for rape survivors; this includes a clinical guideline on management of sexual assault survivors. The guideline outlines a process of HIV testing and the provision of Post Exposure Prophylaxis (PEP) to prevent the transmission of HIV for survivors who report within 72 hours. South Africa has also implemented One Stop Centres, called Thuthuzela Care Centres (TCC), that enable survivors to access all medical, legal and social services. However, the PEP completion rate remains poor and health care providers often lack the training and confidence to manage rape survivors. As a result the needs of survivors remain unmet. The aim of the study was to explore the knowledge, attitudes and experiences of Clinical Forensic Medical Services health care providers from three facilities in Ekurhuleni district, and to assess the quality of post rape care and related post rape exposure prophylaxis (PEP) services provided to rape survivors, in accordance with the National Department of Health Rape and Sexual Assault Policy and Clinical Management Guidelines. The research was conducted in 2015. Methods and materials A qualitative case study approach was used in three clinical forensic medical services in Ekurhuleni District in Gauteng. A total of 17 participants were interviewed, including different categories of staff doctors, professional nurses, enrolled nurses, auxillary nurses and lay counsellors. Participants were interviewed by the researcher using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. A thematic content analysis was carried out. Themes and subthemes were developed from the objectives and from the transcripts. Quarterly registers and statistics generated from the centres were reviewed and compared. Results Most participants were female (82.3%). All professional nurses and doctors had been trained on the management of rape. Participants viewed the training on sexual assault management as informative and recommended it for all clinicians who examine rape survivors. All participants who were interviewed demonstrated professionalism and confidence in managing rape survivors. However, most participants were uncertain about policy and clinical management guidelines and when asked, described patient flow rather than policy. Each centre had its own patient flow and record system. The provision of PEP differed among interviewees: although most participants gave the full 28 days course, some participants did not give PEP unless the survivor had agreed to HIV testing. Participants raised issues relating to the impact of caring for rape survivors on health care providers, and identified lack of psychosocial therapy for survivors, limited psychotherapy for health care providers, and lack of support from other departments as challenges that they experienced when caring of rape survivors. Conclusion Although Gauteng has developed dedicated centres and allocated dedicated staff who have attended training, the management and record system of sexual assault/rape survivors is not standardized. Most dedicated health care providers of Clinical Forensic Medical Service (CFMS) demonstrated confidence in managing sexual assault survivors, but they were uncertain about the sexual assault policies. However, there are still challenges in providing quality care to rape survivors due to lack of resources and lack of support from non CFMS staff who work in the hospital in association with CFMS health care providers. This results in other needs of rape survivors continuing to be unmet.MB201