Health care services for survivors of gender-based violence: a community and clinic-based intervention in Zambézia province, Mozambique

ABSTRACT

Mozambique introduced guidelines for integrated gender-based violence (GBV) services in 2012. In 2017, we trained providers on empathetic and supportive services to GBV survivors and introduced home-based services for survivors who are loss-to-follow up. Rate ratios of clinic visits were compared before and after intervention initiation, using exact significance tests. Data of 1,806 GBV survivors were reviewed, with a total of 2005 events. The median age was 23 years (IQR 17–30) and 89% were women. Among those reporting violence, 69% reported physical violence, 18% reported sexual violence (SV), and 12% reported psychological violence. Rates of care-seeking behavior were higher in the intervention period (rate ratio 1.31 [95%CI: 1.18–1.46]); p < 0.01. Among those eligible for post-exposure prophylaxis (PEP), 94% initiated PEP. Uptake of HIV retesting improved in percentage points by 34% (14% to 48%), 34% (8% to 42%) and 26% (5% to 31%) at 1-, 3- and 6-months, respectively. The intervention led to an increase in the rate of GBV survivors seeking health care services, and improved rates of follow-up care among SV survivors initiating PEP. Strengthening of PEP adherence counseling remains crucial for improving GBV services.

KEYWORDS:

• Gender-based violence (GBV)
• post-exposure prophylaxis (PEP)
• Mozambique
• adherence
• access

Acknowledgements

We thank the participants for their time, the health staff – especially all GBV services focal points - for their collaboration and support in recruitment of participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This publication was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC, the Department of Health and Human Services, or the U.S. Government.