Journal Article > ResearchFull Text
Confl Health. 5 April 2025; Volume 19 (Issue 1); DOI:10.1186/s13031-025-00662-4
Reinholdz H, Palmieri J, Frielingsdorf H, Katungu Kalere E, Nteziryayo Heritier G, et al.
Confl Health. 5 April 2025; Volume 19 (Issue 1); DOI:10.1186/s13031-025-00662-4
BACKGROUND
Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence.
METHODS
The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis.
RESULTS
A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff.
CONCLUSIONS
Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.
Conference Material > Poster
Malden D, Datta P, Pharand S, Gharami D, Akter R, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/3dDCo6vP
Journal Article > ResearchFull Text
Glob Health Action. 25 April 2024; Volume 17 (Issue 1); 2336708.; DOI:10.1080/16549716.2024.2336708
Reinholdz H, Agardh A, Verputten M, Byenda J, Frielingsdorf H
Glob Health Action. 25 April 2024; Volume 17 (Issue 1); 2336708.; DOI:10.1080/16549716.2024.2336708
BACKGROUND
Sexual violence is widespread in war-torn North Kivu province in the Democratic Republic of the Congo (DRC). Timely access to care is crucial for the healing and wellbeing of survivors of sexual violence, but is problematic due to a variety of barriers. Through a better understanding of care-seeking behaviours and factors influencing timely access to care, programmes can be adapted to overcome some of the barriers faced by survivors of sexual violence.
OBJECTIVE
The aim of this study was to describe demographics, care-seeking patterns and factors influencing timely care-seeking by survivors of sexual violence.
METHODS
Retrospective file-based data analysis of sexual violence survivors accessing care within two Médecins Sans Frontières (MSF) programmes supporting the Ministry of Health, in North Kivu, DRC, 2014-2018.
RESULTS
Most survivors (66%) sought care at specialised sexual violence clinics and a majority of the survivors were self-referred (51%). Most survivors seeking care (70%) did so within 3 days. Male survivors accessing care were significantly more likely to seek care within 3 days compared to females. All age groups under 50 years old were more likely to seek care within 3 days compared to those aged 50 years and older. Being referred by the community, a family member, mobile clinic or authorities was significantly associated with less probability of seeking care within 3 days compared to being self-referred.
CONCLUSION
Access to timely health care for survivors of sexual violence in North Kivu, DRC, is challenging and varies between different groups of survivors. Providers responding to survivors of sexual violence need to adapt models of care and awareness raising strategies to ensure that programmes are developed to enable timely access to care for all survivors. More research is needed to further understand the barriers and enablers to access timely care for different groups of survivors.
Sexual violence is widespread in war-torn North Kivu province in the Democratic Republic of the Congo (DRC). Timely access to care is crucial for the healing and wellbeing of survivors of sexual violence, but is problematic due to a variety of barriers. Through a better understanding of care-seeking behaviours and factors influencing timely access to care, programmes can be adapted to overcome some of the barriers faced by survivors of sexual violence.
OBJECTIVE
The aim of this study was to describe demographics, care-seeking patterns and factors influencing timely care-seeking by survivors of sexual violence.
METHODS
Retrospective file-based data analysis of sexual violence survivors accessing care within two Médecins Sans Frontières (MSF) programmes supporting the Ministry of Health, in North Kivu, DRC, 2014-2018.
RESULTS
Most survivors (66%) sought care at specialised sexual violence clinics and a majority of the survivors were self-referred (51%). Most survivors seeking care (70%) did so within 3 days. Male survivors accessing care were significantly more likely to seek care within 3 days compared to females. All age groups under 50 years old were more likely to seek care within 3 days compared to those aged 50 years and older. Being referred by the community, a family member, mobile clinic or authorities was significantly associated with less probability of seeking care within 3 days compared to being self-referred.
