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

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 prepackaged 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.

► In the eastern Democratic Republic of the Congo (DRC), ongoing armed conflict increases the incidence of gender-based violence and also presents a distinct and major barrier to care delivery for all survivors of sexual violence.

► To overcome the barriers to providing a constant inventory of post-rape care medications to survivors of sexual violence within 72 hours, Global Strategies and Panzi Hospital implemented the Prevention Pack Program. The Prevention Pack Program combines community sensitisation, provision of a pre-packaged post-rape medical kit, and a cloud-based and GPS-enabled inventory management system.

► Between 2013 and 2017, we provided 2081 postrape medical kits to survivors of sexual violence at 13 sites in the South Kivu Province of the DRC. This care was delivered continuously and without a single stockout in an unstable and remote area.

► The Prevention Pack Program can improve delivery of immediate post-rape medical care in remote conflict settings by addressing inventory challenges and creating a map of demand for post-rape care across wide geographies.