Problem Comprehensive service delivery models for providing post-rape care are largely from resource-rich countries and do not translate easily to resource-limited settings such as Kenya, despite an identified need and high rates of sexual violence and HIV. Approach Starting in 2002, we undertook to work through existing governmental structures to establish and sustain health sector services for survivors of sexual violence. Local setting In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. Relevant changes A standard of care and a simple post-rape care systems algorithm were designed. A counselling protocol was developed. Targeted training that was knowledge-, skills-and values-based was provided to clinicians, laboratory personnel and trauma counsellors. The standard of care included clinical evaluation and documentation, clinical management, counselling and referral mechanisms. Between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$ 27, with numbers increasing each year. Almost half (43%) of these were children less than 15 years of age. Lessons learned This paper describes how multisectoral teams at district level in Kenya agreed that they would provide post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. The paper outlines which considerations they took into account, who accessed the services and how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

In 2015, LVCT Health (a Kenyan non-governmental organisation) conducted an exploratory study to assess the quality and comprehensiveness of services provided to child survivors of sexual violence at two public health facilities in Kenya. Both quantitative and qualitative data collection methods were used, including a retrospective review of 164 child survivor medical records, a health facility staff inventory, in-depth interviews with 31 healthcare providers and 19 exit interviews with 14 child survivors and their caregivers. Ethical approval was obtained from two independent ethics committees. Quantitative data were analysed using SPSS version 22, while qualitative data were analysed using NVivo 10 based on a thematic coding framework. The health facility staff inventory indicated that only two out of 581 providers had undergone previous training on the management of child survivors of sexual violence. Both health facilities lacked the appropriate equipment for the collection of forensic evidence from children and private rooms in which to conduct the clinical examination. Providers cited challenges in offering psychosocial support to children. Only 27 per cent of child survivors were documented to have received trauma counselling. There is a need for health facilities to enhance their human resource and infrastructural capacity to facilitate the delivery of comprehensive care to child survivors. KEY PRACTITIONER MESSAGES:• There is a need to develop child-specific guidelines for healthcare providers in order to ensure that child survivors of sexual violence receive good-quality services at the facility level. • Healthcare providers in public health facilities need competency-based training to enable them to acquire knowledge and skills to identify and respond to child survivors of sexual violence, collect evidence, communicate with the children and offer counselling support to child survivors effectively. • Services for child survivors should be centralised in health facilities to minimise the number of different contact points.

BackgroundAccess to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. ASRH services in Kenya are primarily offered in health facilities and include counselling, information, and services on family planning, sexually transmitted infections, and HIV and basic life skills. The Ministry of Education also provides age-appropriate sexual and reproductive health information in schools. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services.MethodsThis will be a quasi-experimental study utilizing qualitative and quantitative methods. During the formative phase, data will be collected through focus group discussions, in-depth interviews, and key informant interviews to explore the barriers and facilitators of provision and utilization of ASRH services. A quantitative design will be used to obtain baseline and endline data through household surveys and client exit interviews. Following the formative and baseline household and client exit assessments, an intervention focusing on provision of ASRH service package targeting boys and girls will be implemented for 18 months. The package will include contextualized ASRH services, including counselling and age-appropriate, comprehensive sexual education for behavior change with an aim to increase utilization of ASRH services. An analysis of the primary outcome (utilization of ASRH services) will be undertaken to establish the difference in difference between the control and intervention arm, before the intervention (using the baseline survey data) and after the intervention (using the endline survey data).DiscussionAdolescents have now been included in the World Health Organization’s Global strategy for women’s, children’s and adolescents’ health (2016–2030), acknowledging the unique health challenges facing young people and their pivotal role as drivers of change in the post-2015 era. This study will generate evidence on whether a combined school, facility, and community approach works toward improving utilization of ASRH services. The information generated from the study will be beneficial for programming as it will identify underlying reasons for low utilization of ASRH services. Results will help to shape ASRH programs and reduce teenage pregnancy within Kenya and other similar low middle-income countries.Trial registrationThe study is registered at http://www.pactr.org/, registration number PACTR201906738029948.

This paper demonstrates the importance of utilising official statistics from the voluntary counselling and testing centres (VCT) to determine the association between gender and HIV infection rates in Kenya.The study design adopted was a record based survey of data collected from VCT sites in Kenya between the second quarter of 2001 and the second quarter of 2004. Of those who were tested, significantly more females tested positive (P<0.0001) and had twice as high a chance of being infected by HIV (Odds ratio 2.27 with CI 2.23 to 2.31) than males.We conclude that VCT statistics may lead to better planning of services and gender sensitive interventions if utilised well.

Background More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. Methods This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. Discussion In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. Trial registration The study is registered with the Clinical Trials Registry, NCT03973593 .