Delivering integrated care after sexual violence in the Democratic Republic of the Congo

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.

Conflict-related sexual violence: a review

“…As a single centre, it has provided medical care (including post-exposure HIV prophylaxis), gynaecological surgery, psychiatric treatment, social care, financial aid and legal assistance in addition to referral to places of safety. Its founder, Denis Mukwege, was recently awarded the Nobel Peace Prize for his work 38…”

Sexual and reproductive health and rights of refugee and migrant women: gynecologists’ and obstetricians’ responsibilities

“…30 recognizes that conflict exacerbates gender inequality and gender‐based violence . Rape as a weapon of war in the Congo further traumatizes a population already living in a context of widespread gender‐based violence, with estimates showing that up to 400 000 women are raped each year . Rape as a tactical weapon of war is a form of GBV of particular destructive potential in that it destroys communities totally.…”

Impact of Eastern Congo Ebola Outbreak on Child Health Services Delivery: Decline of Routine Child Immunization and Need for Vaccine Supplementation

“…The epidemic has recently crossed the country's border, with con rmed cases from a family in Kasese district, Uganda, that stayed in Mabalako during the funerals of a relative who was a Congolese pastor infected by Ebolavirus [7]. The eastern DRC is a region affected by two decades of armed con ict and extreme gender-based violence (including rapes of women and children) perpetrated by soldiers and armed militia members, since the beginning of the Congo war in 1998; and North Kivu is one of the provinces that have been bearing the heaviest burden of this con ict [8,9]. While EVD can have major impacts on mortality and morbidity from infection as seen from the 2014-2016 West African outbreaks, it can additionally have other health and societal consequences unrelated to infection.…”

“…Breakdown of healthcare systems and reduced vaccination coverage were considered the worst consequences during the West African EVD outbreak as nearly all health resources were shifted to the EVD response [10]. Disruptions of local health systems could lead to underreporting of other diseases leading to a second crisis that could negatively impact as many as persons as the original outbreak, if not more [9]. Several studies have described this phenomenon during the West African EVD outbreak, showing the movement of resources to response efforts were responsible for signi cant disruptions to the provision of routine health care [11][12][13].…”