SGBV Algorithm used in healthcare facilities

This is the guide on how to go about cases of SGBV that are reported at various health facilities so as to ensure safety

1. Ministry of Health Algorithm for management of survivors of sexual violence


What is to be documented

Demographic information must include
• Official names of the survivor in FULL (as per
the National ID or Birth certificate)
• Gender of survivor
• Age of survivor


Casualty /OPD
• Date of reporting to health facility

• Informed Consent

• Demographic information of the survivor including:
> Marital status
> Existence of any disability

• Details of the complaint:
> Presenting complaint
> Date and time of the sexual violation
> Details of perpetrators (Number; known or unknown)
> Type of sexual violation reported (as per SOA definitions)

• Head to toe examination undertaken

• Medical management provided

• Forensic samples obtained:
> Types of samples
> Whether survivor bathed or changed clothes
> Name and signature of examining health care provider

• Body injuries:
Survivor presents within 72 hours
(Treat this as an Emergency)
Any life theatening injuries should
Offer first line support (LIVES)
take priority over other aspects of
Post Rape Care

Minimum Post Rape Care Package


Accepts HIV Test
Declines HIV Test
Discontinue PEP
HIV Negative
HIV Positive Refer to care clinic
Psychosocial Support
Stop PEP

Continue PEP (2 weeks dose)

2 weeks clinical follow-up
What is to be documented

Laboratory
• Demographic information of survivors

• Type of samples retrieved for:
> Medical or Forensic

• Tests undertaken:
> Indicate results of each test

Documents to fill:
• Lab request form • Customised lab register
• Serology , Haematology & Urinalysis register

Counselling
• Demographic information of survivors

• Presenting complaint (as per SOA definitions)

• Emergency prophylactic treatment given

• Number of counselling sessions held

• Scheduled follow-up counselling visits

• HIV related counselling provided

• Referrals made

Documents to fill:
• Rape trauma counselling form • Customized
counselling register • PRC register
> Anterior and posterior view
> Genitalia/anal-rectal (male and female)

• Referrals made

• Chain of custody :
>Name and signature of health care provider handing
over samples
> Name and signature of police officer receiving samples
> Date of the evidence transfer

Documents to fill:
2 weeks PEP refill
Adherence counseling

HIV Re-test
4 weeks, 12 weeks, 24 weeks
HIV Prophylaxis
Children –Dosage is as per the Kg body weight
ABC + 3TC + DTG for 28 days<30kgs OR
TDF +3TC + DTG for 28 days>30kgs (0-15 years
Follow-up trauma counseling sessions: In 2 weeks, 4 weeks,
6 weeks and 12 weeks
Repeat , Hb, ALTs in 2 weeks; repeat PDT in 4 weeks
Trauma form filling
PRC register filling

Adult (<15 years and (or)< 35kg body weight)
TDF 300mg + 3TC 300mg+ DTG 50mg

National Guidelines on Management of Sexual
Pharmacy
• Demographic information of survivors

• Medication given:
> Type > Regimen > Duration

Documents to fill:
• Pharmacy register • STI register
• PRC form • P3 form • PRC register and adolescent girls of childbearing potentialONCE for
28 days.
Violence in Kenya 2014, recommends that all
aspectsof the survivor consultation are
documented

References: National Guidelines on Management of Sexual Violence in Kenya and Guidelines for Antiretroviral Therapy in Kenya 5th Edition 2022
This publication was adopted from LVCT Health

STI Prevention
As per MOH
guidelines

Hepatitis B
Prevention
Hepatitis vaccine
if indicated and
available

Tetanus
Prophylaxis
T.T injection as
per TT schedule
HIV Prophylaxis Pregnancy Prevention
PEP dose Levonorgestrel (postinor
(28 days) 2) tabs 2 stat OR
(see details at the Eugynon OR
bottom) Neogynon 4 tabs stat, OR
Microgynon OR
Nordette 8 tabs start.
(to women/girls of
reproductive age) OR
IUCD
History, Examination &
Sample Collection
Obtain informed consent
Take history
Examine & Document injuries
Medical tests : HIV, PDT, Hb, HBV,
HCV, CR, ALT , urinalysis and
creatinine.
Collect forensic samples: HVS,
oral/anal-rectal swabs, hairs,
semen, blood stained cothes
Label, pack and store samples
appropriately
Counseling for:
Trauma
Pre and post HIV test
Adherence

Referrals to:
HIV Care clinic
Psychosocial
support
Police and legal care
Shelters