CONCLUSION
Access to timely health care for survivors of sexual violence in North Kivu, DRC, is challenging and varies between different groups of survivors. Providers responding to survivors of sexual violence need to adapt models of care and awareness raising strategies to ensure that programmes are developed to enable timely access to care for all survivors. More research is needed to further understand the barriers and enablers to access timely care for different groups of survivors.
Conference Material > Poster
Reinholdz H, Nkweleko FF, Byenda J, Verputten M, Frielingsdorf H
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/6aaz-a914
Protocol > Research Protocol
Verputten M, Siddiqui R, Gray NSB, Casimir CF, Finaldi P, et al.
1 July 2018
2 Research question and objectives
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
Journal Article > ResearchFull Text
BMC Health Serv Res. 21 February 2014; Volume 14 (Issue 1); DOI:10.1186/1472-6963-14-81
Horter SCB, Stringer B, Reynolds L, Shoaib M, Kasozi S, et al.
BMC Health Serv Res. 21 February 2014; Volume 14 (Issue 1); DOI:10.1186/1472-6963-14-81
Ambulatory, community-based care for multi-drug resistant tuberculosis (MDR-TB) has been found to be effective in multiple settings with high cure rates. However, little is known about patient preferences around models of MDR-TB care. Medecins Sans Frontieres (MSF) has delivered home-based MDR-TB treatment in the rural Kitgum and Lamwo districts of northern Uganda since 2009 in collaboration with the Ministry of Health and the National TB and Leprosy Programme. We conducted a qualitative study examining the experience of patients and key stakeholders of home-based MDR-TB treatment.
Conference Material > Abstract
Verputten M, Gray NSB, Siddiqui R, Mohan H, Borgundvaag E, et al.
MSF Scientific Days International 2020: Research. 20 May 2020
INTRODUCTION
An estimated one in three women globally experience sexual violence (SV) and intimate partner violence. MSF has provided comprehensive medical and psychosocial care for SV and IPV survivors in Port-au-Prince, Haiti, and Delhi, India, since 2015. We aimed to understand the knowledge, attitudes, and practices (KAP) surrounding SV and care-seeking pathways, to improve access to and uptake of services.
METHODS
We conducted two sequential mixed-methods studies between March and October 2018. Quantitative data were collected using a KAP survey in randomly selected households. Qualitative data were collected using in-depth interviews (IDI’s) with key stakeholders and focus group discussions (FGD’s) with community members; in Haiti FGD’s with young people and IDI’s with survivors of SV were also done.
ETHICS
These studies were approved by the ethics committee of the Dr. B.R. Ambedkar Medical College in India (for Delhi), the Comité National de Bioéthique in Haiti (for Port-au-Prince), and the MSF Ethics Review Board (for both).
RESULTS
2340 people participated in household surveys: 1083 in Haiti and 1257 in India. Qualitative data were collated for 382 individuals: 289 in Haiti (24 adult FGD’s, eight youth FGD’s, 15 IDI’s with key stakeholders and eight IDI’s with SV survivors during their follow-up visit) and 93 in India (14 adult FGD’s and 12 IDI’s with health workers). We found an almost universal perceived need for medical care for SV survivors, mostly for injury treatment. However, in both contexts, participants described numerous issues perceived to hinder or prevent survivors seeking and accessing care. Shame, fear of stigma, and social consequences were the most significant barriers reported, compounded by major service-level barriers. There were also context-specific factors. In India, lower knowledge of health consequences and available treatment, combined with media-influenced perceptions of rape as a physically violent event and a 'police issue' were major barriers, compounded by mandatory police reporting and a lack of confidentiality in health facilities. In Haiti, knowledge of medical consequences and care needs was higher than in India, but perceived lack of services, their inaccessibility, and high costs impeded access to care. Participants in both studies explained that most survivors were likely to stay silent. Those who would seek medical help would do so only should physical consequences (eg injuries) arise. A key factor facilitating access to care was support from trusted confidants; improving access would require enhancing social support and facilitating community referral networks, combined with ensuring provision and awareness of quality, comprehensive, confidential care.
