AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #86 - Impact of telephonic psycho-social support on adherence to post-exposure prophylaxis (PEP) after rape: Implications for all PEP uses
Authors: Presenting Author: Prof Naeemah Abrahams - Medical Research Council
Additional Authors: Prof. Rachel Jewkes, Prof. Carl Lombard, Dr. Shanaaz Mathews,
Aim: South Africa has one of the highest rates of both rape and HIV infections and the possibility of HIV transmission during a sexual assault is of great concern. However adherence to post-exposure prophylaxis (PEP) has been varied and low. Qualitative research has shown the lack of psycho-social support in the period after a sexual assault and we developed a telephonic psycho-social support, leaflet and adherence diary intervention for rape victims and tested its impact on adherence to PEP.
Method / Issue: A randomised control trial was conducted in the Western and Eastern Cape, South Africa and 279 rape survivors were enrolled in two arms. The intervention involved providing an information leaflet, an adherence diary and follow-up support through telephone calls by a counsellor during the 28 days of taking the PEP. The controls received the leaflet. Follow-up interviews and tablet checks were done with 253 participants to assess adherence. The primary outcome was completion of 28 days of PEP with no more than three missed doses (94% adherence).
Results / Comments: There was more adherence in the intervention arm (38.2% vs. 31.9%), but the estimated intervention effect of 6.5% (95% CI: 4.6 to 17.6%) was not statistically significant, (p: 0.13). The intervention was associated with the reading of the pamphlet (p: 0.07) and an increased use of the diary (p: 0.01), but did not reduce depressive psychopathology.
Discussion: Overall adherence was greater amongst those who read the leaflet and used the medication diary but the intervention was not effective in significantly improving adherence with levels remaining low in both study arms. Taking of PEP after a sexual assault appears much more complex and these have implications for occupational and non occupational PEP users. Further research to understand reasons for non-adherence is needed to develop effective interventions.
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