Institutional barriers to post-exposure prophylaxis access and related services among survivors of sexual violence in Gaza Province in Mozambique: a qualitative study
Background: The timely provision of health care services for survivors of sexual violence is crucial to
prevent HIV transmission. The government of Mozambique approved implementation of the national integrated care plan, which includes a recommendation to provide post-exposure prophylaxis (PEP) for sexual assault survivors. There are indications that there may be gaps in the implementation of that plan, because it is a multi-sectoral issue (health facility, police sector and community), meaning it should be everybody''s or nobody´s responsibility. Un study done in Mozambique showed that only about 31% of survivors arrived at health facility was administered PEP within 72 hours of the sexual violence incident. The objective of this study was to identify institutional barriers that affect access to PEP in six districts of Gaza province, Mozambique.
Methods: Twenty eight in-depth interviews were conducted with personnel involved in sexual
assault survivors care that we called “key actors” (15 health workers, four police, and nine community leaders) recruited in six heath facilities supported by EGPAF, through convenience sampling in August 2015. The interviews were conducted in Portuguese and in Changana (local language). The interviews were audio-recorded and transcribed in Portuguese. The transcripts were codified and a thematic analysis was done using the MAXqda12 program.
Results: Reported institutional barriers that affect access to PEP, in order of most mentioned,
include: lack of coordination between the cadres of key actors; lack of integrated (police and health assistance) sexual assault services at the health facility; lack of transport to bring survivors from communities to police stations or health facilities; unavailability of all sexual assault assistance services available 24 hours a day at the health facility; and lack of key actors trained in care of survivors.
Conclusions: Although the implementation plan for the national integrated care program is already
in place and PEP is available free of charge in all health facilities, there are still challenges that need to be overcome in order for PEP access to be effective. Strategies that ensure that key actors are adequately informed, working cohesively, and equipped to respond to the needs of survivors should be a national priority.
M.A. Sitoe1, M. Posse2, A.C. Monteiro2, C.L. Fonseca3, A. Angel4
1Elizabeth Glaser Pediatric Foundation, Maputo, Mozambique, 2Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique, 3Elizabeth Glaser Pediatric AIDS Foundation, Technical, Maputo, Mozambique, 4Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Los Angels, CA, United States