CONCLUSION
Sociocultural conceptualisations and structural responses to SV influence perceived and lived consequences for survivors, shaping engagement with support and available services. These findings inform MSF's SV response, supporting adaptation of modalities of care provision and augmenting local knowledge and networks to improve access. We propose a model for understanding context-specific factors affecting access to survivor-centred care in different settings, to better inform development of strategies and activities to improve access and service utilisation.
CONFLICTS OF INTEREST
None declared.
An estimated one in three women globally experience sexual violence (SV) and intimate partner violence. MSF has provided comprehensive medical and psychosocial care for SV and IPV survivors in Port-au-Prince, Haiti, and Delhi, India, since 2015. We aimed to understand the knowledge, attitudes, and practices (KAP) surrounding SV and care-seeking pathways, to improve access to and uptake of services.
METHODS
We conducted two sequential mixed-methods studies between March and October 2018. Quantitative data were collected using a KAP survey in randomly selected households. Qualitative data were collected using in-depth interviews (IDI’s) with key stakeholders and focus group discussions (FGD’s) with community members; in Haiti FGD’s with young people and IDI’s with survivors of SV were also done.
ETHICS
These studies were approved by the ethics committee of the Dr. B.R. Ambedkar Medical College in India (for Delhi), the Comité National de Bioéthique in Haiti (for Port-au-Prince), and the MSF Ethics Review Board (for both).
RESULTS
2340 people participated in household surveys: 1083 in Haiti and 1257 in India. Qualitative data were collated for 382 individuals: 289 in Haiti (24 adult FGD’s, eight youth FGD’s, 15 IDI’s with key stakeholders and eight IDI’s with SV survivors during their follow-up visit) and 93 in India (14 adult FGD’s and 12 IDI’s with health workers). We found an almost universal perceived need for medical care for SV survivors, mostly for injury treatment. However, in both contexts, participants described numerous issues perceived to hinder or prevent survivors seeking and accessing care. Shame, fear of stigma, and social consequences were the most significant barriers reported, compounded by major service-level barriers. There were also context-specific factors. In India, lower knowledge of health consequences and available treatment, combined with media-influenced perceptions of rape as a physically violent event and a 'police issue' were major barriers, compounded by mandatory police reporting and a lack of confidentiality in health facilities. In Haiti, knowledge of medical consequences and care needs was higher than in India, but perceived lack of services, their inaccessibility, and high costs impeded access to care. Participants in both studies explained that most survivors were likely to stay silent. Those who would seek medical help would do so only should physical consequences (eg injuries) arise. A key factor facilitating access to care was support from trusted confidants; improving access would require enhancing social support and facilitating community referral networks, combined with ensuring provision and awareness of quality, comprehensive, confidential care.
CONCLUSION
Sociocultural conceptualisations and structural responses to SV influence perceived and lived consequences for survivors, shaping engagement with support and available services. These findings inform MSF's SV response, supporting adaptation of modalities of care provision and augmenting local knowledge and networks to improve access. We propose a model for understanding context-specific factors affecting access to survivor-centred care in different settings, to better inform development of strategies and activities to improve access and service utilisation.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
J Int Assoc Physicians AIDS Care (Chic). 11 February 2009; Volume 8 (Issue 1); 60-7.; DOI:10.1177/1545109709331472
Elema R, Mills C, Yun O, Lokuge K, Ssonko C, et al.
J Int Assoc Physicians AIDS Care (Chic). 11 February 2009; Volume 8 (Issue 1); 60-7.; DOI:10.1177/1545109709331472
A cross-sectional study of patients living with HIV/ AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy >12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000 copies/mL) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index <18.5 kg/m(2), and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy >12 months showed that positive health outcomes are achievable.
Conference Material > Video
Verputten M
MSF Scientific Days International 2020: Research. 26 May 2021