Development of Post Rape Care services at LVCT were premised on emerging international debate on the links between sexual violence and HIV and PEP utilization in the late 1990's and VCT service provider concerns of survivors of sexual violence presenting for VCT. Further, the health sector provides care for psychological, physical and biological outcomes of sexual violence in HIV infection. It also provides the primary evidence by which the justice sector acts. It thus sits at the nexus of prevention and care of sexual violence. This interface offered LVCT a vital opportunity to impact on the dual epidemics of HIV and sexual violence. In 2003/4, LVCT undertook an operational research study starting with a situation analysis on perceptions of and priorities for post rape care services in Kenya. LVCT developed an intervention informed by the situation analysis. This then informed the development of an operational research study in 3 district hospitals (Malindi, Thika and Rachuonyo) that aimed at ?developing a module for the delivery of post rape care services in resource limited settings, (dubbed PRC1 study). It aimed to: a) develop and implement standard protocols for care; b) strengthen health facility and human capacities for PRC delivery including referral and data collection systems; c) utilise these findings to inform MoH/DRH development of post rape care services.

A report of the operational research study is available

It was the results of this study that we used to work and inform the Division of Reproductive Health (DRH) in the Ministry of Health in developing national standards for the delivery of Post Rape Care (PRC) services.

The results of this study has been shared in a range of fora as abstracts for conference presentations, peer reviewed publication, commissioned papers.

There were gaps emerging from this operational research study, as well as from the PRC programmatic challenges that require further research.

1. Poor medico-legal links and thus many survivors do not get to the criminal justice system. LVCT is part of a 6 country study whose seed funding was provided by the SVRI and core funding by SIDA through the population council, where we aim to develop and test a model for an evidence-chain for sexual violence for Kenya. This study is in collaboration with the University of Nairobi (who are doing the specimen collection and analysis side of things, where we aim to develop and test a model for an evidence-chain for sexual violence for Kenya. This study is on-going and the PI is Carolyne Ajema.
2. Costing the National PRC scale up plan was necessary in order to get the Ministry of Finance to provide a budget line in the DRH resource envelop for Post Rape Care within the National Medium Term Expenditure Framework. In collaboration with the DRH, LVCT and the Health Policy Initiative, a PRC cost study has been undertaken.
3. Long-term psycho social support. This remains a large gap in Africa.
4. Poor PEP adherence, completion and retention for follow up HIV testing; HIV PEP completion rates and retention for HIV testing post PEP are poor and this is partially influenced by social support characteristics (Kilonzo N et.al, 2008). Our PEP completion rate was 51%. We did not measure adherence which is a critical aspect for PEP efficacy. We thus intend to describe adherence, develop a pilot retention module that will allow us to follow up survivors through medication and HIV testing. This will allow us understand better the predictors of adherence and retention, in order to deliver PEP more optimally.