HIV post-exposure prophylaxis for child rape survivors in KwaZulu-Natal, South Africa: Who qualifies and who complies?

Abstract

Objective Our objective was to audit the provision and utilization of HIV post-exposure prophylaxis (PEP) to child rape survivors in the Province of KwaZulu-Natal, South Africa. Methods A prospective design was used to collect data from a convenience sample of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa) in the period October to December 2004. For each case, information was obtained regarding demographic characteristics of the child, the child's HIV status at presentation, any excluding factors for PEP therapy, and the extent of adherence to the antiretroviral therapy regimen. Results One hundred and twenty children (60%) qualified for PEP provision, with children being excluded because they refused initial HIV testing (1.5%), tested HIV positive at presentation (6.5%), or because of delayed (>72 hour) presentation (32%). Of the 113 children who were followed through the PEP provision system, 40 (35.4%) returned for the full 28-day course, and only 4 (3.5%) returned at both 3- and 6-month follow up. Conclusions Adherence rates for PEP therapy following child rape in South Africa are extremely low, with low adherence rates being associated with a theoretical risk of both reduced efficacy and drug resistance. In this context, there is a need for further research designed to identify the reasons for such non-adherence as well as a need for secondary prevention programs designed to both encourage more immediate reporting of child rape and to increase adherence to the PEP regimen.