A study to evaluate the effectiveness of HIV Post Exposure Prophylaxis interevention in sexually abused Children presenting to the University Teaching Hospital,Lusaka

Abstract

Child sexual abuse (CSA) is a growing global problem. In Zambia, CSA was found to be a significant concern in Lusaka and to be associated with a high risk of HIV infection. CSA provides an increasing but highly unfortunate avenue of paediatric HIV infections among Zambian children. OBJECTIVE The aim of the study was to determine the incidence of the human immune deficiency virus (HIV) transmission and the effectiveness of HIV post exposure prophylaxis (PEP) intervention among sexually abused children who presented to the University Teaching Hospital (UTH). RESEARCH DESIGN AND METHODS A cohort of HIV negative female children aged less than 16 years of age presenting with child sexual abuse to the UTH in Lusaka, were recruited over a period of 13 months and conveniently grouped into two study arms based on the time of presentation to UTH. Cases presenting at less than 72 hours post exposure {given HIV post exposure prophylaxis (HHIV-PEP)}, whilst controls presented after 72 hours (not given HIV-PEP). The participants had an HIV Polymerase Chain Reaction ( PCR) test done at baseline and a follow up test done after one month. RESULTS A total of 376 clients were enrolled into the study with 239 cases and 137 controls. Only 166 participants were retained at one month (106 cases and 60 controls) with an overall retention rate of 44%. The overall HIV infection rate among children that came for the second visit was 2.4% (4/166). The HIV infection rate was 1.7 % among controls and 2.8% among cases. However, among cases that received HIV-PEP but did not finish the full PEP course, the HIV infection rate was 15.8%, whilst there were zero infections among those that completed HIV- PEP (p=0.005). Risk of HIV infection was about 16 times more in children that did not complete the full course of PEP compared to children completing PEP. Young adolescents (10 -15 years) were more frequently sexually abused, comprising about 70% of the cases. Kanyama-John Laing, Mtendere-Kalingalinga, and Chawama-Kuku-Misisi residential areas were the places with most occurrences of child sexual abuse cases. Most frequently, the perpetrator

was a person well known to the child, either the neighbour or boyfriend. The majority of the cases (64%) sought PEP intervention within the recommended time frame of within 72 hours. Important influencers of seeking PEP early or starting PEP were age of child (OR: 0.33, CI: 0.13 - 0.86, p = 0.02), abuser's relationship (OR: 0.49, CI: 0.26 - 0.93, p = 0.03), and residence (OR: 2.78, CI: 1.16 - 6.67, p =0.02). CONCLUSION The overall HIV infection rate was 2.4% following child sexual abuse in children presenting to the University Teaching Hospital (UTH), Lusaka regardless of HIV-PEP Administration. However, this could not be generalized to the entire population due to the small sample size and the high drop-out rate of 56% in the study. When HIV PEP was administered, there was no significant difference in HIV infection based on early (within 36hours) or late (36 to less than 72 hours) presentations. However, the risk of HIV infection was about 16 times more in children not completing PEP compared to children completing PEP. Therefore, HIV PEP is effective in reducing the risk of HIV infection following CSA only when it is administered correctly and for the correct duration. The age of the child, relationship of defiler to the child and residence are significant predictors for early presentation for HIV PEP.