Addressing the dual health epidemics of HIV and sexual abuse among children and adolescents in Kenya: uptake of HIV counseling and post-exposure prophylaxis
Addressing the dual health epidemics of HIV and sexual abuse among children and adolescents in Kenya: uptake of HIV counseling and post-exposure prophylaxis
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DOI：
10.2147/ahmt.s149416
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发表时间：
2018-01-01
影响因子：
1.8
通讯作者：
Digolo, Lina
中科院分区：
文献类型：
--
作者：
Ajema, Carolyne;Mbugua, Charity;Digolo, Lina
目的：儿童性虐待和艾滋病毒是肯尼亚面临的主要健康挑战。2015年，LVCT Health开展了一项研究，旨在评估向公共卫生机构性暴力儿童幸存者提供的艾滋病毒相关服务的质量。材料和方法：采用定性数据收集方法。通过对31家供应商的深入访谈收集了定性数据。量化方法包括对164名强奸儿童幸存者的记录进行回顾，这些儿童在研究开始前6个月曾获得服务。采用SPSS Version 22对病历进行描述性分析。使用MS Excel对客户离职访谈和观察数据进行分析。结果：27%(n=164)的幸存者被记录为接受了暴露后预防(PEP)的第一剂。提供者没有对幸存者进行艾滋病毒检测前和检测后的咨询。没有纵向跟踪机制来确保开始接受PEP的儿童幸存者遵守治疗计划。不到30%的幸存者返回设施进行PEP依从性咨询和后续艾滋病毒检测。20个提供者指出，在对儿童幸存者进行艾滋病毒风险评估方面存在能力差距。有限的PEP是预防艾滋病毒的障碍，因为大多数部门只在上午8点到下午5点提供服务艾滋病毒检测只在工作日下午5点前提供。PEP缺货仍然是预防艾滋病毒的障碍。结论：现有的强奸后护理服务结构不够完善，无法向儿童幸存者提供高质量的艾滋病毒相关服务。保健提供者在管理儿童方面的能力仍然薄弱，因为缺乏对儿童幸存者需求作出反应的动态的技能培训。在儿童性虐待的情况下，需要制定预防艾滋病毒的标准作业程序和培训单元。
Purpose: Child sexual abuse and HIV are key health challenges in Kenya. In 2015, LVCT Health conducted a study aimed at assessing the quality of HIV-related services offered to child survivors of sexual violence in public health facilities.Materials and methods: A qualitative data collection approach was utilized. Qualitative data were collected through in-depth interviews with 31 providers. Quantitative methods included a retrospective review of 164 records of child survivors of rape who had accessed services 6 months prior to the commencement of the study. SPSS Version 22 was used in the descriptive analysis of the medical records. Client exit interviews and observation data were analyzed using MS Excel. In-depth interviews were analyzed using a thematic analytical approach.Results: Twenty-seven percent (n=164) survivors were documented to have received the first dose of postexposure prophylaxis (PEP). Providers did not conduct HIV pre- and posttest counseling for the survivors. There were no longitudinal follow-up mechanisms to ensure child survivors initiated on PEP adhered to the treatment plan. Less than 30% of survivors returned to the facility for PEP adherence counseling and follow-up HIV testing. Twenty providers cited capacity gaps in undertaking HIV risk assessment for child survivors. Limited availability of PEP is a barrier to HIV prevention, as most departments only offer services between 8 am and 5 pm. HIV tests were only available on weekdays before 5 pm. PEP being out of stock remains a barrier to HIV prevention.Conclusion: Existing post-rape care services are not adequately structured to facilitate delivery of quality HIV-related services to child survivors. Health provider capacity in the management of children remains weak due to lack of skill-based training on the dynamics of responding to the needs of child survivors. There is a need for standard operating procedures and training modules on the prevention of HIV in the context of child sexual abuse.